Care Home: The Seagulls

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What the care home does well The home is a spacious property with a location that facilitates independence. Each resident has their own key to their bedroom and their space and privacy are fully respected. Residents are involved in the planning of their care and are given opportunities to talk about the things they like and discuss other things that may not be going so well for them. The home has systems in place to ensure that residents` health care needs are met and that they have access to a range of appropriate professional practitioners. People have the option to go on holiday each year and experience new activities. The management and staff team are stable and residents benefit from knowing the people who support them each day. What has improved since the last inspection? The documentation and recording systems have improved and there is evidence that residents are now more involved in the care planning process. A training matrix has been implemented to ensure that the home can more easily identify the training needs of staff. All staff have now completed a National Vocational Qualification to at least Level 2 in Care. Care staff now receive formal supervision sessions from their line manager which gives them the opportunity to discuss any issues about their role. Action has been taken to improve health and safety within the home through the fitting of specialist hold open devices on doors that were previously found wedged open. What the care home could do better: The Seagulls needs to take steps to become more progressive in its approach to care. There is a culture where things are often `done to` rather than `done with` residents and as such residents are lacking in opportunities to develop their skills and work towards more independent living. The home needs to encourage and support people to do as much as they can for themselves and to take greater control of their own lives. The way staff manage behaviour that challenges needs to be improved and the home is therefore required to liaise with other professionals and undertake specific training in this area. Staffing levels need to be reviewed in line with residents` assessed and changing needs. The home must ensure that there are sufficient staff on duty both at day and during the night to ensure that people`s needs and expectations can be met. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Seagulls 6 Crowborough Road Saltdean East Sussex BN2 8EA     The quality rating for this care home is:   one star adequate 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: Lucy Green     Date: 2 2 0 7 2 0 0 9 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. that people have said are important to them: They reflect the things 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 31 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: The Seagulls 6 Crowborough Road Saltdean East Sussex BN2 8EA 01273390610 01273308672 pedniki@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ms Niki Clarke,Mr Driss Zemouli care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home The Seagulls is a detached property situated in a residential area close to the main coast road and cliff tops at Saltdean. The home is registered to provide care for six adults with a learning disability. Local shops and amenities are a short walk away and bus services to Brighton and other areas run close by the home. Accommodation is provided on two floors, with two bedrooms on the ground floor and five rooms on the first floor. Communal areas include a comfortable lounge and a separate dining room, which is also used as an activity room. There is a conservatory used for smoking which leads out to a secure and accessible rear garden. Further information about the services provided at The Seagulls, including the current Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home range of fees can be found in the homes Statement of Purpose and Service User Guide. Copies of both of these documents can be obtained directly from the Provider. Care Homes for Adults (18-65 years) Page 5 of 31 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: one star adequate 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: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term service user to describe those living in care home settings. For the purpose of this report, those living at The Seagulls are referred to as residents. This report reflects a key inspection based on the collation of information received since the last inspection, a site visit and a review of the homes Annual Quality Assurance Assessment (AQAA). The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The AQAA was completed by the Registered Manager and returned when we asked for it. Care Homes for Adults (18-65 years) Page 6 of 31 The site visit was carried out over six hours between the times of 10:15am and 4:15pm on Wednesday 22nd July 2009. We had a look around the home and examined some care, medication and staffing records. We observed the interaction between staff and residents throughout the day. During the visit we met with five of the six people currently living at the home and spent time with two of them individually. The Registered Manager, Deputy Manager and a carer were also present and involved in our inspection. What the care home does well: What has improved since the last inspection? What they could do better: The Seagulls needs to take steps to become more progressive in its approach to care. There is a culture where things are often done to rather than done with residents and as such residents are lacking in opportunities to develop their skills and work towards more independent living. The home needs to encourage and support people to do as much as they can for themselves and to take greater control of their own lives. The way staff manage behaviour that challenges needs to be improved