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Inspection on 05/05/10 for Friern Residential Care Home

Also see our care home review for Friern Residential Care Home for more information

This is the latest available inspection report for this service, carried out on 5th May 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home was clean and tidy. Residents stated that they were satisfied with the accommodation provided. Residents indicated that staff had treated them with respect and dignity. There is close liaison with professionals from the local Community Mental Health Team. The home had co-operated with professionals involved in the care of residents and ensured that recommendations made regarding the management of finances, care plans and medication are responded to. Effort had been made to ensure that care documentation is structured and contain up to date care plans and risk assessments.

What has improved since the last inspection?

Service users are now more involved in making day to day decisions about their lives. These include decisions regarding their finances and the meals provided. Residents` meetings are now held weekly. Residents are encouraged to be as independent as possible and this include involving them in household chores and in tidying their rooms. The medication arrangements have been audited weekly and no gaps were found in the records. New staff had been provided with medication training. The training records had been updated, staff had been provided with regular supervision and there is monitoring of care during the night. The staffing levels had been reviewed and three new staff had been recruited. The home had been redecorated and was clean and tidy. New garden chairs had been purchased. Smoking arrangements had been reviewed and residents have been discouraged from smoking in the home.

What the care home could do better:

The defective fly electrocutor in the kitchen must be repaired. This is to ensure that equipment in the home is in working order and for health and safety reasons. Details of residents` drug allergies must be asked for and recorded prominently in their MAR charts and case records.This is to ensure the safety of service users. The adult protection procedure must be updated and contain guidance on when a medical examination is need, when the Police are to be notified, suspension of any staff member implicated and reporting of staff involved to the Independent Safeguarding Authority. This is to ensure the protection of residents. The local authority adult protection guidelines should be available at the home. This is to ensure that staff are fully informed. The home should have a spreadsheet detailing all the training that staff have undertaken. This is to ensure that there is an audit of staff training provided. All staff must have training in the management of residents with challenging behaviour. This is to ensure that residents are well cared for. A system for summoning assistance promptly in the event of an emergency must be provided for staff. This is to ensure the safety and protection of residents and staff. Prompt and effective action must be taken to ensure that residents do not smoke in their bedrooms. This should include issuing a warning to the resident concerned. This is to ensure the safety of residents.

Key inspection report Care homes for adults (18-65 years) Name: Address: Friern Residential Care Home 26-30 Stanford Road London N11 3HX     The quality rating for this care home is:   two star good 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: Daniel Lim     Date: 0 5 0 5 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 33 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 33 Information about the care home Name of care home: Address: Friern Residential Care Home 26-30 Stanford Road London N11 3HX 02083686033 F/P02083686033 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Bijaye Luxmi Thambirajah,Mr Vevegananthan Thambirajah Name of registered manager (if applicable) Mrs Bijaye Luxmi Thambirajah Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: One exception for over 65 years Date of last inspection Brief description of the care home Friern Residential Care Home is a private care home, which opened in 1989 and is registered to provide care for a maximum of eighteen younger adults who have mental health problems. Mr & Mrs Thambirajah are the registered providers and jointly own the home. Mrs Thambirajah is the registered manager. The stated aims of the home are to meet residents needs in a friendly and efficient way and to strive to preserve and maintain residents dignity, individuality and privacy. The premises have been converted from three adjoining houses. On the ground floor Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 18 0 2 0 6 2 0 0 9 Brief description of the care home are located the office, kitchen and laundry room. Bedrooms are on both the ground and first floors. There is one self-contained flat on the ground floor and another on the first floor. There are two lounges and two dining rooms on the ground floor. To the rear of the house is a garden and patio area. The home is in a residential area of Friern Barnet and close to shops, restaurants and transport links. The fees charged by the home can be obtained from the manager. The provider must make information available about the service, including inspection reports, to service users and other stakeholders. Care Homes for Adults (18-65 years) Page 5 of 33 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: two star good 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 inspection was carried out by two CQC Inspectors on 5th May 2010 and took a total of six hours to complete. We were assisted by the registered manager, Mrs Bijaye Luxmi Thambirajah. Six