Inspection on 25/11/09 for 4 - 6 Cavendish Road

This is the latest available inspection report for this service, carried out on 25th November 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

4 - 6 Cavendish Road 29/04/08

4 - 6 Cavendish Road 24/05/07

4 - 6 Cavendish Road 28/04/06

4 - 6 Cavendish Road 09/01/06

4 - 6 Cavendish Road 11/10/05

4 - 6 Cavendish Road 10/03/05

4 - 6 Cavendish Road 22/11/04

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 15/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: 4 - 6 Cavendish Road 4 - 6 Cavendish Road Felixstowe Suffolk IP11 2AX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Deborah Kerr     Date: 2 5 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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: 4 - 6 Cavendish Road 4 - 6 Cavendish Road Felixstowe Suffolk IP11 2AX 01394286990 01394284878 cavendishroad@together-uk.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Together: Working for Wellbeing care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Service users must be under 65 years of age at the time of admittance to the home. Date of last inspection Brief description of the care home The home is situated in a residential area of Felixstowe within easy reach of the beach and local amenities, such as shops. The home is in two linked adapted domestic houses, providing accommodation on three floors. Cavendish Road has a small back garden, which is accessible to residents and is attractively designed. The home is registered for thirteen residents with mental disorder. Residents are aged below 65 years of age at the time of admission, but may remain at the home over 65 years of age, so long as the home is still able to meet the residents physical and mental health needs. The home is owned by Together, working for well-being. The Registered Manager post is vacant. 1 3 0 5 2 0 0 9 13 Over 65 13 Care Homes for Adults (18-65 years) Page 4 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: This was the second key inspection undertaken this year to follow up on the poor outcomes raised at the previous inspection on the 13th May 2009. The inspection was unannounced on a weekday, which lasted seven hours. This report should be read in conjunction with the previous report to obtain an overall reflection of how the service has improved and what further improvements they need to make. To help us make our judgement of how well the service is performing, we, CQC have assessed the outcomes for the people using the service, against the Key Lines Of Regulatory Assessment (KLORA). Earlier this year we sent surveys to the home for service users to complete and return to us. In June 2009 we received seven service users Have Your Say surveys. These surveys gather information from service users, which tells us how well the service is supporting them. The information helps us to identify what the service does well and what it could do better. Their comments are included in the various sections of this Care Homes for Adults (18-65 years) Page 5 of 31 report. We looked around the home and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. We also spoke to two staff and two people living in the home. The service manager was present during the inspection and fully contributed to the inspection process. Care Homes for Adults (18-65 years) Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Together, working for well being, still need to update information about the service, including the statement of purpose and service users guide, so that the information clearly states they do not provide personal care. This information also needs to tell people using, or considering using this service what arrangements are in place to support them if their ability to manage this aspect of their care changes, such as aging or changes in their mental health needs. Although the service has controlled drugs cupboard, which meets the regulations as specified in the Misuse of Drugs (Safe Custody) Regulations 1973, this must be secured to a solid wall. Additionally, the controlled drugs received into the home and being administered should be recorded in a specific controlled drugs register, especially designed to monitor controlled drugs and not a designated notebook. Improvements have been made to ensure staff have been fully trained to do their jobs, however training records show there are two people who have not yet attended up to date safeguarding adults training and two who needed to reschedule this training. Following discussion with a service user, who raised their concerns that they do not have a means of calling the sleep in member of staff if taken ill during night. Consideration should be given to how people can alert staff, as the home has no call Care Homes for Adults (18-65 years) Page 7 of 31 system in place and no waking night staff. People living in the home were previously identified as being at risk of sustaining burns and scolds from exposed hot radiator surfaces and from hot water outlets. This was further discussed with the service manager, although risk assessments have been completed raising residents awareness, there is still an element of risk, should peoples awareness of the risk change and potentially for new individuals moving into the service. 