and the home is therefore required to liaise with other professionals and undertake specific training in this area. Staffing levels need to be reviewed in line with residents assessed and changing needs. The home must ensure that there are sufficient staff on duty both at day and during the night to ensure that peoples needs and expectations can be met. Care Homes for Adults (18-65 years) Page 8 of 31 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 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 31 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. Prospective residents benefit from an admission process that ensures their individual needs are appropriately assessed prior to moving into the home. Evidence: There have been no new admissions to the service since the last time we visited. During our inspection we saw evidence in care plans that the home had conducted pre admission assessments prior to people coming to live at The Seagulls. Each of the three people whose care was tracked, had been recently reviewed by their funding authority and had received a copy of their updated Social Care Assessment, confirming that at the current time they are appropriately placed at the service. The AQAA states that the home has updated the Statement of Purpose and Service User Guide and that a robust assessment process would be conducted should a vacancy occur. Care Homes for Adults (18-65 years) Page 11 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide useful information about some support needs, whilst other areas require greater collation of information and more specialist input. Outcomes would also be improved if the documentation and knowledge about people were more strategically used to formulate life goals and develop more person centred approaches. Evidence: Through discussion with staff and observation of their practices, it was demonstrated that whilst they generally have good relationships with the people they support, greater insight into how to support them with some of their specialist needs is required. The Inspector tracked the care for three residents, which included a partial examination of their care plans, activity schedules and a discussion with the staff. The Inspector also met with each of these three residents during the course of the inspection. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: Whilst care plans provide a good overview of some of the support needs of individuals, there is a need to more holistically collate information. As such, it would be useful to have a single document which includes assessment details, daily support guidelines, risk assessments and reviews. This would be a more accessible approach to care planning and enable relevant stakeholders to identify strengths and needs and see quickly how people are developing. Areas of more complex support require review and in particular how the service supports people with behaviour that challenges. In respect of one individual, an incident at the time of the inspection highlighted the need for specialist input from the community learning disability team and a referral to Psychology. Staff also need to access training in how to manage challenging behaviours. Staffing levels need to be reviewed in line with the plans of care to ensure that peoples assessed needs are being met and that they are receiving the support they are funded for. In undertaking this exercise, the home must consider how it supports those residents with epilepsy and incontinence issues at night when only a sleep in is employed. Care plans are regularly reviewed and there was evidence of a multi disciplinary approach and consultation with residents. Monthly resident and keyworker meetings are now being held and the minutes of these discussions provide useful information about individual likes and dislikes. Care plans contain a range of risk assessments for each resident which cover the expected risks associated with daily living. Extra thought is however needed to see how more enabling approaches can be adopted to ensure that people are working towards achieving maximum independence. An example during the inspection, highlighted that one resident would like to access public transport independently. This individual already demonstrates their safe access to the local community and as such a teaching plan for expanding this skill further should therefore be in place. Evidence gathered from documentation, feedback from residents and observation of staff practice, highlights that the home needs to become more progressive and develop the person centred process to support residents to more strategically identify and formulate life goals which develop their skills, experiences and independence. Care Homes for Adults (18-65 years) Page 13 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have opportunities to access the local community and to participate in activities they enjoy, but greater emphasis needs to be placed on how activities link with care plan objectives. People need more choice and control over their daily lives, including how they take their meals. Evidence: A review of the activity timetables for three people identified that residents have access to some social and educational activities that are meaningful to them. Discussion with two residents however, identified that they would like to spend more time doing things that develop their skills and independence. Current staffing levels are impacting on the choice and flexibility of activities available. Two residents are funded for 1:1 staffing during the waking day. In addition, it was Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: observed that another resident requires a lot of individual staff time. On the day of the inspection, three staff, one of which was the Registered Manager were on duty. One resident was at day service for the whole period, which left five residents at home undertaking day care activities organised by