Inspection on 14/12/09 for 88 Walliscote Road

This is the latest available inspection report for this service, carried out on 14th December 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

88 Walliscote Road 15/03/07

88 Walliscote Road 08/06/06

88 Walliscote Road 28/02/06

88 Walliscote Road 16/06/05

88 Walliscote Road 14/12/04

88 Walliscote Road 06/07/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: 88 Walliscote Road 88 Walliscote Road Weston Super Mare North Somerset BS23 1EE     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: Jacqueline Sullivan     Date: 1 4 1 2 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 32 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 32 Information about the care home Name of care home: Address: 88 Walliscote Road 88 Walliscote Road Weston Super Mare North Somerset BS23 1EE 01934418465 01179699000 jean.southerton@brandontrust.org www.brandontrust.org The Brandon Trust care home 12 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 12 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home 88 Walliscote Road is a care home for older people with a learning disability. The residents have been resettled from long stay hospitals; some of them have communication difficulties and may exhibit challenging behaviour. The service has a flat for supported living. 1 8 0 3 2 0 0 9 12 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 32 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 key inspection was conducted unannounced over one day in December 2009 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined and feedback was sought from individuals and staff. Prior to the visit some time was spent examining documentation accumulated since the last inspection and this information was used to plan the inspection visit. We received the Annual Quality Assurance Assessment (AQAA) following the visit and comments from this are included in this report. The home can accommodate up to eight people and two residents were case tracked. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The homes policies and procedures were also used to confirm the findings. Care Homes for Adults (18-65 years) Page 5 of 32 Face to face discussion occurred with the senior staff member who was in charge of the shift, other staff on duty and residents. Care Homes for Adults (18-65 years) Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The Statement of Purpose requires further work so that the admission criteria reflects the care that the residents receive. A person centred approach where the residents likes, dislikes and preferred routines are incorporated into their care plans must be developed to empower people to have a say about the way their care is to be delivered. The residents would be more assured that the staff team are meeting their needs if the staff training were further developed. The residents will benefit from the work that the new manager plans to take place to develop the care they receive.They would be further assured when the manager applies to the commission for registration The residents would be more assured that their views are being taken into account by the service if the quality assurance review were completed. The residents would benefit from a complaints procedure that was accessible to them. The residents are not fully protected as the staff team do not have sufficient training in Care Homes for Adults (18-65 years) Page 7 of 32 safeguarding. The residents health needs would be better met if the staff team received further training in this area and the information in the care files were reorganised. The residents cannot be assured that their aspirations will be met by the staff team. The residents have been protected as the risk assessments have been reviewed but these could be further developed to include the work that staff actually complete. The residents could be further encouraged by the staff team to make decisions about their lives. 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 32 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 32 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. The statement of purpose does not fully inform the residents about the care they will receive. The residents can be assured that they will have their needs assessed. Evidence: The organisations mission statement is included in the homes Statement of Purpose which is enabling people to live the lives they choose. The senior staff member, who was in charge on the day of inspection, said that the Statement of Purpose is updated annually to ensure that people wishing to live at the home have up to date information. The admission procedure is described within the Statement of Purpose. This is to ensure that the person wishing to live at the home are compatible with the other people living at the home and that the staff have the skills to meet the needs. The policy does not fully reflect the service that is available to residents. In the AQAA the acting manager stated that ,There needs to be a thorough, formal admissions policy Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: teamed with a current and relevant statement of purpose and service user guide. She went on to say that she intends to, Formalise the admissions policy, statement of purpose and service user guide to reflect the shift in culture within the home. She also stated that Documentation within the home will become more user friendly, and accessible to the individuals who live there. Introductory visits and trial periods are part of the admission process and will establish that the person is compatible with both parties and satisfies the manager that the assessed needs can be met at the home. Since last inspection the Privacy and Dignity policy has been included to ensure that people wishing to live at the home are aware that about the way their rights will be respected at the home. The criteria for admission has also been changed. There are currently two vacancies currently exists as two residents regretfully died. The most recent admission to the home occurred in 2004 and the social workers needs assessments and minutes of reviews confirms that before admission an assessment was conducted to determine