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 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 8 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 9 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service will have their needs set out in their individual community care assessment, however the information provided to people intending to use the service does not clearly reflect what will happen if their condition deteriorates and require support to manage their personal care. Evidence: Together, working for well being has produced detailed information combining the statement of purpose and service users guide, which informs people using or proposing to use their services, about what they can expect from the organisation and the individual services. Previously concerns were raised about lack of support to individuals who needed staff support to mange their personal hygiene. Although, Cavendish Road is registered as a care home staff do not provide personal care. Information about the service does clearly state they do not provide nursing care, but does not stipulate non provision of personal care. The statement of purpose and service users guide have not been amended to reflect this. This was discussed with the service manager who provided a copy of the Suffolk Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: County Council Agreement between them and The Mental Health Aftercare Association (MACA) now renamed as Together, working for wellbeing. This agreement dates back to 2002 and states that the provision of a service to each resident will be based upon the Community Care Assessment of the needs of that person and will be in accordance with the individual care plan. However, the service manager was advised they need to be very clear to people intending to use the service exactly what is provided and what will happen if their condition deteriorates and require support to manage their personal care. The service manager told us they are meeting with Suffolk County Council (SCC) Mental Health commissioners on the 27th November 2009 to discuss ideas about the level of support that elderly tenants using Together, working for well being services need now or in the future. This may be an additional service that is identified as needing to be brought into the service. Cavendish Road is registered for thirteen people, however there are currently seven people residing in the home. The other five residents have had their needs reassessed and moved on to alternative placements to better meet their needs. The service manager and staff spoken with confirmed they are currently working hard to get Cavendish Road back on track to improve the service, so that they are able to admit new people into the service. The service manager confirmed Together, working for well being is still considering the best way forward for Cavendish Road, with regards to voluntarily canceling their registration and to provide supported living accommodation. To provide a supported living service they need to obtain a license for a House of Multiple Occupancy (HMO), for this to happen significant refurbishment of the kitchen area, is required. Three people are funded by Essex County Council (ECC). All three have recently had a psychiatric review and review of their placement. Funding has been agreed for each of the service users to remain at Cavendish Road, however during the review it was discovered service users rents were in arrears. These have been readjusted between Essex and Together, working for well being and back dated to 1st April this year. Residents have been informed of this. New Individual Placement Contracts (IPC) have been issued. All people using the service funded by SCC have up to date IPC contracts in place. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service know they will have their needs and personal goals reflected in their individual care plans and will be supported to take risks as part of an independent lifestyle. Evidence: Three peoples care plans were tracked as part of the inspection process. The care plans are generated from the Care Programme Approach (CPA) completed by Community Mental Health Team (CMHT). The plans are well laid out and divided into nine sections, setting out the individuals aims and objectives to achieve optimum levels in all aspects of their physical and mental health and to ensure continuity of staff support to maintain their plan and to maximise their independence. The three care plans looked at confirmed that each individual had recently had their needs reviewed by a psychiatric consultant and the CMHT to ensure that Cavendish Road could continue to meet their needs. The outcomes showed that each of the service users are in good physical health and remain settled at Cavendish Road and appreciate the support provided by the staff, to enable them to live independently. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: Concerns were raised at the previous inspection where people required one to one staff support to help them manage their behaviours, the staffing ratio did not always allow for this to happen. One individuals CPA review identified that through staff support they had improved their anger management, this was confirmed in discussion with the individual. Additionally, recording of service users daily records and health charts are being better maintained to reflect individual support time with staff. These sessions show that staff are supporting people to cook and prepare their own meals, to go shopping, maintain a laundry and cleaning schedule, as well as providing time to discuss anxieties and concerns. Daily records are being kept which provide a good description of how each individual has spent their day, their health and well being, and decision making about all aspects of their life. Care plans contained a range of risk assessments, which cover all areas of peoples daily living. These are very detailed assessments which identify the risk, the likelihood of these occurring and the action staff and the individual need to take to minimise the risk. Individual risk assessments relating to the use of hot water in the kitchen and bathrooms have been reviewed, following conflicts between service users choice and concerns about hot water exceeding the safe recommended temperatures of 41 degrees for showers and hand basins and 44 degrees for baths. The assessments have also included the risks to people using the service of burning them selves on hot surfaces such as radiators. To minimise these risks precautions, include weekly monitoring of water temperatures, hot water signs are in place adjacent to all taps, thermometers have been provided in each bathroom and 24 hour staff support is provided. The assessments reflect that the risks of