residents who were in the home during this inspection were interviewed. Fifteen CQC completed surveys were received from residents and two from staff. Statutory records were examined. These included three residents case records, the maintenance records, accident and incident records, financial records, complaints records and fire records of the home. The premises including residents bedrooms, communal bathrooms, laundry, kitchen, garden and communal areas were inspected. Three care staff were interviewed regarding the care of residents and other areas Care Homes for Adults (18-65 years) Page 6 of 33 associated with their work. They were noted to be knowledgeable regarding their roles and responsibilities. Staff records, including evidence of CRB disclosures, references, supervision and training records were examined. In addition, the minutes of residents and staff meetings were examined. These indicated that residents and staff had been consulted and informed of changes affecting the running of the home. The completed Annual Quality Assurance Assessment form or AQAA was received by us. Information provided in the assessment was used for this inspection. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The defective fly electrocutor in the kitchen must be repaired. This is to ensure that equipment in the home is in working order and for health and safety reasons. Details of residents drug allergies must be asked for and recorded prominently in their MAR charts and case records.This is to ensure the safety of service users. The adult protection procedure must be updated and contain guidance on when a medical examination is need, when the Police are to be notified, suspension of any staff member implicated and reporting of staff involved to the Independent Safeguarding Authority. This is to ensure the protection of residents. The local authority adult protection guidelines should be available at the home. This is Care Homes for Adults (18-65 years) Page 8 of 33 to ensure that staff are fully informed. The home should have a spreadsheet detailing all the training that staff have undertaken. This is to ensure that there is an audit of staff training provided. All staff must have training in the management of residents with challenging behaviour. This is to ensure that residents are well cared for. A system for summoning assistance promptly in the event of an emergency must be provided for staff. This is to ensure the safety and protection of residents and staff. Prompt and effective action must be taken to ensure that residents do not smoke in their bedrooms. This should include issuing a warning to the resident concerned. This is to ensure the safety of residents. 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 33 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 33 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. Admissions are not made to the home until a full needs assessment has been undertaken by the manager. Admissions only take place if the service is confident that the needs of people to be admitted can be met. This ensures that the admissions to the home are appropriate. Evidence: The AQAA of the home states : We conduct thorough assessments of care needs and involve individuals in decision making wherever possible. Prospective residents are provided with information and guidance to ensure maximum level of care and ownership of the service users choices and care requirements. We examined a sample of three pre-admission assessments. These were noted to be appropriate and comprehensive. The assessments included details of the personal, mental, cultural and spiritual background and needs of residents. Risk assessments had also been prepared for residents admitted to the home. Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: Comments made by residents about the home included the following : No complaints, usually does pretty well. The home is good. I am satisfied. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service recognizes the right of individuals to take control of their lives there is evidence that the home has made effort to ensure that residents are involved in decision making about the home. Each individual has a care plan and these include appropriate risk assessments. The home has started ensuring that residents are consulted regarding their care and preferences. Evidence: The AQAA states : We listen and take into account service users views, endeavouring to meet individual needs by providing choices in the development of care planning. Key worker sessions are recorded, where residents express their feelings and choices. Regular monitoring, whether the needs and choices are being met and whether they are satisfied with the services provided. The three residents case records contained comprehensive and appropriate care Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: plans, assessments and details of reviews carried out. There was documented evidence that residents had been encouraged to be as independent as possible. Risks assessments had been prepared for residents. They were noted to be comprehensive and up to date. Staff we interviewed were aware of action to be taken to minimise risk. There was documented evidence that the care of residents had been reviewed. The minutes of these reviews, including reviews done by health and social services professionals were kept in the case records and available for inspection. We were able to interview residents regarding their needs and choices. They indicated that staff had on the whole, responded to their preferences and they had been provided with support in pursuing various activities and interests. We were also informed that there had been consultation meetings and menu planning meetings. Care Homes for Adults (18-65 years) Page 14 of 33 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 home seeks the views of residents and considers their varied interests when planning their daily routines. Links to specialist support are facilitated when needed. Residents have opportunity to develop skills and participate in a range of activities within the community. The arrangements for the provision of meals take into account the preferences of residents and their dietary needs. Evidence: The AQAA states : We encourage residents to take pride in their appearance, be courteous and be independent. Care plans with short, medium and long term goals show opportunities for development. Daily reports record individual behaviour and movements which indicate how communication, independence and lifestyle skill have improved or deteriorated in certain circumstances. Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: The case records of residents contained details of social and therapeutic activities that residents had been involved in. These included cooking, shopping, going to the day centre and places of interest. We were informed by the manager that residents had also been involved in household chores such as cleaning their bedrooms and assisting with the laundry. The home has a programme of activities. This was on display in the home. On the day of inspection a shopping trip to local shops was organised for residents. A resident suggested that there be trips to the seaside. This was discussed with the manager who stated that this is in the process of being organised. She informed us that a trip to Clacton was organised last year. We discussed computer access for residents. We were informed by her that a computer had been obtained for residents and she would be arranging internet access too. We were also informed soon after the inspection that a meeting had been organised and the views of residents had been sought regarding activities and outings for residents. The kitchens was inspected and found to be well equipped and clean. Daily recorded temperatures of the fridge and freezer had been kept. These were on the whole, satisfactory. A fire blanket and first aid box were in place. We were informed by the manager that residents decide on the daily menus. Residents interviewed stated that they were on the whole, satisfied with the meals provided. One resident suggested that there should be more salads, fresh fruits and Indian and Chinese food. The manager agreed that this would be responded to. She further stated that there were fresh vegetables in the fridge. The fly electrocutor in the kitchen was not in working order. The manager agreed to ensure that it is repaired. Other comments made by residents in this section included the following : Plenty of food. I would like more visits to places, going out maybe abroad. Feeds me well, keeps the garden clean and in order.. I would like full choice of where I go on a seaside trip in the summer and second meals at lunch and dinner times. Care Homes for Adults (18-65 years) Page 16 of 33 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 use the service have access to healthcare services in the local community. There is evidence in the case records that healthcare needs are monitored and appropriate intervention taken. The arrangements for the administration of medication were on the whole, satisfactory. This ensures that residents are well cared for. Evidence: The AQAA states : We ensure that each service user has regular health checks, encouraging and facilitating visits to their doctor, optician, dentist etc regularly and as required. We also ensure that service users receive support in the way they prefer when possible. Individual files record all healthcare appointments and detail of personal and health care support reflecting how physical and emotional health needs are met. We noted that residents we met were cleanly dressed and appeared able to go out freely and come in as they chose. We interviewed six residents who were present during the inspection. They were able to express their views and informed us that they were on the whole satisfied with the care provided, they indicated that they had been Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: in contact with healthcare professionals and could see a doctor if they wanted to. They further indicated that staff had treated them with respect and dignity. This was also confirmed in the completed surveys received. Comments made included the following : I get my medication each day. Staff are respectful. I can see the doctor if I am sick. We examined a sample of three residents case records. These were structured and each contained appropriate care plans and assessments. There were details of one to one sessions with staff. Plans of care had been regularly reviewed with the healthcare professionals involved. However, we note that the plans had not been signed by residents or their representatives. We recommend that this be done as evidence that residents have been consulted. We were informed soon after the inspection, that all care plans had been signed by either residents or their representatives. Risk assessments together with plans for minimising risks were in place. We examined the care and plans of a resident who had a history of recent behavioural problems. The care plans were appropriate and contained a risk management plan for this resident. There was evidence that staff had made effort to assist this resident and the care had been reviewed with professionals involved. This resident was subject to close supervision by staff. We however, were informed that staff continued to have difficulty in caring for this resident and the manager informed us that this resident is not appropriately placed and needed to be transferred to a more appropriate placement