Care Home: Warrington Community Living - Twiss Green

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Warrington Community Living - Twiss Green 53 Twiss Green Lane Culcheth Warrington Cheshire WA3 4DQ The quality rating for this care home is: 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: David Jones Date: 1 8 1 1 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. They reflect the things that people have said are important to them: 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. 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Warrington Community Living - Twiss Green 53 Twiss Green Lane Culcheth Warrington Cheshire WA3 4DQ 01925766982 01925766982 leswhittle@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Warrington Community Living Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 4 Number of places (if applicable): Under 65 Over 65 4 1 4 0 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The home is registered for a maximum of 4 service users to include: * Up to 4 service users in the category of LD (learning disability not falling within any other category. * Up to 4 service users in the category of LD(E) (learning disability over the age of 65) may be accommodated. * 1 named service user in the category MD (mental disorder) may be accommodated. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Staffing must be provided to meet the dependency needs of service users at all times and shall comply with any guidance that may be issued through the Commission for Social Care Inspection The registered provider must ensure that Mr Leslie Whittle achieves the Registered Manager`s Award by 1st November 2006 Date of last inspection A bit about the care home Twiss Green is a care home for four adults with learning disabilities. It is owned and run by Warrington Community Living, a registered charity. The establishment is a domestic style four-bedroom bungalow in a residential area of Warrington and blends in with neighbouring properties. The building has been adapted to accommodate the needs of people with a disability. There is level access throughout the home. Information about Twiss Green, including copies of the most recent inspection report, is made available to each resident and their representatives and can be acquired by contacting Warrington Community Living on 01925 246870. Fees range according to the needs of the individual. Contact Warrington Community Living on 01925 246870 for further information. There are no additional charges made other than transport costs, which are shared between the four people who live at the home. They also pay staffs expenses for admission fees, food and drink when staff escort them on outings. 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: Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This inspection was unannounced. The visit to the home took place over two days and took nine hours in total, starting at 12:10 pm on the first day. Before the visit we (the Commission for Social Care Inspection) asked the manager to complete a questionnaire to give us up to date information about the home. We ask all services to complete this document, which we call an Annual Quality Assurance Assessment (AQAA), once a year. It gives us information about how the home is meeting the needs of the people who live there. We sent questionnaires to the people who live at the home to ask them what they think about the care and services provided and we have taken their views into account in writing this report. As part of the inspection, we spoke with some of the people who live in the home and to a relative of a person who lives there. We looked at some of the policies and procedures that the staff use to help them provide care in the right way. We looked at care plans for two of the people who live at the home to see how their care and support was provided. What the care home does well What has got better from the last inspection The home has recruited a lot of new staff so there are enough staff on duty to give people the help and support they need. Staff recruitment procedures have been improved so the manager knows that staff are suitable to work with the people who live at the home. Staff have worked hard to improve the number of activities on offer for the people who live in the home. Records showed that there are usually different activities on offer each day and a social worker told us that staff at the home were helping people to try new activities so they could live a more fulfilling lifestyle. The bathroom in the home has been improved to make it more accessible so all people who live there are able have a bath or a shower. We saw that staff had improved the way they spoke to the people who lived at the home so they were treated with respect. For example they always spoke to them before they moved their wheelchair so they would know what was happening. We could see that the people who lived at the home got on well with the staff and enjoyed their company. What the care home could do better The service users guide and some other documents such as the complaints procedure should be made available in easy read formats so the people who live at the home are helped to understand the information. All the people who live at the home should be given statements of terms and conditions so they and their representatives know their rights and responsibilities. Care plans need to be reviewed with the person and their relatives and, where appropriate, nurses and social workers. This will help to make sure that the person gets the help they need to make decisions about their care so they are always given care in the way they prefer. Care plans should be illustrated with pictures and photographs so the people who live at the home are helped to understand them. Managers must make sure that staff know about the needs of all the people who live at the home so they know what to do to give them the care they need. Risk assessments must be carried out and, where necessary, risk management plans must be put in place for all possible dangers so people are safe and protected from unnecessary risks, accidents and harm. Complaints records should always show what was done about the complaint so managers and staff can show they have responded to it and know what to do to improve the service, if necessary. Managers must make sure that the training and supervision of staff is good enough to give them the skills and experience they need so they can always meet peoples needs and make sure they are safe. The home needs a system for reviewing the quality of services provided, which is based on seeking the views of the people who use the service and their relatives and, where appropriate, nurses and social workers. This will help to make sure that the home is always run in the best interest of the people who live there. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact David Jones Colston 33 33 Colston Avenue Bristol BS1 4UA 011 7930 7110 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 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 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 . People who use the service have their needs assessed so they receive the care and support they need. Evidence: We looked at the care records of the two people who had moved into the home most recently to see how this had been managed and what care they were receiving. We spoke with them and their representatives, including family members and health and social care professionals. We found that there were good procedures for introducing new people to the home. The manager and staff work closely with the individual and their representatives to make sure their care needs are assessed so they receive care in the way they would prefer. They are invited and encouraged to visit the home so they can get to know the staff, the other residents and the home before they move in. There is a statement of purpose that sets out the objectives and philosophy of the home and a service users guide, which contains information on facilities and services provided. The manager is looking at ways of making these documents available in a range of formats including using photographs and illustrations to make the information easier to understand. The service users guide needs developing to include a standard form of contract or terms and conditions. This will ensure that the people who live at the home and their representatives have written information about terms and conditions so they know their rights and responsibilities. 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 . Support staff do not have all the information and guidance they need to meet needs so care is not always provided in the way people prefer. Some hazards to the health and safety were not identified so the people who lived at the home were not always protected from the risks of accident, personal injury and harm. Evidence: We read the case records of two people who lived at the home to see what care they received. We also spoke with them and their representatives including family members and their health and social care professionals. We could see that care plans had been reviewed and revised since our last inspection and some had been improved. They covered a wider range of personal care needs and included more personal preferences so people would receive care in the way they preferred. For example each persons care plan had a new section on how they would wish to receive affection from their care workers. Other improvements we saw included the introduction of the All about me booklets. Staff told us that these were completed with the people who live at the home and recorded their likes, dislikes, personal preferences and things important to the person. This shows us that managers and staff were sensitive to each persons preferences and changing needs. However, when we talked with staff and watched them working, we found that the care plans were not used as working documents and some needed further development to confirm basic care needs. For example one staff member was not aware of a care plan about the way the person needed their meal preparing. This had Evidence: been written and introduced in May 2008 to improve the presentation of the persons meals. We could see that the care plan was not being followed. The staff member told us that they had never seen the care plan before. Another staff member was not aware that one of the people who lived at the home was prescribed vital rescue medication to be used if the person had a prolonged epileptic seizure. They told us that they had received training in how to give the medication but they had not been shown or asked to read the persons care plans. The persons care plan confirmed that they were prescribed this medication for epilepsy but there was no clear guidance on what should be done to make sure the person had their medication when they were out of the house. This meant that the persons health care needs were at risk of not being met. This staff member was also unaware of the All about me booklets so they did not know about each persons personal preferences, likes and dislikes. We observed staff offering people choices of what to eat and where to go. This showed us staff recognised the rights of people to take control over their lives and make decisions but there was little evidence of how they involved them in the development of their care plans. Care plans were not illustrated with symbols, photographs or pictures to make them easier for the people who live at the home to understand and were not signed by the individual or their representatives. One of the people living at the home told us they liked the way staff cared for them and they were happy living at the home, but they had never seen their care plan. Some risk assessments were written but these did not cover all possible dangers and were not always reviewed or revised when there had been an accident in the home. For example one of the people living at the home was at risk of being burned because the radiators in their bedroom were not fitted with guards. Accident records showed that they were prone to falls but there was no environmental risk assessment so the dangers presented by the unguarded radiators had not been identified. One persons risk assessments on mobility, and maintaining a safe environment had not always been reviewed or, where necessary, revised after a fall so they remained at risk of injury from falls. Another persons case records did not contain a risk assessment on the use of rectal diazepam so hazards of taking the person out without their medication had not been identified. There was no risk assessment on the use of bed rails that had been put in place to prevent the person falling out of bed. This meant that the dangers associated with the use of bed rails had not been assessed or recorded. This showed us that the risks to health and safety of the people who lived at the home had not been identified or, as far as possible, eliminated. 