having water hotter than recommended have been discussed with all of the people living in the home. Staff have discussed and provided them with instructions on the procedure for filling baths and sinks, shown them how to use the thermometer and made them aware that water should be near to 43 degrees, when taking a bath or shower. Time was spent talking with service users who confirmed they are aware of the risks, and that they know how to use the thermometer to check the temperature and to add cold water, before getting into a bath or taking a shower. Discussion with a senior member of staff confirmed that none of the residents are deemed to be at risk at present, longer term one individual, as they get older, may become more at risk and staff will need to reassess their needs. Staff are currently supporting the individual to run their bath and monitoring the temperature. The incident and accident records reflect there have been no incidents of burns or scolds recorded to date. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service told us they are supported in the way they want to be and have the freedom to choose a lifestyle, which meets their needs. Evidence: Discussion with service users told us, they are very happy with the staff, and the home is better now there are less people living there. They were observed to come and go from the house as they chose and move freely around the home, using different parts of it, including the paved garden area, the sitting rooms and the dining room, affording them lots of options as to where their spent time. Information provided in the seven service users Have Your Say surveys told us, that five people feel they are supported to make decisions always and two felt this was sometimes the case, comments included, I always let staff know about day to day decisions I make and we frequently meet with staff to discuss daily activities and staff support me to organise my day. All seven service users told us, they are able to do what they Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: want, when they want to, one person commented I dont go any where, but I could if I wanted to. Discussion with service users confirmed they are able to make choices about what they do, comments included, I have been out shopping on my own to a local supermarket, another person told us they been to a residents forum meeting at the London head office the previous day and had had lunch out. Six people told us, staff always treat them well, one person felt they did sometimes five people told us staff always listen and act on what they say, with two people telling us they did sometimes. However, one person told us, I receive first class care, in a first class home, I always receive my correct medication and treatment and it is good living here. There have been previous concerns raised about the high temperature of the fridge in the kitchen. Records reflected the fridge temperature is being checked and was observed to be within safe recommended temperature, during the inspection. Care Homes for Adults (18-65 years) Page 15 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. Through improved recording, monitoring and introduction of health plans the health needs of people using the service are being identified and met at an early stage to prevent further ill health or ill being. Evidence: The previous report identified the majority of the people living in the home are able to manage their own personal care, however staff do not provide personal care, therefore people who required support to help them manage their personal hygiene were not receiving the support they need to promote their self esteem and dignity. Following a review of their placement five people have had their needs reassessed and have moved on to more suitable placements. Following the last inspection the manager was required to ensure that prompt action is taken at early signs and symptoms of service users showing ill being or ill health. Improvements have been made in this area, with the introduction of health plans. These identify peoples health care needs, so that all staff are able to look and see how and when peoples health care is being met. These show the dates of Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: appointments due and those that people have attended, including regular blood tests to check lithium levels and diabetes, podiatry, heart conditions, cardiology and ECG, eye examinations, flu vaccines, dietitian visits, kidney function and where required 4 weekly depot injections. These also include the dates of regular Community Psychiatric Nurse (CPN) Community Health Team (CMHT) meetings and Psychiatrist consultants visits. Improvements were also noted, where prompt action was taken to support an individual who was showing signs of poor health due to high blood sugar. A doctors appointment was made for the same day. Risk assessments and support plans have been further developed to monitor peoples health, including lithium levels, diabetes and healthy eating plans. Daily checks are being recorded to aid people to manage their own health, such as blood glucose monitoring and diet. The health plan and assessment for one individual with diet controlled diabetes showed they had gained weight causing inconsistencies with their blood sugar and a referral had been made to the dietitian. The practice of administering medication is being generally well managed. The home uses the Monitored Dosage System (MDS). The Medication Administration Records (MAR) charts inspected were found to be completed correctly, with no gaps. Care plans also contained medication information, listing each individuals current medication, the affects and side affects of taking each prescribed medicine. Since the previous inspection one individual has been prescribed the Temazepam and Lorazepam. These are classed as controlled drugs (CD) and are required to stored in a metal controlled drugs cupboard. The service does have a large metal floor standing medicine cupboard, with an