or into hospital. We noted that there was written evidence that this had been communicated to the purchasing authority and professionals involved. However, there was no notice given to the purchasing authority for a transfer. This was discussed with the manager. To ensure that this resident receives appropriate care, the manager must ensure that there is written evidence that the purchasing authority is informed that the resident should be transferred to a more suitable placement by a specific date. The manager agreed to this. Soon after the inspection, we were provided documented evidence that this had been done. We examined the arrangements for the administration of medication. Medication Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: received had been recorded. Medication was stored in a locked cabinet which is secured to the wall. The temperature of the rooms where medication was stored had been recorded daily and were satisfactory. The Medication Administration Record Charts were examined. We noted that these had been signed to indicate when medication had been administered. No unexplained gaps were noted in the charts examined. There is a weekly audit of medication which is good practice. Details of allergies that residents have were however, not clearly identified in all the case records and the manager informed us that this information is not routinely asked for. This information is necessary to ensure the safety of residents. The manager agreed to ensure that this information is provided. Soon after the inspection, we were informed that this had been done. The home has a medication policy with an accompanying procedure. The policy and procedure examined, had not been updated within the past year. Moreover, it was not sufficiently comprehensive as it did not include a section on the management of medication errors and guidance to staff on what action to take in such circumstances. This was discussed with the manager who agreed to ensure that the policy and procedure are updated. We were informed soon after the inspection, that the policy had been updated accordingly. Care Homes for Adults (18-65 years) Page 19 of 33 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. The home has a culture that allows residents to express their views and concerns. This ensures that residents are well treated and protected from abuse. The arrangements for responding to complaints and for adult protection were on the whole, satisfactory. Evidence: The AQAA states : We are effective and efficient n dealing with complaints. We acknowledge and respond to concerns orcomplaints quickly. Investigation and resolution are usually completed within 28 days. All relevant authorities or parties are informed of protection issues orconcerns with correct time scales. Residents who were interviewed informed us that they knew who to go to if they wanted to complain. They were on the whole, satisfied with the services provided at the home and indicated that staff were respectful towards them. One resident complained that she had to pay for the steam cleaning of her bedroom carpet. This was discussed with the manager who explained that this was an additional service asked for by the resident and she had agreed to the payment. We note that the residents contracts examined were unclear as to whether this charge should be made. In view of the lack of clarity, this matter must be discussed with the resident Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: and the purchasing authority. The manager agreed to record this as a formal complaint. This resident had agreed that her name can be disclosed. We were informed soon after the inspection that the matter had been recorded as a formal complaint and had been discussed with the professionals involved. The manager also clarified that in fact, this resident had arranged for the steam cleaning herself and was liable for the charge. She further stated that following this complaint, the tenancy contracts had been reviewed regarding such charges. The complaints record was examined by us. Complaints were recorded and kept in a book. We examined several recent complaints made. We note that there was an error in the date when a complaint was responded to as the date was a future date. This was brought to the attention of the manager. The manager informed us soon after the inspection that this had been rectified. In addition, she stated that staff had been instructed to check and ensure that the dates recorded are accurate. The protection of vulnerable adults was discussed with staff. They were aware of the procedure to follow when responding to allegations of abuse. They informed us that staff training had been provided. This was also confirmed by the manager. The home has an adult protection policy and procedure. We however, noted that the adult protection procedure was not sufficiently comprehensive as it did not contain guidance on when a medical examination is needed and when the Police are to be notified. It did not contain guidance on suspension of any staff member implicated or reporting of staff involved to the Independent Safeguarding Authority. This is required to ensure the protection of residents. The local authority guidelines were also not available. This is needed to ensure that staff are fully informed. The manager agreed to obtain them. We further noted that two recent safeguarding incidents were reported to us and to the local Community Mental Health Team. The home had co operated with us and the CMHT and recommendations made had been responded to. One of these involved close supervision arrangements for residents who had challenging behaviour which places them and others at risk. Care Homes for Adults (18-65 years) Page 21 of 33 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 physical