that the staff can meet the needs of the person. The house has recently been redecorated and we were told that they are waiting for new photos for the brochure /service users guide. Consideration should be given completing this promptly. Care Homes for Adults (18-65 years) Page 11 of 32 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. The residents cannot be assured that their aspirations will be met by the staff team. The residents have been protected as the risk assessments have been reviewed but these could be further developed to include the work that staff actually complete. The residents could be further encouraged by the staff team to make decisions about their lives. Evidence: We looked at the Planning for Life files and saw that they contain review meetings, social workers needs assessment, Care plans and risk assessments. Two people were case tracked during the inspection visit. The senior staff member said that reviews are convened by the Local Authority annually with the people at the home, their relatives where appropriate and staff at the home. From the review meeting, care plans are then updated. Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: We looked at some examples of reviews that the staff team had completed and saw that staff members regularly write No change. We recommend that the recording in these reviews is expanded. The senior told us that two staff members have attended the training to develop person centred plans for those people that want this pathway to be used. We were also told that some staff have attended person centred thinking to incorporate the individuals likes, dislikes and preferred routines into their care plan. At last inspection it was stated that person centred planning and person centred thinking have not meshed and there was little evidence that people have a say about the way their care is to be delivered. At this inspection we noted that there have been some improvements. We saw that one person had a person centred plan and all the residents had boards which gave examples of their likes and dislikes. However, the senior staff member said that they cannot complete the person centred plans for all residents as they cannot find a facilitator. We looked at the care plans and saw that there was little planning about how the residents likes and dislikes were to be achieved.by the staff team. There was also little evidence that the residents were actively choosing the care they would like to receive on a day to day basis. In the AQAA the acting manager has identified this issue.She stated that, All individuals need to have a person centred plan that states clear steps to work towards their dreams and aspirations. Individuals will be supported to take more risks and have more choice in their lives. The culture of the home needs to shift to a more pro active approach to support instead of the established care approach. At the last inspection it was noted that the care plan of residents with communication needs were examined and it was stated that action plans must be more detailed about the way staff must avoid anxiety provoking situations situations. At this inspection this was seen to have been completed. Risk assessments are in place for activities that may involve an element of risk. However, they could be developed to ensure that the the residents are living as full a life as is possible. The acting manager who wrote the AQAA recognised that this work needs to take place,as she stated that, Not all individuals are able to explore as many Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: opportunities as they might as appropriate risks are not always explored. A recommendation has been made about this. At the last inspection it was noted that one person had very specific environmental needs but the actions taken by the staff to meet these need were not documented. Their clothing was kept in the occupied room next door to meet the need. It was stated, in the report, that the manager must undertake a risk assessment to meet the persons environmental need. At this inspection this was seen to be completed. This persons wardrobe is now in his own room. The home has people that at times exhibit aggressive and violent behaviours and can self harm. Care plans in place describe the triggers and signs of agitation with an action plan to guide the staff on providing an atmosphere that will prevent an escalation of these behaviours. At the last inspection it was noted that risk assessments provided little evidence that external agencies were involved. It was stated that risk assessments must support the advice sought to prevent the person harming themselves, others or property. At this inspection this was seen to be completed. However the risk assessment need additional work to accurately reflect the work that the staff team do. We looked at the risk assessment for one person which stated that staff members stay in the bathroom when he has a bath. However, we were told that this is not what the staff team actually in practice. The risk assessment needs to be changed to reflect what staff actually do. The senior told us that the staff members support him in the bath then leave the room and then check on him periodically. A requirement has been made about this. Behaviour charts are in plans for two people that at times exhibit aggressive and violent behaviours. Reports are detailed about behaviours exhibited and the staff team have started to report the actions taken to support that they consistently follow the care plan. Care Homes for Adults (18-65 years) Page 14 of 32 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. The residents enjoy a range of activities in and out of the house. The residents enjoy a healthy diet but they are not currently offered any choice in the food they eat at mealtimes. Evidence: Records show that people attend day care centres, go on outings, shopping, visit family and undertake in-house activities. On the day of inspection two residents had gone horse riding. Four other residents were going to see the Christmas lights Staff members assist people to use public transport independently and local shops are used so that people living at the home can be recognised in the local community. The people at the home celebrate festivals and invite neighbors and people that live in Trust homes within the vicinity to their BBQ and parties. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: The Service User Guide and Statement of Purpose specify the arrangements for visiting at the home. The procedures in place show that the staff, recognise the importance of maintaining links with family and friends. For this reason visiting is open and can take place in bedrooms for additional privacy. The senior staff member told us that each person has a designated day each week for independence living skills which are known as home days. People on home days generally tidy their bedrooms do their laundry vacuum and shop for personal toiletries. The manager stated in the AQAA that she intends to develop the activities for residents and involve them more in household tasks to promote independence. On the day of inspection it was noted that the administrator was doing an activity with the residents and other staff members were seen sitting in the lounge without residents. We would have been more assured that staff members were fully encouraging residents to develop activities and skills if we saw more involvement on the day. Menus are accessible in picture format. to ensure that the people for whom its intended can understand them. It was also stated that during residents meeting, menus were prepared by the people at the home. On the day of inspection the meal was faggot ,peas and green beans. We noted that there are no offered choices for residents. In the AQAA the manager stated that,Individuals will be offered more choice in relation to what they eat and be encouraged to be involved more in the kitchen. Individuals live will be more reflective of their thoughts, feelings and preferences and will become more individualised. Support plans will be structured to become more of a working document used to inform practice. Care Homes for Adults (18-65 years) Page 16 of 32 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. The residents health needs would be better met if the staff team received further trainingi n this area and the information in the care files were reorganised. Evidence: Initial health assessments are in place for people at the home and include their personal details, medical history and medication. It is evident that people at the home have access to NHS facilities and, regular visits are arranged for people to visit the dentist,, optician and chiropodist. Documentation from health care professionals show that people have input from physiotherapists and psychologists through the Community Learning Disabilities Team (CLDT), are registered with a GP. Discussions with the senior staff member confirmed thats staff accompany people on health care appointments. Outcome of health care appointments along with the purpose of the visit and advice given is recorded. When we looked at the health information in the care files we noted it was disjointed and there were few examples of residents choosing the care they would like to receive. The introduction of health action plans would bring this information together Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: and assist staff members care for the residents consistently. We were told that the health needs of some of the residents are changing as they become older. There has been some staff training but this could be further developed to included training in dementia. ( this has been included also in the section about staff training). The manager has identified these issues in the AQAA. She states that,Individuals could be supported to become better informed about the choices involved in their healthcare provision. She also states that, Staff will become trained in order that they can better respond to the changing needs of the individuals who live within the home. Medications are administered through a monitored dosage system and with the exception of one, the staff administer medication to the people at the home. The records of administration were signed after medications are administered and codes are used to record the reasons for not administering the medication. Protocols are in place for people that have when required medications which describe the purpose of the medication and side effect. A record of medications no longer required is maintained and signed by the pharmacist to indicate receipt of the medication for disposal. Homely remedies are not kept at the home. Care Homes for Adults (18-65 years) Page 18 of 32 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. The residents would benefit from a complaints procedure that was accessible to them. The residents are not fully protected as the staff team do not have sufficient training in safeguarding. Evidence: The Complaints procedure is described in the Statement of Purpose and Service User Guide and copies held in the individuals Person Centered file. It can also be found in the handbook provided by the trust. We noted that there is a clear procedure for the reporting and recording of complaints.The Annual Quality Assurance Assessment completed by the acting manager stated that the service, Needs to get better at making this an accessible option for those who live at the home and also for better recording all complaints no matter how minor. At the last inspection we recommended that the people at the home should have meaningful access to the complaints procedure. We noted that this work has not as yet been completed. The acting manager stated in the AQAA that she intends to Make an accessible, user friendly document that can be utilized as its intended, thereby ensuring more accurate recording of complaints. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: Since last inspection there has been a safeguarding incident. It was noted in minutes of this meeting that staff members at the home were not t proactive about reporting and recognising such incidents. We looked at staff training in safeguarding and saw that whilst three quarters of the staff team have attended training as result of meeting, not all staff have had this training. We have made a requirement about this. We have also recommended that there is a system in place to ensure that all safeguarding incidents are recorded promptly. Care Homes for Adults (18-65 years) Page 20 of 32 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 residents benefit from a homely, clean environment. Evidence: The home is situated in a residential area and blends well with its local environment. It is close to shops and bus routes. The house is arranged over three floors with single bedrooms on all floors and communal space on the ground floors. Communal space consists of two large lounges and a spacious dining room for the people at the home to undertake shared activities or for private use. A tour of the homes premises took place during the inspection and the home is accessible for people to move around independently. The premises were generally bright and cheerful and free from offensive odours throughout. At the last inspection it was stated that two two bedrooms were in need of redecoration and the carpet in the foyer was rippled . There was some damp in the dining room and the seal in a downstairs toilet needed attention. At this inspection this workwas seen to have be completed. The premises were sufficiently warm and had a reasonable access to heat, light and ventilation. The bedrooms are single and lockable with the fixtures and fittings that meet National Minimum Standards. There is a self contained flat on the third floor for one person that is more independent and provides a bedroom, bathroom and sitting room. Care Homes for Adults (18-65 years) Page 21 of 32 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. The residents would be more assured that their needs were being met if staff member received additional training. The residents can be assured that the staff team are supervised and the acting manager is working towards developing more consistent care. The residents would be better protected if the staff team were all clear about their roles and responsibilities, Evidence: Members of staff personnel records are held at the Brandon Trust office and employment record sheets to support recruitment details kept at the home. These record sheets are used to evidence that the manager saw Criminal Records Bureau (CRB) checks and references. Personal details were listed in the employment record sheets. At last inspection it was noted that there was no evidence for eight staff that the manager had seen their CRB disclosures or references. It was stated that the manager must make arrangements to view staff files and documentation in place must be completed to show that a robust recruitment process is in place. At this inspection Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: there was no evidence the files had been seen by the new manager but the senior staff member stated all staff are having their CRBs renewed. The training records of the staff were examined and it was evident that staff are encouraged to undertake vocational qualifications. Eight staff have NVQ level 2 and above. There is a programme of mandatory training that includes Moving and Handling, First Aid, Safeguarding Adults, Food Hygiene and Fire Safety. Comments have been made else where in the report about the need for all staff to have safeguarding training. At the last inspection it was noted that not all staff have attended specific training that meets the needs of the people at the home. At this inspection the senior said that staff have attended training about person centred planning, epilepsy and there has been some staff training around aggressive and violent behaviours and Autism. However, we noted that there was limited training in meeting the needs of people with Dementia or training on the Mental Capacity Act. Both of which are important to meet the needs of the resident group. The acting manager in the AQAA has identified the need for further staff training and states that, All staff are to undergo both formal and informal training around key aspects of their role. They will be trained in areas such as safeguarding of vulnerable adults, accident and incident reporting, mental capacity and the deprivation of liberty. The aim will be to improve the ability of staff to carry out their role to a standard that improves the lives of those they support. A requirement has been made that this training is completed promptly. We looked at the supervision records for the staff team. We saw that staff supervision is taking place and there is a plan in place for the new acting manager to supervise all the staff team. During the inspection we saw that the staff interacted well with the residents but the staff team work in different ways. Evidence in the communication book and the care files showed that staff are working inconsistently and communication between the staff members could be improved. We looked at the communication book and saw that the new acting locality manager is starting to look carefully at staffing practises. On 14/12/09 she wrote in the communication book directives for staff in relation to residents money as there was some inconsistencies. There was also an issue where a staff member had thrown away residents old clothes without consulting other staff or the resident. This showed a lack of person centred thinking and practice. The issue about members of staff not working Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: consistently was raised at the last inspection and must now be addressed. It was noted that the staff turnover has been very low with the same staff team being in place for the last two years. Care Homes for Adults (18-65 years) Page 24 of 32 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 residents will benefit from the work that the new manager plans to take place.They would be further assured when the manager applies to the commission for registration The residents would be more assured that their views are being taken into account by the service if the quality assurance review were completed. The residents can be assured that the house is safe. Evidence: Since the last inspection there have been managerial changes. The manager sadly died and an acting locality manager took over who then became unwell. Another actingLocality manager has