integral metal CD cupboard. To comply with regulations as specified in the Misuse of Drugs (Safe Custody) Regulations 1973, this must be secured to a solid wall. Additionally, the controlled drugs received into the home and being administered are being recorded in a note book. The senior was advised a specific controlled drugs register should be used for this purpose. A check of the stock of medication held against the records, was found to be accurate. All staff are in the process of completing medication training. Distance learning workbooks, have been issued to staff by the pharmacy and endorsed by Keele University. The training is designed to enable care workers to safely administer medicines in care homes. Workbooks consist of three units. Following completion of each unit, this is checked and signed off by the service manager and forwarded for accreditation and certification. Care Homes for Adults (18-65 years) Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service know that their complaints will be dealt with appropriately and protected from abuse. Evidence: The policies and procedures for dealing with complaints, whistle blowing and safeguarding the people living in the home were seen. The service has also obtained a copy of the updated local authority safeguarding adults organisational policy and procedure. The complaints log reflected four complaints have been received, by the service in the last twelve months. All four had been made by people using the service about another service user. These had been dealt with in line with the homes complaints procedures and discussed with those concerned to establish a satisfactory outcome. Have Your Say surveys told us, that all seven service users know who to talk if they are not happy, however five said they new how to make a complaint, with two people commenting they sometimes would know how to make a complaint. Discussion with staff confirmed they are aware of the procedures to take if they witness or are informed of an allegation of abuse. They were clear about their duty of care and about whistle blowing policies. And that they would need to report concerns Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: to the manager, local authority and / or the police. Training plans in staff files show one member of staff has completed a safeguarding course for carers and two were scheduled attended Safeguarding Vulnerable Adults (SOVA) training since the last inspection. A senior has also attended a one day safeguarding children and younger people seminar, provided by Suffolk County Council (SCC). There are two staff who have not yet attended this training. Care Homes for Adults (18-65 years) Page 19 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. Improvements made to the decor and cleanliness has ensured that people living in the home are provided with a safe, well maintained and homely environment. Evidence: Significant improvement has been made to the environment since the previous inspection. The overall impression of the home is cleaner brighter, well maintained and no odours. Carpets throughout the home have been steam cleaned. New curtains and net curtains have been purchased for the lounge and a quote has been obtained for new carpet. Staff and service users spoken with are much happier with the environment, commenting it is a nicer place to live and work. Have Your Say surveys told us five people thought the home was always fresh and clean, two commented that some improvements could be made. The downstairs toilet and bathroom on 2nd floor have been refurbished, and put back into use. These have been nicely decorated. There are two small tiles missing in the refurbished bathroom, however this has been noted in a newly established maintenance book, for these to be fixed. All bathrooms, toilets and showers are looking cleaner and more hygienic, with paper towels and liquid soap provided. Evidence of thermometers and hot water caution signs were seen in all bathrooms and showers. The laundry room was clear of chemicals and was observed being used by a Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: service user doing their own laundry. The laundry was clean and tidy. A maintenance file commenced on 11/08/09 which reflects ongoing plan of work planned and completed. Quotation seen in maintenance file for painting and maintenance contractor, to decorate twelve bedrooms, all woodwork on staircases, doors, frames and skirting boards. One service user showed us their room, it is nicely decorated, clean, tidy and comfortable, and contained their own furniture and belongings. We also viewed several other residents rooms, these are now looking better kept, cleaner and tidier, decoration of some of the bedrooms has taken place, and carpets have been or are in process of being replaced or cleaned. A service user raised their concerns with us that they do not have a means of calling the sleep in member of staff if taken ill during night. The home has no alarm call system in place and no waking night staff. This was reported back to the service manager who agreed to look into this. Concerns were raised at the previous inspection about no self closures fitted to bedroom doors and missing intumescent strips. The Fire and Rescue service visited Cavendish Road on the 10th June 2009, at our request. Following their visit they advised us, that although generally satisfied with the fire safety arrangements within the home, missing intumescent strips needed to be replaced and to meet fire safety requirements, self closures should be fitted to all bedroom doors. We found all of the intumescent strips in place, however a check of all service users bedrooms identified that only half have been fitted with automatic self door closures. There are thirteen bedrooms in the home (one of these rooms has been turned in to an office). Seven bedrooms including the office have been fitted with the closures. There are currently six rooms unoccupied, these were found to be locked shut during the inspection. All people