Inspection on 28/04/10 for Bolealler House

This is the latest available inspection report for this service, carried out on 28th April 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bolealler House 07/08/07

Bolealler House 18/08/06

Bolealler House 11/11/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Honeybourne House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/07/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Bolealler House Bolealler House Westcott Cullompton Devon EX15 1RJ     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: Sue Dewis     Date: 2 8 0 4 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Bolealler House Bolealler House Westcott Cullompton Devon EX15 1RJ 0188438275 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): bh.ltd@tiscali.co.uk Bolealler House Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 21. 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 categories: Learning disability (Code LD) Mental disorder, excluding learning disability or dementia (Code MD) Date of last inspection Brief description of the care home Bolealler House is owned by Bolealler House Ltd, a subsidiary of Allied Care Ltd. The property consists of a large detached country house with a converted stable block and a further extension, called Angels. It is situated in a rural area between Broadclyst Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 0 21 21 Brief description of the care home and Cullompton. The main property is a period style house retaining many original and interesting features. The recent extension, Angels, is a stylish and modern house that operates separately from the main house, with its own kitchen, lounge, dining room and bedrooms. There are large grounds and lovely views of the surrounding countryside from many of the rooms. The home provides support and personal care for 20 adults with a learning disability or a mental health problem. The home has transport to enable service users to use local facilities. The inspection report is available in the home for anyone who requests to see a copy. Fees range from £354.20 to £1470.18 per week. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced visit took place over 8 hours, one day at the end of April 2010, as part of our usual inspection programme. The home had been notified that a review of the home was due and had been asked to complete and return an AQAA (Annual Quality Assurance Assessment). This should show us how the home has managed the quality of the service provided over the previous year and also confirm the dates of maintenance of equipment and what policies and procedures are in place. Although this document was not fully completed information from this document was used to write this report. Although only one inspector undertook this inspection, throughout the report there will be reference to what we found and what we were told. This is because the report is written on behalf of the Care Quality Commission (CQC). Care Homes for Adults (18-65 years) Page 6 of 31 During the inspection 3 people were case tracked. This involves looking at peoples individual plans of care, and, where possible speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process CQC likes to ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to some people living at the home, and some staff. At the time of writing the report, responses had been received from 10 staff and 10 people living at the home, 5 of which had been completed with help from staff. Their comments and views have been included in this report and helped us to make a judgement about the service provided. During the inspection 2 people living at the home were spoken with individually, several in a group setting and 3 staff. We also spoke with the quality assurance manager for Allied Care who was the providers representative for the inspection. A tour of the communal areas of the building was made and a sample of records was looked at, including medications, care plans and staff files. All key standards were inspected. Some people living at the home have limited verbal communication skills, and as we are not skilled in their other methods of communication it was difficult for us to have any meaningful communication with them. However, the interaction between the people living at the home and those who care for them was closely observed. The unregistered manager has now left the home and whilst another manager has been appointed they have not yet taken up their post or submitted an application to CQC register as manager of the home. The home is currently being overseen by a manager from another Allied Care service. A safeguarding issue was identified by the previous manager and is currently being investigated through the safeguarding adults process. Two minor concerns had been raised with CQC over the qualifications and experience of the previous manager. This report is based on a sample of the evidence available during our inspection process. It does not provide a comprehensive risk assessment of the home. Registered persons are reminded that it is their responsibility to assess and manage risks in accordance with the Care Homes Regulations 2001 (Health and Social Care Act 2008 (Regulated Activities) Regulations 2009) and other relevant legislation. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Two requirements and several recommendations were made during this visit. One requirement is that recruitment procedures must be robust so that people are not employed at the home who may be unsuitable to work with vulnerable adults. The other requirement is that people should be protected from unnecessary risks which refers to restrictors being fitted to all windows above ground floor level. Recommendations were that, daily recordings should evidence where identified needs have been met. The communication book should not be used to record personal information about people living at the home. Ways should be sought to ensure people who are able have access to the kitchen as they wish. The refurbishment programme should include the decoration of individuals bedrooms, the institutional feel of the communal areas and addressing the unpleasant odour in the stables. The providers should ensure that robust systems are in place to monitor the management of the home and a fully completed AQAA (Annual Quality Assurance Assessment) should be sent to the Commission. Care Homes for Adults (18-65 years) Page 8 of 31 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good assessment and admission process in place, which means that people thinking of moving into the home can be sure that their needs will be met. Evidence: The home has a detailed Statement of Purpose giving a wide range of written information about the home with some photographs. This document needs to be updated to show the changes in staffing. Most of the people living at the home have done so for some time. However, the file of one person who had recently been admitted was looked at, as were the files for 2 other people. Nine people told us via survey forms that they felt they had received enough information about the home before they moved in. The providers representative told us the admission procedure for people who are thinking of moving into the home. This included completing a detailed assessment to ensure the home could meet the persons needs, and making arrangements for the person to spend time at the home so they can see if they like it. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: The process can be lengthy and include overnight stays, the person will then move into the home for a trial period of 4 weeks to ensure they like it and the home can meet their needs. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can generally be assured they will receive sufficient support to achieve their personal goals and that risks to their personal safety will be properly identified and managed. Evidence: The plans of care for three individuals were looked at in some detail. They were well organised and contained a detailed assessment of the individuals abilities. They also contained good instructions for staff on how to meet the persons needs. There are three files in total, one historical, one working and one daily. The historical file contains pre-admission assessment information, the daily file contains daily recordings and the working file contains an individual profile, assessment, care plans, lifestyle plans and risk assessments. The individuals ability in many areas, such as personal care, communication and decision making is initially assessed and areas where help is needed are identified and Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: translated into a lifestyle plan. The lifestyle plan focuses on what the person would like to achieve and the help they need to achieve this. Detailed risk assessments are completed where appropriate and show any control measures that have been put into place. Daily recordings are made on a pre-printed form that covers personal care, medical appointments, visitors, activities and mood. However, the recordings that were saw were, in the main very basic and did not contain evidence of where identified needs have been met or issues acted upon. For example one night record stated that the person had been talking about their anxieties, but this had not been followed up the next day. We also saw that for one person there had been no recordings relating to personal care or activities for several weeks. There is also a communication book kept by staff, this contains personal information about people living at the home. Such information should be recorded on peoples individual care plans. The staff that we spoke with told us about how they support people to make decisions about some areas of their lives. For example, getting up and going to bed times, whether to join in activities and outings and what they want to eat or drink. However, during the visit we saw that people were not given access to the kitchen and one person told us Its not right we cant get a piece of bread or a drink of milk. We were told that the kitchen is locked when the cook is not on duty and this is to prevent 2 people taking food and cutlery. This is not acceptable and ways need to be found to ensure people who are able, can access the kitchen as they choose. We saw that risk assessments had been completed for individuals where these were needed. We saw one risk assessment completed for someone preparing light meals. Risks had been identified and control measures to minimise the risk had been put into place. Care Homes for Adults (18-65 years) Page 14 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 who live at Bolealler are able to take part in activities that suit their needs and wishes and are supported to access the local community and maintain family and friends contacts. However, they are limited in their access to the kitchen. Evidence: There was much activity around the home on the day of our visit, with people out and about, doing a wide range of different things. People told us of some of the goals they have achieved including weight loss and becoming happier and more confident in their lives. We saw peoples lifestyle action plans that details who is important to them and their future goals and plans. We saw that some peoples goals included going on holiday, while another person wanted to become more independent and move into one of the flats at Bolealler. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: Each person also has a form that details What I like to do each day. However, one persons form was not completed at all and most forms stated likes to choose what to do. We saw evidence that people are encouraged to participate in the local community. Some people attend church and everyone enjoys meals out at a nearby pub on a fairly regular basis. Several people also attend a local drop-in centre. We were also told that several people work as volunteers in the community. We were told that other activities available to people outside of the home included horse riding, the Gateway Club and shopping in Tiverton. However, we received comments on survey forms saying that people would like to go out on more trips. One person told us how much they enjoy going out for walks every day. Everyone living in the home has a bus pass and is able to catch a local bus that will take them either to Exeter or Cullompton. Transport is also provided by the homes minibus. Some of the things people enjoy doing when they are at home include during the warmer weather sitting in the garden, or having barbecues, Bingo sessions, dramatherapy and Tranquil Moments. Most people have televisions, videos and music equipment in their rooms and told us how they can use their rooms as bed-sitting rooms as they wish. There are regular meetings for people to discuss concerns and make decisions about menus and holidays. People told us about how they are supported to keep in touch with their families, with the home arranging visits if requested. Menus are planned 2 weeks in advance and there are always 2 choices available for people. Staff told us that mealtimes were flexible and people could choose when they wanted to eat their main meal and that people could also choose where to eat their meals. Several people commented on survey forms that they enjoyed the meals and that the food was always good. As already discussed in Section 2 the kitchen is kept locked when the cook is not on duty. This means that people cannot choose to make snacks for themselves if they wish. This not only limits their choice, but