Care Home: The Maples

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What the care home does well The Maples is a very comfortable home that is led by a dedicated staff team. The people living at the home require a high level of care and staff are required to be highly skilled in care and communication. Staff demonstrated their knowledge of individuals and treated them with respect and understanding at all times. The care is person centred and the home provides a family environment for people to live comfortably. Medication administration was observed and was seen to be particularly well done. The medications were safely managed, checked appropriately, administered with the persons agreement and with great care and attention. The procedure was in line with the individuals care plan which was detailed and person centred. The Maples has been extended and the premises are pleasant, homely and very clean. The home is well managed. Staff are safely recruited, well trained and are given training opportunities to develop their skills for the benefit of the people they care for. There are opportunities provided for entertainment at the home and in the community. Links with families and friends are encouraged and supported by the manager and staff at the home. What has improved since the last inspection? The home has been extended and one extra place has been created. The home is well equipped to meet the needs of the people living there. The home has further developed it`s sensory room facility. Support plans have been redone to take into account the Mental Capacity Act guidance for good practice. The home has a new minibus and a newsletter with photographs has been produced. What the care home could do better: Where people develop anxiety or there is a change to their behaviour, this should be recorded in their care plan. Specialist nutrition training should be considered for the staff team. Policies and procedures should be reviewed to ensure they are up to date and appropriate to meet the needs of the client and staff groups. Hot water checks on bath hot water outlets when found to be higher than the maximum safe limit should result in a repair being arranged to adjust the failsafe device down to a safe hot water temperature. Attention to the staff accommodation should be made, any improvements for staff were overlooked when The Maples was extended and refurbished. The staff sleepingroom should have washing facilities and there should be lockable storage available for the safe keeping of staff personal property. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Maples Catherines Close Castle Cary Somerset BA7 7HP     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Barbara Ludlow     Date: 2 2 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: The Maples Catherines Close Castle Cary Somerset BA7 7HP 01963351991 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Irene Helen Royan Type of registration: Number of places registered: Somerset County Council (LD Services) care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 8. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home The Maples is registered to provide residential care and support for up to eight service users with profound, multiple, learning disabilities. It is owned by the Local Authority. The Maples is a bungalow with eight single bedrooms. There is also a sensory room, a dining room, a lounge, two bathrooms and WCs, a laundry room and a kitchen. Overhead hoists are provided in some communal, one of the bathrooms / shower room and private rooms to meet the needs of service users. Sleep-in staff facilities are provided in a room that is also used as an office. The home is sited close to the main street in Castle Cary. Outside there is a spacious and level garden to the back of the Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 8 Brief description of the care home house and a pleasant patio to one of the sides. Adjacent to the patio there is a car park with a gate leading to the facilities of the main street. The manager of the home is registered with the Commission for Social Care Inspection. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Prior to the inspection visit the Annual Quality Assurance Assessment document was completed for the commission. Comment cards were sent to the service for people living there and for staff to complete and return. Analysis and comment from the feedback we received is incorporated within the text of the report. This unannounced inspection visit was carried out during one day over a period of six and a half hours. The inspection was positively received. The visit commenced at 11am, the manager was on duty and people living at the home were up and prepared for a music session which was held in the lounge. People were seen to be enjoying the interactive music session. Care Homes for Adults (18-65 years) Page 6 of 29 A tour of the premises was made, all communal rooms were seen and bedrooms were sampled. People living at the home were seen during the day and the routines of daily life at the home were observed. Staff were spoken with and observed as they interacted with people they support at the home. Staff were also observed with specific tasks such as medication administration and catering. The manager gave her time to the inspection and sourced records as requested. These included care plans, staff recruitment and training information, maintenance and servicing records. All people living at the home looked well cared for and appeared to be content. The fee range or declared unit cost is 800 pounds per week. There are mobility costs for vehicular use that are calculated on usage. The inspector would like to thank the manager staff team and the people living at the home for their assistance with the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: Where people develop anxiety or there is a change to their behaviour, this should be recorded in their care plan. Specialist nutrition training should be considered for the staff team. Policies and procedures should be reviewed to ensure they are up to date and appropriate to meet the needs of the client and staff groups. Hot water checks on bath hot water outlets when found to be higher than the maximum safe limit should result in a repair being arranged to adjust the failsafe device down to a safe hot water temperature. Attention to the staff accommodation should be made, any improvements for staff were overlooked when The Maples was extended and refurbished. The staff sleeping Care Homes for Adults (18-65 years) Page 8 of 29 room should have washing facilities and there should be lockable storage available for the safe keeping of staff personal property. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good systems in place to support informed decision making. Pre admission assessment is thorough and visits or short stays to try out the home, are welcomed. Evidence: The home was full with eight people in residence. There had been two admissions to the home since the last inspection. One new person was case tracked for inspection purposes and evidence of a visit to the service was recorded. The homes manager confirmed that care is taken to ensure that people are fully assessed and assisted to make an informed choice. Staff had accompanied one person to help them to settle in and had worked alongside the homes staff to ensure a smooth transition of trust and care. Supporting relatives and care managers were referenced in the care plans. A contract was seen on one case file that had been signed by a relative. Support reviews were well documented confirming that the care package was meeting the individuals assessed needs. Care Homes for Adults (18-65 years) Page 11 of 29 Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have detailed person centred care plans to inform staff caring for them. People are enabled and are involved as much as possible in decision making about their daily life. Evidence: All people had a care plan. Care plans were selected for examination and were sampled in line with case tracking. Individual service plans (ISP) or care plans contained appropriate information about contact and significant others in the persons life. The service keeps in touch with the families of people living at the home showing mutual respect for their wishes and the individuals living at the home. Relatives that are involved are invited to participate in care reviews. The local authority has corporate appointee status for people living at this home. Support with finance is given and a recent audit was undertaken by Somersets County Hall staff. This was very thorough, all records examined were well maintained. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: People have a lockable tin within their lockable storage in their bedroom for storing personal valuables. There was information about the level of support required for key areas such as personal care, equality and diversity, health and medications money and finance. Risk assessments were completed and held in the file. Action is taken to minimise risks for the individual. People living at The Maples have sufficient staff support throughout the day. The home has one waking night staff and there is one sleeping night staff on duty to provide support if needed during the night. People were observed and spoken with during the day to sample the experience of daily life at the service. The people living at the home have profound disabilities and staff communicate using techniques preferred by the individuals to good effect. Episodes of care and support interaction were preceded by staff communication and an acknowledgement of agreement / consent from the person. Care plans are followed and staff record all care interventions by code into a daily record. People have their My Day and support plan stored in a cupboard accessible to staff. The individuals support file is stored in their own room. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities in daily life that are age appropriate. The activities are varied and designed for the individual to enjoy. Families can be a part of life at the home if they choose. People were seen to enjoy their lunch and a good diet is encouraged. Evidence: At the start of this visit people had gathered in communal areas of the home. A music listening and music making activity, which is run twice per week was held. People were seen to be very involved and enabled to participate in what appeared to be a very popular, regular event. People have an individual plan of activities and participate in a wide range of events. The manager identified in the AQAA that they try to find varied activities for people to Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: try out. Taster sessions had been arranged at the Fiveways centre. No one here is funded for one to one attention at all times when at home, this level of support would be given when people are taken out into the community for activities or visits. The manager described how she tries to involve families and keep them in touch with their relative and life at the home. All people in residence have social workers and about half have family that regularly support and visit them at the home or take them home for breaks. Daily routines are maintained but people can choose how they spend their time. People who are unable to communicate are enabled by staff who are familiar with their way of special communication or by experience of their body language. Staff were seen and heard to be respectful, friendly and very kind in their interactions with people. Breakfast is varied and a cooked option is offered on some days. Drinks were offered and served regularly throughout the day. Lunch was prepared by the support staff. Lunch was a hot snack was served individually, most ate together in the dining room. People had chips and grated cheese, some had scrambled eggs. Sufficient staff were available, assistance was given one to one as required in a sensitive manner. The meal time was unhurried and fairly relaxed. The main meal of the day is served in the evening. Nutritional assessments are made and individuals weights are monitored regularly. The AQAA did not indicate that specific malnutrition training is available for staff. The manager confirmed that individual dietary needs are catered for such as soft diet and diabetic diet. Risk assessments are made where any hazards are identified, such as a risk of choking. Outdoor activities include hydrotherapy, horse carriage riding, walks and trips out for meals, the theatre and evening discos at Fiveways. The feedback from staff working at the home indicated that they feel the service accommodates the needs of people living at the home and treats them as individuals, with respect and with dignity at all times. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home look well cared for. Health and personal care needs met in a supportive and caring manner and support is given with regard for the individuals personal preferences, privacy and personal dignity. Evidence: All people in residence were seen during the day. All looked to be well groomed, appropriately dressed and comfortable. People who have aids for daily living such as wheelchairs are able to move around the home with assistance and have use of the communal areas. Equipment such as adjustable beds have been purchased to suit the individuals assessed needs. The care plans examined at this inspection demonstrated clearly the decision making process and the amount of support each person would need. Where their contribution to the care planning process was not evidenced a measure of capacity was recorded. Chronic health conditions such as epilepsy and diabetes were very clearly recorded with appropriate information about the condition, the monitoring and rescue guidance. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: There was evidence of input from the relevant community health care specialists. The AQAA indicated that people are registered with a doctor and a dentist. The people living at The Maples receive a good level of medical support from Bruton surgery, we were informed that regular visits are made and medication is regularly reviewed. People with epilepsy have medication prepared for their trips out and carry this in a pouch in case they need to take it. Excellent medication administration practice was observed. With the consent of the person, the procedure by two staff was overseen. Staff dealt with this task very professionally and very carefully. The medication administration record was completed accurately. The person taking their medication was well supported and compliant. Staff were knowledgeable and good care practices were adhered to. Chiropodist visits and dental care were recorded. There was consent from next of kin where required for any treatment planning and intervention. People are weighed regularly and any loss or gain is monitored. Eating and drinking is recorded and monitored. There is a missing person form in each care plan, the ones sampled did not have photographic identification. One care plan where some anxiety was identified did not have a mental health plan or behaviour plan, some record of their anxiety and management or coping strategy is recommended. It was noted that any accident or incident is recorded and the forms are submitted to the social services learning disabilities team with a photocopy held on the file. It is recommended that any injuries are recorded preferably with the my day plan to prompt monitoring and complete the audit trail. People are offered a key to their bedrooms and this is recorded in their care plan. Each bedroom has a locked storage cupboard for their medication. This is accessed by two staff at each administration. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are protected from abuse. The home has well trained staff and policies and procedures that support good caring and management practices. Evidence: The home has a complaints policy and procedure to deal with any complaints promptly. The manager was asked if there have been any complaints, there has been one concerning the trees at the home needing to be pruned back, this work has been carried out. There have been no concerns raised about the service or care given at the home. CSCI have not received any concerns or complaints about this service. The comment cards returned from people living at the home indicated that one person would know who to speak to if unhappy. Five people indicated they are reliant upon staff to ensure their needs are met. People indicated that staff treat them well. All staff responding in writing confirmed that they would know what to do if concerns are raised with them about the home. The AQAA indicated that the complaints procedure is available in DVD format. It stated that finances are checked every three months by the finance officer from Fiveways and that there is an annual audit by staff from County Hall. This had been recently undertaken at the home and was reported to be satisfactory. The AQAA indicated that there are policy documents for staff to adhere to for, conflict of interest, vulnerable Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: adults protection, staff whistle blowing and an other peoples money and belongings policy. The home has policies and procedures to protect people from the risk of harm. These include staff recruitment. Staff recruitment and training was of a good standard. People have lockable storage in their bedrooms. Two staff were seen to access persons locked cupboard only after first consulting with the individual concerned and gaining their consent. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and hygienic, the premises are suitably adapted, homely and well maintained. Evidence: A tour of the premises was made with the homes manager. The Maples is a bungalow with ramped level entrance access and level access throughout. Corridors are wide and wheelchair access is good. There is a large dining room and lounge, both are well used. All communal space is comfortable and homely. The home has been upgraded since the last inspection and the premises are well maintained. A sensory room has been created for people living at the home, this room has been improved with new equipment installed. This room is reported to be well used. The additional bedroom was seen and this has been nicely decorated and fitted out to meet the needs of the new occupant. There were no changes made to improve the accommodation for staff. The second member of night staff who has a sleeping in duty, has a bed in the small office. There Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: is no separate staff wash handbasin, toilet, shower or any clothes or lockable storage. A requirement was made at the last inspection for improved staff accommodation when the alterations to the premises were at the planning stage. A recommendation is made at this inspection for ongoing review of provision for staff such as lockable storage facilities. Staff, visitors and people in residence have access to the same communal toilet facilities. Individual bedrooms are personalised, decorated to taste and are furnished to a good standard.People have a lockable storage for medication and a small safe for the safe keeping of personal items. There are two en suite bathrooms and one assisted communal bathing facility with overhead tracking. There is one other assisted bathroom. Adjustable beds with integral rails have been purchased to suit individuals needs and meet with their assessed safety requirements. The home has a domestic style large kitchen in the centre of the home next to the dining room. There are hand washing facilities for staff and visitors and there is appropriate waste management. The home was clean, fresh throughout and is well maintained by the staff. The laundry was equipped with an industrial style washing machine and separate dryer. Chemicals hazardous to health (COSHH) data sheets were available for staff and their is an appropriately equipped first aid box. The home is fitted fire safety equipment such as a fire alarm and fire extinguishers. All fire safety equipment was seen to be serviced and tested appropriately. The local town of Castle Cary can be accessed from the home. At the last inspection it was reported that the cobbled street areas of the town can be difficult to negotiate. Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a dedicated well trained staff team. The recruitment of new staff is a thorough but slow process. Evidence: Three staff were on duty at the start of this inspection. Staff were observed to be kind in their interactions with people they were supporting. Tasks were competently undertaken and medication administration was carried out in a person centred and professional manner. Staff commented that they receive induction and training to carry out their support work and other duties at the home. We ( the commission) heard both verbally and in writing that the recruitment process is very slow. Staff felt this impacted on their work when the home has shift vacancies waiting to be filled by staff who are caught in the recruitment processing stages. A recommendation is made at this inspection for a review of the recruitment process in light of the feedback received by CSCI at this inspection. At this inspection the manager reported that three new staff have been recruited since the last inspection. These three staff files were sampled for the inspection process. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: There was evidence of thorough recruitment practice. Two references had been taken up for each person and these were satisfactory. The Criminal Record Bureau(CRB) checks had been made prior to the person commencing employment. New staff are subject to a two month probationary / review process. Where induction courses do not coincide with a new worker starting at the service, it was reported that household tasks are undertaken and assisting other staff with caring duties but always working under supervision. No catering, manual handling or medication administration would be undertaken. Staff files showed that new staff interviews are reported on and are signed. Staff had received induction and supervision. Regular supervision records were in place for staff. There were reported to be five staff starting National Vocational Qualification training, four at level two and one at level three. The AQAA indicated that five staff hold National Vocational Qualifications in care. Staff have received a range of training, the AQAA indicated that fifteen staff have undertaken basic food hygiene training. The AQAA indicates that no one living at the home has malnutritional needs. The AQAA also shows that seven people require help with their food but no staff have received training in malnutrition care and assistance with eating. A recommendation is made for the consideration of the nutritional training needs of the staff team. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and well maintained. Staff are trained to use manual handling and specialist equipment safely. There is good attention to the safety of equipment, of the premises and of record keeping. Evidence: Time was spent with the manager for the service and who now has a deputy in post. The home is well supported by the Fiveways network and is well managed. The generic risk assessments for the service had been updated in July 2008. Each person has a bed rail risk assessment with their care plan. One person was due to be assessed by the occupational therapist for the suitability of their bed. When incidents or accidents occur the reports are sent to the Somerset County Council Learning Disabilities team, a photocopy is held on the persons file. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: The fire safety records were examined. The home has a fire risk assessment dated April 2008 which the manager reports the fire service have agreed is satisfactory. Fire alarm checks are made each week, emergency lighting is checked each month.Fire extinguishers were serviced in May 2008. Gas safety had been checked in June 2008. The hot water outlets had all been used and the shower heads are cleaned on a monthly basis to reduce the risk bacterial growth, the last record was on 19th October. 2008. Showers, baths are checked for temperature to maintain them at a safe limit and a note is kept of the results. These indicated that one bath hot water was slightly too high and requires very slight adjustment down to a safer temperature. The homes portable appliance tests had been carried out in July 2008. A workplace health and safety inspection was carried out in August 2008. Hoists and specialist manual handling equipment is checked monthly in house and servicing is undertaken every six months in line with lifting and load regulations (LOLER). There is ongoing monitoring of the standard of care. The manager indicated that family contact is encouraged and invitations are sent to key family members to attend reviews. Newsletters with photographs have being published and people are being encouraged to celebrate anniversaries by sending cards. The first aid box was seen and sampled and was found to be complete. The AQAA information indicated that policies and procedures are in place for the majority of topics indicated . The AQAA showed that the home does not have policies in place for individual planning and review, pressure relief and referral and admission. Not all policies have been updated annually, the policy and procedure for induction for example was dated April 2003. A review is recommended to ensure the policies remain up to date and where relevant, are in place. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 19 Where anxiety is identified a mental health plan or behaviour plan may be required. A record of the anxiety and management or coping strategy recommended for the individual should be made. Staff sleeping in facilities should have washing facilities and should be made as comfortable as possible with lockable space available for personal property safe keeping. The management should review the recruitment processes and examine why the process is considered to be slow. A review may indicate how the process could be improved. The manager should identify if there is a need for staff to undertake specialist training relating to malnutrition and assisting with eating. Policies and procedures should be regularly reviewed to ensure they are still relevant, up to date and in place where required. Where hot water safety checks are made there should be action taken to adjust the hot water fail safe device if the hot water temperature becomes even slightly higher than the required maximum safe limit. 2 28 3 34 4 35 5 40 6 42 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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