environment that is aimed at the specific needs of the people who live there. It was clean and tidy. Bedrooms were adequately furnished. Evidence: The AQAA states : We offer means and support to service users to ensure that their home environment is one of comfort and safety. For instance, wherever possible we endeavour to ensure individual rooms are spacious and cater to each service users wants and needs. Facilities are maintained and easily accessible to all service users for use. These include clean bathrooms, kitchens, lounges, laundry amenities and garden access. Many service users take full advantage of the communal areas and these are in frequent use. During our inspection of the premises, we note that bedrooms had been personalised by residents with their own pictures and ornaments. The bedrooms were well furnished. All the residents we spoke to said they were satisfied with the accommodation provided. The main lounge is bright and comfortable and overlooks Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: the garden. The gardens had seating and shade. We note that residents were able to sit out in the garden. The completed CQC surveys received indicated that the home was usually fresh and clean. No offensive odours were detected in the home. The required safety inspections of the electrical installation, gas and portable appliances had been carried out. The laundry room was inspected and noted to be well equipped. We were informed by the manager that residents had been encouraged to do their own laundry. This was confirmed by residents we interviewed. Following a requirement made in the last key inspection, the home has been redecorated. During our inspection of the premises, we note that in one of the upstairs bathrooms, the end bath panel had come off. This must be repaired. The lock in the downstairs toilet next to the lounge did not lock properly. This must be repaired too. No paper hand towels were noted in one of the upstairs toilets. These must be provided. These deficiencies were brought to the attention of the manager who agreed that they would be rectified. She also explained that the cleaner was on duty and was in the process of placing hand towels in the toilet concerned. We were also informed that improvements are due to be made and the gardener had been instructed to make the garden more attractive and colourful. Soon after the inspection, we were informed by the manager that the bath panel identified has been repaired, the faulty toilet lock had been replaced and paper hand towels are in all bathrooms and toilets. In addition, improvements to the garden had been made by purchasing more flowers and plant pots. To ensure that in future, repairs are promptly carried out, a system of regular maintenance checks is needed. Care Homes for Adults (18-65 years) Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a good recruitment procedure that is followed in practice. The manager recognizes the importance of training and tries to deliver a programme that meets statutory requirements. Residents and their representatives are on the whole satisfied with the staffing arrangements. Evidence: The AQAA states : All our staff are appropriately qualified and with satisfactory references and security checks. A low turnover of staff means that good rapport has been developed with service users. Staff are able to actively support service users with the aid of robust policies and procedures. A strong recruitment procedure ensures that the right staff are employed. Staff stay longer with the home showing loyalty to the home and service users. Service users willingly partake in communal activities with staff members. Two staff who were on duty were interviewed on a range of topics related to their work. They were noted to be knowledgeable regarding their roles and responsibilities. There was documented evidence in the three staff records examined, to indicate that Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: staff had been provided with most of the essential training relevant to their area of work. the records indicated that not on staff had received training in the Management of Challenging Behaviour. The manager reassured us that such training would be provided. We were not provided with a spreadsheet detailing all the training that staff had received. This is needed to ensure that such information is readily available. The records of three new staff were examined. These indicated that the required recruitment standards and procedures such as obtaining satisfactory CRB disclosures and references had been followed. There was documented evidence of regular formal staff supervision. This was also confirmed by staff interviewed. The supervision notes indicated that staff had opportunity to discuss work related issues related to the care of residents and their training. We examined the duty rota. It indicated that in addition to the manager, there was normally a minimum of two care staff on duty during the day shifts and two care staff on duty during the night shifts. Staff stated that there was a good team spirit and they worked well together. The issue of Equalities and Diversity was discussed with staff. Staff demonstrated an understanding of the need to treat all residents sensitively and with respect Care Homes for Adults (18-65 years) Page 25 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service aims to be user focused and work in partnership with residents and their representatives. Staff supervision is in place. The manager is aware of areas that are deficient and is working to improve the care and management of the home. Further improvements are needed in ensuring the safety of residents and staff. Evidence: The AQAA states : We have well qualified staff to manage the home, some of whom have RMA and NVQ Level 4. The wellbeing of service users in line with policies and procedures is the primary focus of the home and we endeavour to ensure that all parties involved are aware of this ethos and work to it. Numerous policies and procedures are available for staff to call upon. Service users are aware of the person in charge at all times and who to approach for assistance in different circumstances. Increased staff input and feedback through individual and group meetings. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: We were provided with evidence that residents and staff had been consulted regarding the management of the home. The minutes of these meetings were available for inspection. There was evidence that suggestions made by residents had been responded to. These included suggestions regarding meals provided. Evidence of consumer surveys were found in residents files. Residents and staff who were interviewed indicated that they were on the whole, happy with the management of the home. Residents indicated that they had been treated with respect. Staff indicated that there is a good team spirit. The manager was knowledgeable regarding her role and responsibilities. The home has a current and appropriate certificate of insurance. The financial records of three residents were examined. Receipts were obtained for transactions which had been made on behalf of residents. Signatures of residents and staff were evident for transactions made. Following a requirement made in the last inspection report, residents now have individual bank accounts. The fire logbook was examined. The weekly fire alarm tests, emergency lighting checks and fire drills had been carried out and documented. There is an updated fire risk assessment. The required health and safety inspections on the portable appliances, gas and electrical installations had been carried out. Following a requirement made in the last inspection report, a fire door which had not been closing properly had been repaired. We noted that a resident had been reported to be smoking occasionally in the bedroom. An appropriate risk assessment had been carried out and staff had been instructed to ensure that this resident does not smoke in the bedroom. We however, note that no formal written warning had been given to this resident. The manager agreed that this would be done in the future and if necessary, the tenancy would be terminated. Prompt action is needed to ensure that residents do not smoke in their bedrooms as this presents a fire risk. The home has a Mental Capacity Act policy and procedure. However, not all staff interviewed were familiar with this and there was no evidence that they had been provided with this training. To ensure that staff are fully informed and residents rights are protected, training in this area is needed. The manager stated that she would arrange for staff to attend the training. In view of the two incidents of assault reported to us, we discussed safety issues with the manager. She informed us that in an emergency, staff can summon assistance from internal phones located in three areas of the building. We discussed the need for Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: staff to be provided with an emergency call buzzer or alarm system. This is to ensure the safety and protection of all in the home in the event of an emergency. The manager agreed to look into providing such a system. Care Homes for Adults (18-65 years) Page 28 of 33 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 29 of 33 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 17 23 The defective fly electrocutor in the kitchen must be repaired. This is to ensure that equipment in the home is in working order and for health and safety reasons. 01/07/2010 2 20 13 In future, details of residents drug allergies must be asked for and recorded prominently in their MAR charts and case records. This is to ensure the safety residents. 05/07/2010 3 23 13 The adult protection 23/07/2010 procedure must be updated and contain guidance on when a medical examination is needed, when the Police are to be notified, suspension of any staff member implicated and reporting of staff involved to Page 30 of 33 Care Homes for Adults (18-65 years) 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 the Independent Safeguarding Authority. This is to ensure the protection of residents. 4 24 23 A system of regular 05/07/2010 maintenance checks is needed to ensure that defects are promptly identified and repairs carried out. This is to ensure that residents live in a well maintained home. 5 32 18 All staff must have training 30/07/2010 in the management of residents with challenging behaviour and in The Mental Capacity Act. This is to ensure that residents are well cared for. 6 42 13 Prompt and effective action must be taken to ensure that residents do not smoke in their bedrooms. This should include issuing a warning to the resident concerned. This is to ensure the safety of residents. 05/07/2010 Care Homes for Adults (18-65 years) Page 31 of 33 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 7 42 13 A system for summoning 12/07/2010 assistance promptly in the event of an emergency must be provided for staff. This is to ensure the safety and protection of residents and staff. 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 23 The local authority adult protection guidelines should be available at the home. This is to ensure that staff are fully informed. 2 35 The home should have a spreadsheet detailing all the training that staff have undertaken. This is to ensure that there is an audit of staff training provided. Care Homes for Adults (18-65 years) Page 32 of 33 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. 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