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 who live at the home are encouraged to take part in a range of activities in the home and local community so they can lead fulfilling lives. Evidence: We looked at the activity records for two of the people living at the home and we spoke with them and their representatives, including a relative and a social worker. All the people we spoke with told us that arrangements for providing activities had improved. Records we saw showed that people were getting out more and they were enjoying more activities in the home, but there was still room for improvement. The manager had revised each persons activity plan but records showed that these were not always followed and on some days the person did no activities at all. The manager told us that she was aware that further work needed to be done to improve the activities on offer but was confident that this would be achieved through improved care planing, recording and evaluation. Visiting social work staff told us that staff had worked in partnership with them, relatives and other social care professionals to improve the quality of life of the people who lived at the home. For example managers and staff were helping one of the people explore and take advantage of opportunities for leisure and social interaction in the local community. The person had reduced the number of days they attended the local day centre and were doing other things that they enjoyed including listening to music, watching DVDs and going out to places of interest such as the library. This shows us that managers and staff are working to improve the range of activities on Evidence: offer so people who live at the home can enjoy a fulfilling lifestyle. A relative told us that they were always made welcome and they were kept informed of significant events in the home. This showed us that the people who lived at the home are supported to maintain links with family members. We observed support staff helping people who needed assistance with their meals. Staff were sensitive to the needs of each person and provided them with the support they needed at a suitable pace. We saw that people were offered well-balanced meals that they enjoyed. One person living at the home told us that the food was lovely and they enjoyed their meals. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Health and personal care is based on individual needs but support staff do not always have all the knowledge and guidance they need to make sure each persons health care needs are met. Evidence: We sent our survey questionnaire to some of the people who live at the home. Those people who were able to reply told us they were always treated well and care staff always or mostly acted on what they said. Some of the people who lived at the home were unable to tell us about the care they received because of communication difficulties so we spoke to some of their representatives, including a relative and health and social care professionals. A relative told us they were satisfied with the care provided and communication had improved so they had more confidence in the home. Social workers told us that they were satisfied with the care provided and staff had the right skills so peoples needs were met. We observed staff interacting with the people who lived at the home and we could see care and personal support was provided in a way that promoted each persons privacy, dignity and independence. For example personal care was always given in private and staff were seen to offer choice and respond sensitively to each persons changing moods and needs. Anticipatory care calenders were used to monitor each persons health and well being and records showed that any indications of ill health were identified and dealt with at an early stage. A visiting district nurse told us that the staff know what to do if people are unwell. They seek and act on advice so peoples health care needs are met. Evidence: Arrangements for the storage, recording and giving of medicines were satisfactory in the main. Records showed that there were some recording errors but these had been spotted by staff and action was being taken to make sure that peoples medication was given and recorded appropriately. All staff had received training on how to give and record medication, including rescue medication. However, one staff member was unaware that one of the people living at the home was prescribed rescue medication to be given in the event of a severe epileptic seizure, to prevent further injury and harm. This staff member told us that they had worked alone with this person but had not been shown their care plan or asked to read it in the six months they had worked at the home. This meant that the persons health and well being had been put at risk. This showed us that the home had not made always proper provision for the care of this person. Discussion with the manager and staff member showed that the training they had been given on rectal diazepam did not give them the skills and knowledge they would need to make sure the procedure was carried out effectively and safely. 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 . People who use the service are able to express their concerns and are protected from abuse by the homes adult safeguarding procedures. All complaints needed to be recorded in full so managers and staff can demonstrate accountability and complaints can be reviewed to make sure they are acted upon. Evidence: There is a detailed complaints procedure for the home. This should be made available in formats that are suitable and accessible for the people who live there. Various formats and methods should be considered including using illustrations and possibly audiovisual media so more people will be helped to understand the information. The complaints book showed that the home had received two complaints since the last inspection, but these were not recorded properly. In each case the details of the compliant were recorded but there was no record of action taken to resolve the complaints. The manager told us that each complaint had been acted upon and showed us that action had been taken to improve the service. However it is important that a record of all complaints, including action taken to address them, is kept in the care home so managers and staff can demonstrate accountability and review complaints records to make sure all complaints are addressed. The home has good procedures for responding to any suspicion or evidence of abuse including whistle blowing so staff know that they can report poor practice if needed. All staff had training on safeguarding vulnerable people so they know what to do to make sure people are protected. Records and information provided by the manager showed that the home had made two safeguarding referrals since our last inspection there. Information provided by the social services department showed that managers and staff had worked in partnership with them and other agencies to make sure vulnerable people were protected. However the most recent incident was not reported to the commission. The manager explained that this had happened because of a misunderstanding and action was taken Evidence: to make sure that all incidents of abuse are reported to the social services department and the commission without delay so the people who live at the home are always fully protected. 