the home. One of the people who is funded for 1:1 staffing spent much of the day alone. Staff are not allocated to work with specific individuals and as such staff support is organised on a generic and ad hoc basis rather than individual assessed needs. Three staff is not sufficient to meet the current needs of the people living at the home. There is evidence that people do participate in some things that they enjoy. One resident went swimming at the time of the inspection and they reported that this was a weekly activity that they really liked. Another resident spoke of their college course on a Friday that they love. The main issue is that activity schedules are not wholly linked to peoples longer term aspirations. Two residents expressed a wish to be more involved in the preparation of their own meals and yet their only involvement in cooking is as part of planned activity, rather than inclusion at mealtimes. Similarly, one resident who currently accesses the local community independently expressed a wish both to the Inspector and at their review to use public transport to go to shops further away. There is currently no plan in place for this to be achieved. In order to develop good outcomes in this area, the home needs to demonstrate how the activities and goal planning are linked to person centred plans of care which support individuals to achieve live goals and maximum independence. The home has a positive approach to enabling residents to maintain contact and relationships with families. There is evidence in the care plans that the home supports residents to meet with and receive visits from their relatives. Discussion with the Manager and Deputy Manager confirmed that the home understands the importance of good relationships with other stakeholders. The home is reminded however to ensure it is always the best interests of the individual that they follow. Meals are prepared according to a menu that is reported by the Manager and Deputy Manager to be reflective of individual likes and dislikes. There was evidence of a pictorial menu in place and whilst the menu stated that there was always a choice, the food records highlighted in reality the meals people ate were the same as the menu. At the time of the inspection, the Inspector observed one resident being told lunch was going to be baked beans on toast and salad. The resident in question said she does not like salad and therefore only ate the baked beans on toast, there was no evidence of her being pro actively offered an alternative. Care Homes for Adults (18-65 years) Page 15 of 31 Care Homes for Adults (18-65 years) Page 16 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive appropriate support in respect of their personal and health care needs. Medication is managed in a way that protects people, but some residents would benefit from being enabled to take greater control in this area. Evidence: There was documentary evidence that each resident has a care plan which evidences that personal and health care needs are identified and appropriate support provided. For one resident the support they have received at the home has enabled them to regain their health. It was evident that referrals are made to external professionals, including GPs, dentists and chiropodists. It was identified through the inspection process that a psychology referral now needs to be made in respect of one resident to support them with a difficult period. The home maintains a generic weight book and whilst this provides evidence that peoples weights are regularly monitored, this information should be recorded in individual care plans, along with clear documentation about action that has been taken as a result of weight loss. It was noted that one resident was admitted into the home Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: with a nutrition plan that stated that all food and drink consumed must be recorded to ensure a daily calorie intake was maintained. It was identified that whilst this had been completed for the agreed time period, quantities of food were not stated and as such an overall figure could not be calculated. In the future, the home must ensure that such recording is more precise. The home is aware of the need to introduce health action plans and demonstrated that it has now sourced the relevant information to implement these. It is expected that these will now be put in place. Personal care was observed to be being provided in a sensitive and respectful way during the course of the visit. Interaction between staff and residents as support was being provided was noted to be positive and relaxed. Systems are in place to ensure medication is managed appropriately. Staff receive appropriate training in the management of medication. No residents manage their own medication at the current time, although discussion with one resident identified that they could potentially be more involved in the management of their own medicines. This was raised with the Registered Manager and Deputy Manager who responded positively to this situation and have agreed to undertake risk assessments in respect of this activity. Due to recent changes in legislation, a requirement has been made in respect of making provision for the safekeeping of any controlled medication that may be brought into the home. Care Homes for Adults (18-65 years) Page 18 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their visitors are encouraged to speak openly about their views of the service. Greater protection would however be afforded if staff knowledge and understanding of challenging behaviour were developed and reflected in their practice. Evidence: The home has a complaints procedure in place and an accessible copy is available for residents and visitors to access. The home has received three minor complaints about its service since the last inspection and there was documentary evidence that these issues had been resolved to the complainants