now taken over in the last three weeks. This actingmanager must apply to the Commission to undergo the registration process to become the registered manager. The staff team have also experienced two residents deaths and some personal issues Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: which has made morale low. The senior staff member felt that this was period of change and was confident that new acting manager would be able to establish stability. From discussions with the senior it was clear that in the past the senior staff were not given enough responsibility in the running of the home and therefore the staff members did not understand the role of the senior. With the new restructuring the role of senior staff is very important as they are in effect managing the running of the home with the locality manager overseeing three homes. The senior on duty was able to demonstrate a sound understanding of the needs of the residents and was clear what changes needed to be in place to ensure the staff team are working consistently. In the AQAA the acting manager was also clear about what changes needed to be in place. She stated that, There needs to be a clear aim for the service in what it wants to achieve and the timescales for this. There needs to be a stability in the management of the home to achieve consistency of the service. She stated that, A change in the style of management will hopefully see staff better informed of the job and responsibilities they are employed to carry out. There will be clear and measurable goals to be achieved in order to improve the quality of the service that is delivered. The acting manager also stated that, Individuals will be supported more personally and reflective of their differences. This will be done by completely revisiting support plans and making them usable documents that are workable in the everyday lives of the staff and individuals we support. In addition to this, staff will become better informed and trained in a number of key areas of the service that they provide. The service that is provided will be measured in its success by the outcomes it gives to the individuals it supports. The manager has made a good start into establishing what work needs to be completedand putting together a plan to complete it. The Trust operates their own Quality Assurance system. At the last inspection it was stated that an action plan has not been developed because of the impending changes with restructuring. At this inspection we were told that a staff member from the Trust came recently to complete this piece of work. As the production of a quality assurance report has been outstanding since the last inspection a requirement has been made that it is completed promptly We looked at the fire safety records and saw that the Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: Fire Authority visit regularly. Fire risk assessments are in place. A contractor regularly checks the portable electrical equipment.. The rota in place shows that between three to four staff are rostered in the morning and in the afternoon the staffing levels are between three and two staff. At night there is one member of staff awake and one asleep in the premises. Ancillary staff for cooking and cleaning are employed at the home.. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R 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 35 18 The manager must ensure that the staff employed at the home are trained to the work they are to perform. The manager must ensure that staff at the home attend training that meets the needs of people with autism and behaviours that challenge. This will ensure that staffs awareness is raised and increase their skills to meet the range of needs of the people accommodated at the home. 16/08/2009 Care Homes for Adults (18-65 years) Page 28 of 32 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 must accurately reflects the the care that the residents receive. This will ensure that residents have full information. 25/03/2010 2 6 12 There must be a clear plan about how the residents wishes and feelings will be ascertained and actioned by the staff team This will ensure that the staff know the residents needs. 26/05/2010 3 8 12 Risk assessments must be an accurate reflection of the work the staff actually complete. This will ensure that the staff are working consistently. 26/04/2010 Care Homes for Adults (18-65 years) Page 29 of 32 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 4 23 18 Staff members must have 26/04/2010 sufficient safeguarding training so as to fully protect the residents. This will ensure the safety of the residents. 5 35 18 The staff team complete training that ensures they are competent to meet the changing needs of the residents. This will ensure that the residents needs are met. 26/04/2010 6 39 35 The quality assurance review is completed. This will ensure the service is aware of the views of the residents about the care that they receive. 26/03/2010 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 6 The recording in their residents reviews is more detailed. The residents are encouraged to take appropriate risks. 2 3 4 7 17 19 There are more opportunities for residents to make decisions about the care they receive. The residents are offered a choice of meals. The staff team receive sufficient training to meet the residents changing needs. Care Homes for Adults (18-65 years) Page 30 of 32 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 5 6 7 8 9 22 23 31 34 37 The residents should have meaningful access to the complaints procedure. There should be a system in place to ensure that all safeguarding incidents are recorded promptly. There is evidence to show that the staff team are all clear about their roles and responsibilities. The manager should provide evidence that they have viewed that staff files and documentation. The manager applies to the Commission to undergo the registration process. Care Homes for Adults (18-65 years) Page 31 of 32 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. 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. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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