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 well maintained so people who live there have comfortable, bright cheerful accommodation that meets their needs. Evidence: 53 Twiss Green Lane is a bungalow in keeping with the local community. We looked around the home and found that it provides comfortable, bright and cheerful accommodation that is generally suitable for the needs of the people who live there. Interior decoration, furniture, fixtures and fittings are good and each persons bedroom reflects their individual needs and personality. Changes have been made to the home over time to meet the needs of people who live there. Since our last visit there the furniture in the lounge has been changed to make more room for people to move around. The bathroom has been refurbished and fitted with specially adapted shower facilities so all people can bathe. The main bathroom has a toilet in it. Unfortunately the only other toilet in the home is located in a persons en-suite bathroom. This means that staff and the people who do not have en-suite facilities have to use the toilet in other persons bedroom when the main bathroom is occupied. This is inappropriate because it compromises the privacy and rights of the people who live at the home. Although there is no sluice facility in the home, appropriate arrangements are made for handling and disposal of waste and infection control. The home is clean and well presented throughout. 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 . Ineffective staff induction training procedures mean that new staff do not always have the knowledge they need to meet the health care needs of the people who live at the home. Evidence: Our observations and records that we looked at showed there were enough staff on duty to meet the needs of the people living at the home. The manager told us that a successful recruitment drive meant that all vacant posts at the home had been filled. Rotas showed that a minimum of two staff were on duty each morning and afternoon. Shifts overlapped between 1pm and 3pm, increasing the number staff of available during this two hour period to four. This meant that there were enough staff to offer people opportunities to go out each day and take part in activities in the community. Information provided by the manager before our visit showed that staff training is recognised as important and the organisation tries to deliver a training programme for staff so they can meet all the needs of the people who live at the home. However, discussion with staff and the manager, and observation, showed that the training staff had received on induction and on the administration of vital rescue medication did not always give them the knowledge they needed to ensure the health and welfare of all the people who lived at the home. We observed that some staff did not always have a working knowledge of the needs of the people who lived at the home as detailed in their care plans. For example one staff member did not know about a care plan that had been in place since May 2008. This showed us that communication in the home needed to be improved. Another staff member did not have a working knowledge of the likes, dislikes, personal preferences and needs of some of the people who lived at the home. They told us that they had never seen or been told about the All about me books so they did not know what had been recorded about each persons likes, dislikes, and personal preferences. This member of staff had attended a Skills for Care induction training course but their induction training had not included familiarising Evidence: them with the needs of the people who lived at the home. They had not been shown or asked to read each persons care plan so they had not been able to apply their learning to meeting the needs of the people who live at the home. For example they were unaware of the health care needs of one of the people living at the home so they did not know that the person had been prescribed rescue medication to be given if they had a severe epileptic seizure. This showed us that the homes staff induction procedures did not provide staff with the knowledge they needed to ensure that the needs of the people who live at the home are met. Information sent to us before our visit showed that seven staff had an NVQ in care at level 2 or above and a further three were working toward the qualification. This means that more than 90 percent of staff had or were working toward a nationally recognised qualification in care. Staff training records showed that staff had received training in a number of relevant topics but two had no record of receiving training on the administration of rectal diazepam and they had not received refresher training on the administration of medication since 2004. The manager was aware that there were gaps in the staff training programme and planned to deal with this. All staff we spoke with during our visit were knowledgeable about equality and diversity so they knew about the importance ensuring equality, valuing diversity and developing services to meet all peoples needs irrespective of their race, ethnic origin, disability, gender or sexual orientation. We spoke with staff about recruitment processes and we looked at a staff recruitment file. This showed us that arrangements for the recruitment of staff were thorough so vulnerable people were protected from possible abuse, harm or poor practice. All staff were helpful, friendly and cheerful. They told us they are well supported. They had regular staff meetings and regular supervision meetings with the manager or assistant manager. However observation and discussion with staff showed us that the day to day supervision of staff needs to improve so they receive the guidance and support they need to carry out their work effectively. For example, records and observation showed that staff were not always following care plans properly but this had not been picked up by the manager or assistant manager. The manager and assistant manager need to make sure that all staff are appropriately supervised and are using care plans so they are aware of the needs of the people who live at the home. The manager does not visit the home on a daily basis as she is based in an office in Warrington town centre. Some staff were happy with this arrangement but others told us they would like to see the manager more often. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The manager and the assistant manager have the necessary experience and skills to manage the home but problems with care planning, communication between staff and a lack of risk assessment means that health and safety of some of the people who live at the home may be at risk. Evidence: Since our last visit to the home, the previous manager had moved to another job with Warrington Community Living. The former assistant manager had been appointed as manager of the home on 31 March 2008 and a new assistant manager had also been appointed. The new manager had not applied for registration with us (the commission) because of some unforeseen complications. She told us that she expected to resolve these problems and will put in an application for registration in the near future. The management structure is suitable for the homes stated purpose and includes the manager, assistant manager and eleven support staff posts. Both the manager and the assistant manager are registered nurses in learning disabilities. The manager is experienced in the field of learning disabilities but does not hold a management qualification so is working toward the Registered Managers award. It is important that the manager completes this qualification so she can demonstrate that she has the necessary skills to manage the home effectively and ensure all the needs of the people who live there are met. Information provided to us before this visit and discussion with the manager shows that the manager promotes equal opportunities, has good people skills and Evidence: understands the importance of person centred care with positive outcomes for the people who use the service. The manager told us that she had tried to promote person centred care planning. She wants to make sure people are involved in the development of their care plans and where necessary receive support from relatives and other representatives when required. In this way each persons diverse needs will be recognised and recorded so care staff are given the information and guidance they need to provide care in the way the individual prefers. Unfortunately the managers plans have not worked out as she would have wanted. Four of the eight requirements we made at our last inspection of the home in 2007 had not been met in full. Some work on reviewing and revising care plans had been completed but observation and discussion with staff showed us that care plans were not used as working documents and staff were unfamiliar with their contents. Important risk assessments were missing from peoples care files. In some instances care plans needed revising so staff would have basic guidance on how to carry out their work safely and in the best interest of the individual. For example, there was no risk assessment on the dangers presented by unguarded heated surfaces. Records showed that one of the people living at the home had a number of falls in their bedroom. The radiators in their bedroom were not fitted with guards so the person was not adequately protected from the risks of burns. Warrington Community Living revised quality assurance procedures for its care homes in 2007 but this work had not been put into practice at Twiss Green. There had been no recent survey to find out the views of the people who used the service. Staff were not aware of the homes quality assurance system or how the home assessed the quality of service and care provided. The new manager told us after the inspection that a suitable quality assurance system will be introduced based on seeking the views of the people who live at the home and their representatives. A report on quality issues will be published so people will know that their views are taken seriously and are acted upon. Information provided to us before this visit indicates that routine maintenance checks of gas and electrical systems, fire alarms and fire fighting equipment, hoist and electrical appliances are carried out. We checked some of the maintenance records and we could see that these were up to date. The home takes precautions against the risk of fire including routine checks of fire prevention equipment and training of staff in fire drills and fire evacuation procedures. However there is no fire risk assessment and no risk assessment on the use and storage of oxygen in the home. The manager told us that the company that fitted a piped oxygen supply into the home did their own risk assessment. However the manager did not have a copy of this and there was no other evidence that would confirm that the risks of using and storing oxygen were controlled. At our last inspection, we were made aware that the health and safety advisor had made a high priority recommendation that the homes water supply should be inspected and a risk assessment developed on the control of Legionella. The current manager was unable to tell us whether this had been addressed and there was no risk assessment on the control of Legionella. The manager should make sure this Evidence: recommendation is addressed so the people who live and work at the home are safe. Staff told us that they had not had any specific training on equality and diversity, however some had covered it on NVQ training and all had an understanding of the issues. They were aware that the home aimed to meet each persons diverse needs through person centred care and support planning. Are there any outstanding requirements from the last inspection? Yes  No  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 1 9 13 (4) Risk assessments and risk 31/12/2007 management plans must be developed for all people who live at the home to make sure that any activity they enter into is free from unnecessary and avoidable risk or unnecessary restrictions so they are safe and their independence is promoted. 