using the service have a key to their room, and keep their doors locked at all times. Staff have an override key in case of an emergency. As already mentioned in the individual needs and choices section of this report, people living in the home were previously identified as being at risk of sustaining burns and scolds from exposed hot radiator surfaces and from hot water outlets. Risk assessments have been completed and training provided by staff to service users to raise their awareness, however there is still an element of risk, should peoples mental health fluctuate and potentially for new individuals moving into the service. Care Homes for Adults (18-65 years) Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and available in sufficient numbers to ensure people receive the individual support to meet their needs and to maintain a clean and healthy environment. Evidence: There is currently seven staff working in the home, three full time seniors, two fulltime and one part time support workers, plus one regular relief worker. The service has not been using agency staff. The reduction in the number of people using the service has meant that these staffing levels have been sufficient to meet the remaining service users needs. This was confirmed through observation, discussion with people using the service, staff and information seen in care plans, reflecting service users are now receiving one to one support, as required. Together, working for wellbeing have employed an outside consultant to look at staffing levels across all of their services, which provide 24 hour support. The service manager is part of the working group and has assessed Cavendish Road as a service providing support to clients have high complex needs and/or are at risk. As a result of the consultants findings a proposal is being made to the board of directors to increase staffing levels, if agreed Cavendish Road will gain a further full time member of support staff. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: Staff told us, that a lot of training has taken place, in the last six months. This was confirmed in each of the seven staff files, which have been updated and now contain a personal training plan. These reflect all staff have completed a five day induction provided by Together, for wellbeing and the Skills for Care Common Induction (CIS) Standards induction through, Suffolk Care Training. Other training has included health and safety, emergency first aid certificated by Suffolk Association of Voluntary Organisations (SAVO) Pharmacy medication training, safe handling, personal safety, fire safety, safeguarding adults, mental health awareness, moving and handling and food safety. As already identified in the complaints section of this report, training records show there four staff yet to attend up to date safeguarding adults training. Other more specific training to meet peoples needs has included, person centred care, personality disorders, alcohol abuse, recovery approach to goal planning, conflict resolution and breakaway training, menu planning for people with special diets, introduction to diversity and cultural awareness and a two day moving and handling course, certificated county back care advisor. Senior staff have also attended training relevant to their post, which as included effective team building and leadership, human rights and mental health, welfare benefits and mental health and employment and support allowance The file of a recent new member of staff seen confirmed all relevant documents and recruitment checks, required by regulations, to determine the fitness of the worker, had been obtained prior to them commencing employment. Discussion with the member of staff confirmed that all their recruitment checks had been carried out prior to their appointment. Currently the home has three staff who have achieved a National Vocational Qualification (NVQ) level 2 and or above. These figures reflect the home has not achieved the 50 of staff to hold a recognised qualification, in line with the National Minimum Standard (NMS). However, the service manager has advised us they have met with an NVQ assessor on the 24/11/09 and has put forward four staff to undertake NVQ 3 promoting independence which will bring the ratio up to NMS standard on completion. Supervision records and discussion with staff confirmed that regular supervision is now taking place and that staff find these helpful and supportive. Care Homes for Adults (18-65 years) Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there has been a more proactive approach to the overall running of the service, people using or potentially using this service are not fully protected by the management of heath and safety issues in the home. Evidence: Together, working for wellbeing have had a management and staffing restructure throughout its services. The new structure was implemented on the 1st September 2009. As part of this restructure, Cavendish Road has been allocated a new services manager. Tracey Norman is responsible for overseeing Cavendish Road and two other services in the Suffolk Area. They are currently based at Cavendish Road managing the service until a new project co-ordinator is recruited. They have worked for the organisation for twelve years gaining relevant qualifications, experience and promotion to their present role as services manager. The service managers approach to managing the service has created a more open, positive and inclusive atmosphere in the home. This was confirmed through conversations with staff and people using the service, who told us they have regular Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: staff and residents meetings where current issues and decisions about the day to day running of the home are discussed. Together, working for well being has organisational trustees, each is allocated a number of services. Service managers are expected to provide an action plan to address any issues identified by CQC inspections to the trustees and the operational directors