satisfaction. The home seeks to operate an open culture where issues are openly discussed and opinions shared. Residents are encouraged to voice their opinions about the things they like and dislike, although an incident which occurred at the home highlighted that staff and residents need to be more respectful in how they speak about the behaviour of other people. During the inspection an incident of challenging behaviour on behalf of one of the residents was badly handled. When talking to residents it was identified that this is not the first occasion such an incident has occurred with this individual and when two residents were asked how staff handle these situations, they replied that the resident gets told off. This is not an acceptable response to these behaviours and the home Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: must ensure that verbal and physical aggression by a resident is understood and dealt with appropriately. Discussions with residents also highlighted occasions where residents had been pushed by other residents. These incidents have not been reported to the Commission or raised as safeguarding alerts. It is therefore required that staff access training in managing challenging behaviour and undertake a refresher course in safeguarding to ensure that they manage challenging situations in a way that safeguards all concerned. There are systems in place for supporting residents with their finances and financial declaration forms were found in two of the three care plans viewed which indicated residents consent to their money being held by the home. The home should consider ways of supporting residents to become more independent in this area so that, where able, people have more control over their finances. Care Homes for Adults (18-65 years) Page 20 of 31 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. Residents benefit from a homely, safe and comfortable environment that meets their current needs. Evidence: We had a look around the home with the Registered Manager and two residents showed the Inspector their bedrooms and pointed to things that they had chosen and which were important to them. It was evident that both of these people had been supported to personalise their bedrooms and took pride in their belongings. Communal areas include the kitchen, a lounge, separate dining area, and a conservatory which provides a separate smoking area. There are sufficient toilet and bathroom facilities to meet the needs of the people who live there. A secure and accessible garden to the rear of the property provides residents with a safe outdoor area. With the exception of one bedroom which was noted to be slightly malodorous, the home was found to be clean, tidy and hygienic at the time of the inspection. There is evidence of an ongoing programme of maintenance and redecoration and many parts of the home have been upgraded since we last visited. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: We observed that the upstairs toilet had a lock on the outside of the door. The Registered Manager stated that this had been there since the home was purchased many years ago and that they did not have a key for this lock. It was agreed that this lock would be therefore be removed. Care Homes for Adults (18-65 years) Page 22 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are insufficient staffing levels to meet the assessed needs of the people living there. Further improvements would be achieved by ensuring that staff undertake more specialist training. Evidence: Discussion with the Registered Manager and a review of the rota identified that there are currently insufficient staffing levels to fully meet the needs and lifestyle choices of the group. As detailed in the lifestyle section of this report, two residents are funded for 1:1 staff support during the waking day and in addition another resident was observed during the inspection to require high levels of staff attention. A review of the rota identified that on 19/07/09 two staff were on duty between 8am and 8pm. The Deputy Manager confirmed that one resident was staying with family until 7pm, but with five residents, including two people who are funded 1:1, two staff is insufficient. Furthermore, in the last five weeks the maximum staffing level has been 3 staff. When all the residents are at home, assessed needs indicate that minimum staffing levels should be maintained at 4 staff. The Registered Manager stated that this was because one staff member had taken an extended holiday period, but this was planned leave and as such staffing levels should be scheduled to be maintained. The Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: home does not use agency staff and as such needs to ensure that it has other means of covering staff leave and absences, it is not acceptable to simply reduce staffing levels during these periods. At night, the home is staffed by one staff member asleep. During a tour of the building one bedroom was found to contain a urine odour. The Registered Manager stated that this individual can be incontinent at night. When asked if this is an issue during the day, it was said that it was not because he is regularly toileted throughout the day. The Deputy Manager stated that when she undertakes a sleep in, she gets up to support this individual. There is also a resident with epilepsy who is known to have early morning seizures at certain times during the month. The home is therefore required to review the provision of staffing levels both day and night according to the current assessed needs of the people living at the home. One new staff member has been employed since the last inspection and the recruitment information in respect of this individual was viewed. There was evidence of a completed application form, appropriate checks with the Criminal Records Bureau being in place. It was however highlighted that although there were two written references on file, these had