Inspection on 22/12/09 for Pemdale

This is the latest available inspection report for this service, carried out on 22nd December 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pemdale 06/01/06

Pemdale 07/04/05

Pemdale 12/10/04

Pemdale 14/04/04

Pemdale 16/09/03

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Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Pemdale 26a Nursery Close off Sandy Road Potton Bedfordshire SG19 2QQ     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: Nicky Hone     Date: 0 4 0 1 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 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Pemdale 26a Nursery Close off Sandy Road Potton Bedfordshire SG19 2QQ 01767262515 F/P01767262515 John.Farrar-Hockey@Aldwyck.co.uk www.aldwyck.co.uk Aldwyck Housing Association Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Karen Ellwood Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: Date of last inspection Brief description of the care home Pemdale is a purpose built bungalow on the edge of Potton. The home is within walking distance of local shops, pubs, public transport and places of worship. The home was registered in 1996 to provide residential care for 6 people with learning disabilities including people who are also over 65 years of age. The building was built to a full wheelchair specification and provides six single bedrooms, a bathroom and shower room, large lounge and kitchen combined with dining room. There is also a quiet room/study and an office combined with sleep-in room. The home has parking facilities and a beautiful garden to the rear of the home. 6 0 Over 65 6 6 Care Homes for Adults (18-65 years) Page 4 of 29 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: For this inspection we (the Care Quality Commission) looked at all the information that we have received, or asked for, since the last key inspection of Pemdale. This included: - The AQAA (Annual Quality Assurance Assessment) that the manager completed and sent to us in December 2009. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living at the home. It gives the manager the opportunity to say what the home is doing to meet the standards and regulations, and how the home can improve to make life even better for the people who live here. The AQAA also gives us some numerical information about the service; - Surveys which we sent to the home to give to people who live here, their relatives/carers and to staff. We received 7 replies: 2 from people who live here (completed with assistance from the manager); 2 from relatives; and 3 from staff; Care Homes for Adults (18-65 years) Page 5 of 29 - What the service has told us about things that have happened in the home. These are called notifications and are a legal requirement; - Any safeguarding issues or complaints that have arisen; and - Information we asked the home to send us following our visit. This inspection of Pemdale also included a visit to the home, on 22nd December 2009. No-one who was living or working at the home knew we were going to visit on that day. All 6 people who live here have difficulty using words to communicate, so we spent time observing what was happening in the home, and how staff and the people living here were reacting to each other. We spent time in the morning with the manager, and in the afternoon with the deputy manager, and spoke with some of the staff. We looked round the bungalow and looked at some of the paperwork the home has to keep including care plans, risk assessments, medication charts, and records such as staff personnel files, staff rotas, menus and fire alarm test records. Aldwyck Housing Association has announced that it will be selling its care homes, including Pemdale. According to the manager, relatives and the people who live here have been kept informed, although at the time of the inspection there were no prospective buyers. The advocate who visits the home is also involved in making sure people understand as much as they can about the sale, and what this means for their future. Care Homes for Adults (18-65 years) Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: We are disappointed that standards at Pemdale have not been maintained since our last inspection which means there are a number of areas in which the service offered must improve so that the people who live here have a really good quality of life. Staff have worked hard to do their best for people, but have become frustrated by the way the service has changed, and how lack of staff, combined with a change in some peoples needs, have led them to believe they are not satisfactorily meeting anyones Care Homes for Adults (18-65 years) Page 7 of 29 needs well. Overall, the provider must improve the management of the service which should then improve all the other areas where standards have slipped. Things that must get better include: - there must be enough staff on duty at all times so that peoples needs (social and emotional as well as physical) are fully met; - people must be offered more opportunities for personal development and leisure activities; - there must be full information available to show that healthcare needs are fully met; - residents money must be handled properly; - information to show that the provider has carried out full pre-employment checks on all staff must be available in the home; - staff must receive infection control training and should have regular supervision sessions; - a representative of the provider must visit unannounced at least monthly, and leave a report of that visit in the home, available for inspection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home, and