2 20 13 (2) Appropriate arrangements 30/11/2007 for the administration of rescue medication must be made so that all staff know how to give it as and when required and the health care needs of people who live at the home are met. 3 41 17 (1) and 17 Records required by the 30/11/2007 (3) regulations must be kept up to date and available for inspection at all times, including care plans and the record of all complaints and the action taken in respect of any such complaint so staff have access to up-to-date information which can be reviewed and evaluated to make sure the needs of people who live at the home are met. 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 Description 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 Description Timescale for action 1 6 15 The care plans of the people living in the home must be reviewed and where necessary revised following consultation with the people who live at the home and their representatives. 25/01/2009 This will help to make sure that the individual receives the care they need in the way they prefer. Not reviewing and where necessary revising a persons care plan in consultation with them or their representatives is a contravention of regulation 15 of the Care Homes Regulations 2001, which is an offence. . 2 9 13 25/01/2009 Risk assessments must be carried out and, where necessary risk management plans must be implemented for all identifiable hazards including use of bed rails, the administration of rectal diazepam and environmental hazards such as unprotected heated surfaces. This will help to make sure that all unnecessary and avoidable risks to the health and safety of the people who live at the home are identified and so far as possible eliminated. Not making sure that all unnecessary hazards to health and safety of the people who live at the home are identified and as far as possible eliminated is a contravention of or failure to comply with regulation 13 of the Care Homes Regulations 2001, which is an offence. 3 19 12 Proper provision for the care 25/12/2008 and where appropriate treatment and supervision of the people who live at the home must be made. So the needs of the people who live at the home are met, their well being is assured and that staff caring for them are aware of all their care needs. A failure to make proper provision for the care and where appropriate treatment and supervision of the people who use the service is a failure to comply with regulation 12 of the Care Homes Regulations, which is an offence. 4 20 13 Appropriate arrangements for the administration of rescue medication must be made. 25/12/2008 So the health, safety and well being of the people who live at the home is ensured and their needs are met. Failure to make appropriate arrangements for the administration of all medication is a contravention or failure to with regulation 13 of the Care Homes Regulations 2001, which is an offence. 5 35 18 25/12/2008 Staff must receive training appropriate to the work they are to do including structured induction training and familiarisation with the needs of the people who live at the home. So staff have the skills, and knowledge they need to meet the individual needs of the people who live at the home and ensure their health and well being. A failure to comply with regulation 18 of the Care Homes Regulations 2001 is an offence. 6 39 24 A system for reviewing the quality of care provided at the home must be 09/02/2009 established, and a report on this provided to the commission. To make sure that home is being run in the best interests of the people who live there. Not establishing and maintaining a system for evaluating the quality of services provided in the home is failure to comply with regulation 24 of the Care Homes Regulations 2001, which is an offence. 7 42 13 Unnecessary risks to the 09/01/2009 health and safety of the people who use the service must be identified and so far as reasonably possible eliminated. So the people who use the service are safe and protected from avoidable accidents. Not ensuring that unnecessary risks to the health and safety of the people who use the service are identified and so far as possible eliminated is a contravention or failure to comply with regulation 13 of the Care Homes Regulations 2001, which is an offence. 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 1 The service users guide and statement of purpose for the home should be available in formats that are easier for the people who live there to understand. The service users guide should include a standard form of contract or provide a statement of terms and conditions so people know their rights and responsibilities relating to services provided. Care plans should be illustrated with pictures, symbols and, where permission is granted, photographs of the individual, so the information is made meaningful to them and they are helped to understand it. Care plans should be revised with the involvement of the individual and where appropriate their family members and their health and social care professionals so the person receives the assistance and support they need to help them with their decision making including evaluating their care and agreeing plans for their care and future development. All new staff should be familiarised with the needs and care plans of all the people who live at the home so they have the guidance they need to meet the persons needs and ensure their health and well being. All complaints about the conduct of the home should be recorded in the complaints records and should include details of any investigation, action taken and the outcome of the complaint so managers and staff can demonstrate accountability and regularly review the complaints records to make sure all complaints are addressed. The complaints procedure should be made available in format(s) suitable and accessible for people who live at the home so they are helped to understand the information. The day to day supervision of staff needs to be sufficient to make sure that they are aware of the care needs of the people who live at the home and are following care plans or reporting where changes need to be made. This will help to make sure that the needs of the people who live at the home are met in the way they prefer. 2 5 3 6 4 7 5 19 6 22 7 22 8 36 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. 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. 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