been supplied by former work colleagues and not the previous employer or line manager. The Registered Manager telephoned the Inspector the week following the inspection to advise that this matter had been chased up and that a reference from the appropriate person was being forwarded. As action has been taken to remedy this situation, a requirement has not been made, but the home must ensure that robust recruitment protocols are followed in the future. The Registered Manager has now compiled a training matrix in line with a requirement of the last inspection. There was evidence that staff have access to mandatory training and the AQAA dataset states that all permanent staff have completed National Vocational Qualification (NVQ) to at least level 2 in Care. Due to the incident observed at the time of the inspection, as detailed under the Complaints & Protection section of this report, it is required that alls staff attend training in managing challenging behaviour and a refresher course in safeguarding. The Inspector saw evidence of regular staff meetings and supervision sessions now being conducted with minutes recorded. Care Homes for Adults (18-65 years) Page 24 of 31 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. Residents live in a home that has a stable and experienced management team and which is run safely. Residents would however benefit from a progressive approach that recognises and develops their strengths in addition to meeting their support needs. Evidence: The Registered Manager is also one of the Registered Providers and as such has been in post for a number of years. Her background is in psychiatric nursing and more recently she has kept herself up to date by completing NVQ Level 4 in Care and the Registered Managers Award (RMA). During the inspection, it was observed that the Manager had a good relationship with both staff and residents and feedback from two residents was that they liked the Manager and found her easy to approach. The Registered Manager is supported by a Deputy Manager who has also recently completed the RMA and is now looking to undertake NVQ Level 4. The inspection has identified some practice issues which need to be addressed and the home needs to develop into a more progressive service which enables things to be Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: done with residents rather than done for. During feedback of these matters however, the management team were responsive to the shortfalls and the Deputy Manager demonstrated an enthusiasm to identify areas of development which will improve outcomes for the people using the service. It is therefore expected that the service will work hard to deliver on moving the sections rated as adequate forward. The home has a system of quality monitoring in place which includes weekly residents meetings. There is also evidence that annual satisfaction surveys are sent out to stakeholders, although at the current time the results of these have not been formally collated and published. This inspection considered the Deprivation of Liberty Safeguards and concludes that the home is not currently accommodating any person who is the subject of an authorisation or referral for authorisation. The home has various systems in place to ensure the health and safety of the home are maintained. The Inspector sampled some of the records in place and with the information supplied in the AQAA, concluded that the home has satisfactory recording and monitoring systems in place. Care Homes for Adults (18-65 years) Page 26 of 31 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 31 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 1 6 13 Regulation 13(1)(b): The Registered Person must make arrangements for the service user discussed at inspection to be referred to the relevant healthcare professionals so that they receive advice and other services about the identified need. To ensure that the care plan for this individual reflects a multi disciplinary and best practice approach to managing their challenging and specialist needs. 19/08/2009 2 11 15 Regulation 15(1): The Registered Person must ensure that service users are supported to set, monitor and achieve both their long and short term goals and aspirations. The home should work with service users to identify goals and to support them 01/09/2009 Care Homes for Adults (18-65 years) Page 28 of 31 to develop skills to achieve maximum independence and fulfilment. 3 13 16 Regulation 16(2)(n): The Registered Person must ensure that each service user has a programme of activities that meets their needs, choices and expectations. To ensure that each person has the opportunity to enjoy a fulfilling life that is led by their own needs and choices. 4 20 13 Regulation 13(2): The 01/10/2009 Registered person must ensure that medication is stored in accordance with current regulations and guidance issued by the Royal Pharmaceutical Society of Great Britain. The Registered Person must ensure the safekeeping of all medicines, including making provision for the safe storage of any controlled medication. 5 23 13 Regulation 13(6): The Registered Person must make arrangements, by training or other means to ensure service users are safeguarded at all times. To ensure that physical and verbal aggression by a service user is understood is and dealt with appropriately. 01/09/2009 01/09/2009 Care Homes for Adults (18-65 years) Page 29 of 31 6 33 18 Regulation 18(1)(a): The Registered person must ensure that staffing levels are kept under review to ensure that there are sufficient numbers of competent and qualified staff to meet the needs of service users both during the day and at night. To ensure that service users are safely supported to lead their lives as identified in their individual plans. 01/09/2009 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 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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