peoples contracts, do not give sufficient detail about what people can expect from this service. Evidence: The people who live at Pemdale have lived here for a long time. Some people moved here over 20 years ago when a local long-stay hospital closed, and the last person to be admitted arrived early in 2006. This means that pre-admission assessments were not available in the files we looked at. However, peoples needs are regularly assessed, both by the homes staff, and by each persons social worker during their annual review. Any changes to peoples needs are recorded and any changes necessary to care plans are made. We looked at the paperwork the home keeps about 2 of the people who live here. On one of the files we saw that a full assessment of the persons needs had been carried out by their keyworker, plus other staff, in July 2009 and the information had been used in the new care plans. The social services review was in May 2009, and the homes annual care review in August 2009. The manager told us that one persons Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: needs are changing as the persons health deteriorates, so his/her needs are reassessed very regularly, however staff that we spoke with were concerned that this persons needs have not been assessed well enough. Although Pemdale was offering an excellent service when we last carried out an inspection visit, it is no longer meeting the needs of the people who live here. This is shown in following sections of this report. Each person has a licence agreement. We saw that one of these referred to the NCSC (one of CQCs predecessor organisations - from 2002 to 2004), and gave the address as the office in Bedford (which closed in 2007). The manager said the licence agreements are not changed from the one the person receives when they first arrive. The licence agreement should include the costs to the service user, so this information will change regularly. If the licence agreement does not change, the service must make sure people using the service know the most up to date details for organisations they might need to contact, such as CQC. The home must also make sure people, and their relatives if appropriate, are very clear about what each person will have to pay for. Care Homes for Adults (18-65 years) Page 11 of 29 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. Care plans and risk assessments give staff good guidance on how people want to be supported, but people are not given the opportunity to make meaningful decisions about their lives. Evidence: Each person has a care needs file. We looked at 2 peoples records. Both contained an overview of the persons needs, for example, in the areas of personal care, eating and drinking, sleep, psychological and so on. Care plans contained good, clear details and guidance for staff. They were cross-referenced to risk assessments, and included the persons goals. There was space for changes, and additions to the plans, as well as signatures and dates for when the plans should be reviewed. On one of the plans we noted that this person enjoys a relaxing spa bath: daily records showed that he had been supported to have a spa bath whenever he wanted one (almost every evening). One plan also gave good details about the deterioration in the persons health, epilepsy and so on. This was cross-referenced to the file where staff would find detailed guidance for administering medication if the person needed it for a seizure. Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: The manager told us that one persons care plan is constantly changing as this persons health is deteriorating. She said this would be discussed at the staff meeting, planned for the day we visited, and any changes needed would be made to the care plan. A basic risk assessment/hazard inventory had been completed for each person, and then detailed risk assessments drawn up when a risk had been identified. The risk assessments included detailed risk management guidelines so that staff were clear about how to minimise the risk (for example, getting into/out of the mini-bus). However, we saw no risk assessments around peoples personal development or goals, for example helping in the kitchen. There was some evidence to show that people are involved in making some of the decisions about how they live their lives, but the majority of decisions are out of their hands, and some decisions are not made for positive reasons. For example, several people now decide to spend time in their rooms, but this is because they find it hard to tolerate the noise made by 2 of the other people who live here. Care Homes for Adults (18-65 years) Page 13 of 29 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are few opportunities for people to develop or maintain their skills, and people do not have enough to do to make sure they lead a happy, fulfilling life. Evidence: We looked at what people do each day, and how activities and opportunities for personal development are built into their daily lives. There is a basic activity plan for the home which shows the minimum that is to be achieved. This plan give each person one day of activity each week. For one person, activities included listening to music, watching TV, helping staff with jobs, visit from relative, playing backgammon, and trip to shops. We found nothing to show that peoples skills are maintained or developed, and very little person-centred activity, other than one person has a greenhouse in the garden where we were told he enjoys growing vegetables. One of the staff completes an analysis each month of activities that have taken place. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: The results are produced as graphs, including pie charts, giving reasons why activities have not taken place. We noted that from February to August 2009, the main reason was not enough staff. We looked more closely at the results for the last 5 months, July to November 2009. The charts showed that people had done little activity in this period. In a month there are a minimum of 90 periods when activity could take place (that is morning, afternoon, evening x 30 days). In July, the person who likes to be out and about all the time if he could had been out 25 times, and done 22 inhouse activities (so 47 in total). This reduced to 27 each month for the next 4 months, which is less than one activity a day. For another person, who staff told us also liked going out and doing things, the chart showed 23 activities in July (16 of which were outside), then 11, 9, 12, and 13 in the next 4 months. All the staff we spoke with, and who returned our surveys, told us about their frustrations at not having enough time to do day care activities with people. The manager said this is one of the areas the home needs to do better. Meals are prepared by the staff on duty. There are some menus in place, but residents also meet each Sunday to choose what they want to eat the following week. Occasionally some of the residents will help with the shopping. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is not an adequate system in place to make sure that peoples healthcare needs are addressed in the best way to make sure they remain as healthy as possible. Evidence: Care/support plans indicated that people get the support they need in they way they want it. However, staff said that sometimes when there are only 2 staff on duty, people are not always supported in the way they would like to be. For example, sometimes people cannot get up when they want to: they told us there have been times very recently when people were not up until nearly midday. Each person has a health file. Both peoples records that we looked at contained documents to record when people had been seen by other healthcare professionals, for example optician, dentist, physiotherapist, audiology, chiropodist and so on. These records showed that these 2 people had seen some, but not all of the professionals listed. For example, there was no information about dental check-ups. Peoples weight is monitored monthly. A hospital pack had been produced, to go with the person if they needed to be Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: admitted to hospital. However, one persons information had not been kept updated. Also, this person had been prescribed a medication for epilepsy which involves a specialist means of administration. We were told this person had not needed this medication for a long time. Staff had been trained some time ago by another Aldwyck Housing home manager. CQC guidelines state that this task can be delegated to staff by the healthcare professional who retains responsibility (in this case, probably the district nurse) . Paperwork should be available to show that the healthcare professional is satisfied that staff are trained. The Governments Valuing People document said that everyone with a learning disability would have a Health Action Plan (HAP) in place by 2005. None of the people who live at Pemdale had a HAP. The manager explained that until very recently she had not been aware that people should have one of these. The health of one of the people who lives here has been deteriorating over several months. On the day of the inspection the home had arranged for the speech and language therapist (SALT) to visit this person to assess her ability to eat and drink. The staff had already started to thicken any drinks they were giving her. The SALT told the staff to increase the amount of thickener. She told us that staff had acted appropriately in what they had done and when they had asked her to visit: she said they were spot on. However, staff told us that they felt this persons health needs had not been assessed properly, and that some of the guidance they had for moving this person, and for managing continence, had not been appropriate. Staff spend a lot of time with this person, who needs assistance with all care needs, including hoisting to use the toilet every 2 hours. None of the people who live at Pemdale are able to manage their own medicines. We looked briefly at the way staff administer the medicines and noted that they do a daily stock check of all medicines that are not in dosette boxes, which is good practice. Staff sign the Medication Administration Record (MAR) charts to show that medicines have been administered, or explain why they have not been administered. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples money is not handled well enough, and complaints and safeguarding procedures and policies are not up to date enough to be sure that everyone has the information they need to keep the people who live here safe. Evidence: There is a complaints procedure at Pemdale. In the AQAA the manager told us that this had been put into picture form to make it more user friendly but we did not see this. The procedure we were shown was not fully up to date with contact details for other organisations such as CQC. A record of complaints is kept but the AQAA stated that no complaints have been received this year.Details of the ways in which people can contact the Care Quality Commission were not up to date. All staff have undergone safeguarding training and the manager said there will be further training in 2010. The policies and procedures in the home, both the local authoritys policy and the Aldwyck Housing policy were not up to date. Aldwyck Housing Association has announced that it will be selling its care homes, including Pemdale. According to the manager, relatives and the people who live here have been kept informed, although at the time of the inspection there were no prospective buyers. The advocate who visits the home is also involved in making sure people understand as much as they can about the sale, and what this means for their future. Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: None of the people who live here are able to manage their own money. A small amount of cash is kept in the safe for each person, and records are kept of all money that goes in and out. We checked the records for 3 people. One set of records was accurate but the other 2 were not. There were mistakes in the maths, and the cash in the tins did not match either the balance recorded or the balance that should have been there. Care Homes for Adults (18-65 years) Page 19 of 29 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. Once the planned replacements have been done, Pemdale will offer a clean, comfortable and homely place for the people who live here. Evidence: The bungalow was purpose-built and has wide doorways and corridors so that people in wheelchairs can get around easily. Generally the whole home was clean, well decorated and well maintained. People buy whatever they want for their own rooms, including bedding and towels. We noticed that the towels in one persons room were quite frayed. One person has just bought an overhead tracking hoist for her room. There is an overhead tracking hoist in the bathroom, as well as a specialised bath which people like as it has spa jets. The manager said the bath is to be replaced in the New Year, with a new one of the same model, and the flooring in the bathroom will be replaced. The carpets in the hall are also to be replaced, as they are stained. Care Homes for Adults (18-65 years) Page 20 of 29 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. There are not enough staff on duty to fully meet the needs of the people who live here. Evidence: There are 5 senior staff (including the manager and deputy manager). The manager told us that she tries to put 3 staff on duty for each shift. The rotas showed that there are often only 2 staff on shift. This is not adequate for 6 people, one of whom needs 2 staff for all personal care. We saw that there were to be only 2 staff on duty for Christmas Day: the manager rang an agency while we were there to try to get more staff. The manager told us that Aldwyck stopped using agency staff during the summer of 2009, but have now re-started so that staff vacancies and leave can be covered. There is one waking night staff, and one staff member sleeping in. Records showed that there is quite a lot of activity during the night: the sleep-in person often has to get up to help the waking staff member with personal care for one person who needs 2 staff. This supported what the staff and the manager told us, that they often get little sleep. The sleep-in staff then has to work the following day and they are worried that mistakes might be made, for example with medication, because they are so tired. They also said that sometimes they feel unable to drive the house vehicle if they are Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: tired. On the day of the inspection the manager said she had worked up to midnight the evening before, and had been up several times during the night: she had arranged to go home at 13:00 (but stayed till 14:00). We were not able to check whether the service recruits staff properly. AHA tell us that they had an agreement with CSCI (now CQC) that staff files could be kept at head office. We spoke with the Responsible Individual (the providers representative) who agreed that part of the agreement was that there should be a pro-forma in place in the service, giving verified details about each member of staff. The manager was not aware that these should be in place, because the manager of the home at the time of the agreement had not set this up. During the inspection we received confirmation by email that all staff have a current Criminal Record Bureau (CRB) check. The manager agreed she would get the pro-formas in place very quickly. In the AQAA the manager wrote that all staff a National Vocational Qualification (NVQ) in care level 2 or 3, and 2 staff have achieved level 4. Staff told us they are given a lot of opportunities for training. The manager said that most staff have done most of the health and safety training required, including moving and handling; food hygiene; first aid; and fire safety awareness. The home has purchased a DVD for infection control training but none of the staff have watched it yet. All staff have attended safeguarding training, and all have done medication training. The manager said that staff had not been able to go on training on the Mental Capacity Act and Deprivation of Liberty safeguards last year due to staff shortages, but that this training had been booked for 2010. The manager told us that staff meetings take place at least once a month and staff receive regular supervision and an annual performance and development review. However, staff are not happy about the staff meetings: they feel the meetings are used just to tell them off about what theyve done wrong, and their opinions and ideas are not welcomed or listened to. One staff member told us they had one formal supervision session in 18 months, but they did say they often worked with their supervisor so could discuss issues informally when they needed to. Staff we spoke with, both during