so that they are able to monitor improvements. Also to monitor how the service is meeting the needs of people using their services, they and their relatives and staff are asked to complete satisfaction surveys. Samples of completed surveys were looked at. Nine service users surveys had been completed and returned, confirming staff listen to what they say, do things the way they like and that the staff team had improved in the last year. Comments included, first class staff and organisation, they support me to develop within the scope of together and to stay here. Carers and supporters comments included, my relative is happy in home, however they expressed there could possibly be more group activities, both within and outside the home, but felt overall their relative had progressed, within the limitations of their disability. They also commented, my relative has been provided with new opportunities to do unpaid work and has gained confidence in going out and about locally and further a field using public transport. Staff surveys reflected, they are happy in their role and commented that mostly they felt appreciated by the people using the service, they also commented where improvements could be made to the environment and staffing. Discussion with staff confirmed that the surveys had been completed prior to the recent improvements. They told us, since our inspection in May, staffing is much better now, as there are only seven clients, previously every body wanted attention at the same time, now have more time and feel better about being able to spend time individually with residents. They also told us, the home is much better organised, a better filing system has been implemented so that information is readily available, the environment is much cleaner and more homely, the staff and new manager are much better, we have a more cohesive team, we have regular meetings to share information and the atmosphere is so much better. A health and safety file has been implemented, which shows weekly and monthly monitoring checks are now in place. These include monitoring hot water temperatures, however staff are entering a tick to reflect these have been checked and not recording a temperature reading. Risk assessments have identified that these checks are necessary to ensure the safety of people when bathing and /or showering. Although Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: the risk assessments reflect people currently living in the home are not deemed to be at risk and have received instruction and training to raise their awareness, about the hot water, there is still an element of risk, should peoples mental health fluctuate and potentially for new individuals moving into the service. Following the last inspection the provider was required to confirm with the fire service that self closing devices needed to be fitted to all bedroom doors, to contain the spread of fire in an emergency. Although, the provider had not sought confirmation from the fire service, we found that seven of the bedrooms had been fitted with automatic self door closures, including the room turned into an office, however there are six rooms remaining currently unoccupied and being kept locked shut. The service manager telephoned the fire service during the inspection, who confirmed all bedroom doors must be fitted with the closures. Following this call, the service manager contacted the company that services their fire alarms and equipment and arranged for the remaining self closures to be fitted to the doors. The fire log book reflects that the alarm, emergency lighting and fire fighting equipment are being regularly serviced and regular fire drills are taking place. Certificates to ensure the home are complying with relevant health and safety legislation previously unavailable were inspected and were found to be up to date. These included the most recent gas safety certificate, electrical certificate and record of Portable Appliance Testing (PAT). 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 1 4 The statement of purpose and service users guide, must clearly state what services it does / does not provide. This will ensure people already using, or considering using this service will know the arrangements in place to support them, if their ability to manage their personal care, changes, such as aging or changes in their mental health needs. 30/12/2009 2 29 16 The registered person must make available suitable arrangements and procedures for people using the service, to contact the sleep in member of staff. This will ensure people can summon help if they are unwell during the night. 18/12/2009 Care Homes for Adults (18-65 years) Page 28 of 31 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 3 42 13 The registered person must ensure that the automatic door closures are fitted to the remaining six bedroom doors before these become occupied. This will ensure people working and living in the home are protected from unnecessary risks to their health and safety. 18/12/2009 4 42 13 The registered person must ensure proper procedures and appropriate checks, including a thorough risk assessment of peoples ability to manage hot water are in place and any action to reduce the risk is taken prior to that individual moving into the home. This will protect vulnerable people from potential harm due to the hazards of scolding water. 18/12/2009 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 1 20 The controlled drugs received into the home and being administered should be recorded in a specific controlled drugs register, especially designed to monitor controlled drugs and not a designated notebook. Care Homes for Adults (18-65 years) Page 29 of 31 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 2 23 Arrangements should be made to ensure the remaining four staff attend up to date safeguarding adults training. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 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. 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