also their independence. Whilst it may not be appropriate for everyone to have unlimited access to the kitchen, ways must be Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: sought to ensure those that are able can access the kitchen as required. Care Homes for Adults (18-65 years) Page 17 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. People who live at Bolealler are supported in their personal and health care needs in a way that suits them. Systems for the administration of medicines are well managed. Evidence: All bedrooms are for single occupancy, with the exception of a flat in one part of the home occupied by a couple. All doors are lockable and staff were seen respecting peoples privacy by knocking on bedroom doors before entering. The plans of care that were looked at, gave clear directions to staff to ensure that care and support is provided in a respectful and consistent way. Health care issues were clearly identified and any specific issues were followed up. Information about visits from healthcare professionals had been recorded in individual care plans, showing clear evidence that people are supported to maintain access to specialist medical services. Daily recordings show that staff are aware of and comment on individuals emotional well being, and 1:1 time with staff allows individuals to talk about any issues that might be causing them concern. However, we saw evidence that these issues were not Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: always followed up, see also Section 2. While people living in the home mainly have good mobility, the staff have recognised where some people are beginning to experience difficulties and have provided aids and equipment as necessary. We found that the home stores medication in a secure manner and has in place a good system to record the receipt of medicines into the home. We also saw that all administrations of medicines had been recorded on the Medication Administration Record charts. Staff have received training on the safe administration of medicines, and this has included checks to ensure they are competent and have understood the content of the training. The home has a homely remedies policy for when people require non-prescribed items such as paracetamol or cold remedies. We also saw that the home has clear protocols for how medicines prescribed to be administered when required are to be used. Care Homes for Adults (18-65 years) Page 19 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. There is a good complaints procedure and people can be confident that their concerns will be listened to. Procedures are in place to ensure that people are protected from abuse. Evidence: The home has a stated complaints procedure that is in an easy read format and is posted in various parts of the home. We looked at how the home responds to complaints. A record of formal complaints is maintained by the home, and this showed that no complaints had been received since our last visit. Everyone we spoke with was clear about who they would speak with if they were unhappy about anything and felt sure that their concerns would be dealt with. People who completed a survey form were not always sure about how to make a complaint but did know who to speak with if they were unhappy about anything. Since our last visit the deputy manager has left the home following a safeguarding alert. The issues raised by this alert are currently being investigated by the local Safeguarding Adults team. During the course of the investigation initiated by the provider the acting manager and the area manager left the employment of Allied Care. Records show, and staff told us that they had received training in Safeguarding Adults issues. All staff that we spoke with were able to discuss different forms of abuse and Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: said that they would report any suspicions they had to the senior person on duty. They were also able to tell us who they would report any concerns to, outside of the home, if necessary. The home manages the finances for some people living at the home. Where this was the case individuals finances were well managed and records show that two signatures are obtained for all transactions. Care Homes for Adults (18-65 years) Page 21 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. The home provides a generally pleasant, comfortable and safe environment for those living in, working at and visiting the home. Evidence: A full tour of all the communal areas of the home was made and two individuals were kind enough to show us their bedrooms. All areas of the home have been decorated and furnished to a good standard and appeared comfortable. However, the main building although pleasant, does have an institutional feel about it. One person commented on a survey form that they would like to see new furniture in the main lounge. Another commented that they would like their room painted. Several staff commented on survey forms that peoples rooms need to be decorated and the house made to feel more homely. There is level access to the outside of the premises and the pleasant well maintained garden. There is a programme of refurbishment underway and a new wet-room is being created on the ground floor. Radiators are covered throughout the home and thermostatic valves are fitted to bath taps to ensure the risks of people being burned or scaled are minimised. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: There are no restrictors fitted to windows above ground floor level. This means people are at risk of falling from these windows. The bedrooms that we saw were very individualised, contained many personal items and reflected the personality of the occupant. People living at the home are supported to keep their own rooms clean and tidy. One bedroom that we looked in had many cobwebs around the window, the individual told us they had asked staff to clean these away as they could not reach them, but that staff had not done this. The kitchen in the main house is well equipped with a range of commercial stainless steel equipment and fittings. Most areas of the home were clean and free from unpleasant odours. However, there was a very strong unpleasant smell of urine in one area of the stable block. People living in the home help with cleaning tasks and one person told us how much they enjoy this. The laundry area is situated away from the main building and has suitable and functional equipment installed. An impervious floor covering is fitted to minimise the risk of cross contamination. Some people use this area to do their own laundry. Staff confirmed that disposable gloves and aprons were available to them in order to minimise the risk of cross infection and we saw them being used and disposed of appropriately. Staff also told us and records confirmed that they have received training in health and safety and infection control procedures. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A wide range of training is provided and the numbers and skill mix of staff on duty are sufficient to meet the needs of people currently living at the home. However, recruitment procedures need to be more robust to ensure that people who may be unsuitable to work with vulnerable people are not employed at the home. Evidence: On the day of the visit there were 20 people living at the home. On duty during this time were 7 care staff, and 4 ancillary staff (kitchen and maintenance staff). A cook has been employed by the home in order to free care staff from cooking duties during the day time. Staff were praised by people living at the home when we spoke with them and one person told us about how the staff help them. Staff that we spoke with demonstrated a good awareness and understanding of peoples needs. They were able to describe peoples personal preferences as well as displaying a good knowledge of their individual needs and goals. Staff told us they enjoyed working at the home and that it was a family orientated place with a lovely atmosphere, and that everyone gets on well together. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: Three staff files were looked at. One file contained all the required information including satisfactory CRB (Criminal Records Bureau) checks, two written references and proof of identity. However, one file did not contain 2 written references and 2 files did not contain employment histories or CRB checks. This means that people may be at risk of harm by staff who may be unsuitable to work with vulnerable adults. Records show and staff told us that they have received training in a variety of subjects including Moving and Handling, Fire procedures, Safeguarding Adults and Infection Control. Staff also have the opportunity to study for NVQs (National Vocational Qualifications). Care Homes for Adults (18-65 years) Page 25 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. The home is not well managed and does not have robust management systems in place to check the quality of the services and facilities provided. This results in practices that do not promote and safeguard the health, safety and welfare of people who live and work in the home. Evidence: There has been no registered manager at the home for some while and the deputy manager and manager have recently left the home. The home is currently being overseen by a manager for another Allied Care service. We were told that a new manager for the home has been appointed but has not yet taken up the post or submitted an application to be registered with CQC. The area manager responsible for line-managing the previous manager has also left Allied Care. The quality assurance manager told us that there was no-one living at the home that is subject to a deprivation of liberty authorisation and we saw no evidence to show that anyone living at the home is having their liberty deprived without an authorisation. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: We found some gaps in the recording/management systems for the home. For example complaints and concerns information had not been returned to Allied Care and some staff recruitment files were incomplete. The quality assurance manager for Allied Care who was present during the visit explained the processes in place to monitor the quality of care at the home. Last year four audits were conducted by their team for the home. We were told they would also expect the manager of the home to do their own audits on medication and monies kept at the home. Questionnaires are also sent out to people who live at the home, staff and visiting professionals. This information would then be collated into a report. In line with Regulation 26 of the Care Standards Act a representative of Allied Care visited the home each month and wrote a report on their findings. It was clear through discussions and looking at reports that the monitoring by Allied Care had failed to identify some key areas where policies and procedures had not been followed. The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit was incomplete in several areas and did not give us all the information we asked for. In particular it did not provide evidence that Bolealler complies with health and safety legislation in relation to maintenance of equipment, storage of hazardous substances, health and safety checks and risk assessments. Nor was information provided that evidenced that policies and procedures are in place and along with risk assessments are reviewed regularly and updated where necessary, to ensure they remain appropriate and reduce risks to people living and working at the home. So that the risk of burning from hot surfaces is minimised all radiators within the home have now been covered and all taps are fitted with thermostats to minimise the risk of people being scalded. Windows above ground floor level are not fitted with restrictors and therefore there is a risk that people may fall from these windows. Care Homes for Adults (18-65 years) Page 27 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 28 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 34 19 The home should not employ anyone to work at the home unless all the information required under Schedule 2 has been obtained. This is so that people are protected from staff who may be unsuitable to work with vulnerable adults. 28/06/2010 2 42 13 The registered person should ensure that all unnecessary risks are eliminated. The risk of people falling from windows above ground level must be eliminated. 30/08/2010 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 You are recommended to ensure that all personal Page 29 of 31 Care Homes for Adults (18-65 years) 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 information is recorded on the individuals care plan only. 2 3 4 5 6 7 8 6 7 26 28 30 39 39 You are recommended to ensure that daily recordings evidence where identified needs have been met. You are recommended to look at ways of ensuring that people who are able can access the kitchen as they wish You are recommended to ensure individuals bedrooms are decorated as required. You are recommended to ensure communal areas of the building are decorated and furnished in a homely manner. You are recommended to ensure all unpleasant odours are eliminated. You are recommended to ensure there are procedures in place to monitor the quality of care at the home. You should send a fully completed copy of the homes AQAA to the Commission within one month of receiving this report. 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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