the inspection and afterwards on the telephone, and those who completed the survey we sent back, all raised a number of concerns. These included that there are not enough staff to meet peoples needs and give them a good quality of life; that they have to spend most of their time doing personal care; that some peoples health needs have not been properly assessed; the home is not being effectively managed; and that they are not valued or listened to. We have written to the provider separately about this. Care Homes for Adults (18-65 years) Page 22 of 29 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 management of this home is not good enough to make sure that the people who live here have a good quality of life and are kept safe. Evidence: The manager, Karen Ellwood, told us she was the deputy manager at Pemdale and became the acting manager in December 2007. She was registered with CQC in July 2009. She has completed the Registered Manager Award (RMA). When asked What could the home do better? the manager said More staff to meet the needs of the residents so that I can come off the floor and do my job as the manager. The number of requirements we have made following this inspection, and our observations during the inspection, have led us to conclude that the management of this home is not good enough. The manager completed the AQAA when we asked for it. She gave us a lot of information. However, we found that some of what she told us what not happening in practice. For example, in the What our service does well section of the summary of the comments, she wrote We provide a wide range of quality day care activities Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: which are person centred and reflect the residents wishes. Pemdale is a happy home for the residents. Our observations, discussions and records we read show that this is not the case. (See, for example, Lifestyle section of this report). There are a number of ways the manager checks out the quality of the service being provided at the home. She told us that there is a residents meeting every Sunday, when people decide what activities they want to do, and what they want to eat in the coming week. Residents are involved in their annual reviews, and there is a house advocate who visits every 2 weeks. A stakeholder meeting is held every quarter to which relatives and the advocate are invited. Staff said relatives rarely turn up. The fire log includes the homes fire risk assessment, plus a plan of which resident is in which room and what their needs are. Weekly tests of the fire alarm system are carried out, and there was evidence that action is taken to rectify any faults. Monthly tests of the emergency lighting are also carried out as required by regulation. Almost all the staff had been involved in a fire drill in 2009. A representative of the provider visits the home. Regulation 26 of the Care Homes Regulations 2001 requires these visits to be unannounced, and that a report of the visit must be written and be available for inspection. This is the providers way of showing us that they are monitoring what is happening in the home. Staff said they always know when this person will be visiting. The last report available for us to look at was written in 2003. Following the inspection the responsible individual (RI) told us that there had been an agreement with the previous inspector that the reports of these visits could be held on the computer. The RI gave us dates of visits for the previous 12 months. Although we have not seen the reports we have accepted this, and have not made a requirement. However, we have recommended that these visits be unannounced as required by the regulations. Care Homes for Adults (18-65 years) Page 24 of 29 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 25 of 29 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 11 16 Opportunities for personal development must be provided for all the people who live at Pemdale. So that they can maintain or develop skills and achieve their personal goals. 31/03/2010 2 14 16 A wide range of social activities must be offered to people. So that they can lead happy, fulfilling lives. 31/03/2010 3 19 13 People must have the opportunity to see the full range of healthcare professionals. So that their healthcare needs are met and they are as healthy as possible. 31/03/2010 4 23 13 Residents money must be handled correctly. 28/02/2010 Care Homes for Adults (18-65 years) Page 26 of 29 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 So that peoples money is safe and they do not suffer financial abuse. 5 33 18 There must be enough staff on duty. So that peoples needs are fully met. 6 34 19 There must be evidence to show that pre-employment checks required by the regulations have been carried out for all staff. So that people are protected from staff who should not work with vulnerable adults. 7 37 9 The home must be managed 28/02/2010 effectively. So that the people who live here are safe and have the best possible quality of life. 8 42 13 All staff must have infection control training. So that they know how to keep people as safe as possible from infections. 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 19/02/2010 19/02/2010 31/03/2010 1 36 The National Minimum Standards recommend that all staff Page 27 of 29 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 have regular, recorded supervision sessions with their manager at least 6 times a year. 2 41 Visits to the home by the provider, as required by regulation 26, should be unannounced. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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