Inspection on 01/12/09 for Percy Hedley Foundation

This is the latest available inspection report for this service, carried out on 1st 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 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Percy Hedley Foundation 07/04/09

Percy Hedley Foundation 10/04/07

Percy Hedley Foundation 28/02/06

Percy Hedley Foundation 07/12/05

Percy Hedley Foundation 25/09/04

Percy Hedley Foundation 15/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Percy Hedley Foundation Chipchase House & Ferndene Station Road Forest Hall Newcastle Upon Tyne NE12 9NQ     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: Janet Thompson     Date: 0 1 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 36 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 36 Information about the care home Name of care home: Address: Percy Hedley Foundation Chipchase House & Ferndene Station Road Forest Hall Newcastle Upon Tyne NE12 9NQ 01912381300 01912701290 sarahmccormick@percyhedley.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Percy Hedley Foundation Name of registered manager (if applicable) Type of registration: Number of places registered: care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 50 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Physical disability Code PD, maximum number of places: 50 Date of last inspection Brief description of the care home The Percy Hedley Foundation is a registered charity caring for people with cerebral palsy and related physical disabilities. The Foundation also runs a school where there are boarding facilities for children. Both share the same management and administrative team. Accommodation at the home is made up of 34 single bedrooms and a three bed Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 50 2 7 0 5 2 0 0 9 Brief description of the care home roomed self-contained flat, housing two people, in the main building. Four single selfcontained bed-sits and 10 self-contained bungalows are located separately in the grounds of the home. The bungalows are found within a covered street known as Ferndene. There is a dining room on the ground floor of the main building attached to the main kitchen. Meals are prepared here for people who do not wish to make their own. At the entrance to the home there is a day centre that many people who live at Chipchase and Ferndene use. It has a separate lounge/dining area, and includes a bar that people from both residential and day care services use. Chipchase House is in a quiet residential area of Forest Hall close to a metro station and bus routes. Nursing care is not provided but staff are trained to carry out some delegated nursing tasks. Fees start at £691.69 per week, and increase dependant on individual need. The home has a Residents Handbook that gives information about the support and care anyone living at Chipchase or Ferndene can expect. Copies of inspection reports are available in the home. Care Homes for Adults (18-65 years) Page 5 of 36 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: The quality rating for this service is 1 star, this means that the people who use this service experience adequate quality outcomes. An unannounced visit was made on the 1 December 2009. Two inspectors spent a total of six and a half hours in the service. The manager was present throughout the inspection. Before the visit we looked at Information we have received since the last visit on the 15 April 2009; How the service has dealt with any complaints and concerns since our last visit; The providers view of how well they care for people; Care Homes for Adults (18-65 years) Page 6 of 36 The views of people who use the service and the staff who work there. We have also reviewed our practice when making requirements to improve our National consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. During the visit we Talked with people who use the service, staff and the manager; Looked at information about the people who use the service and how well their needs are met; Other records which must be kept; Checked that staff had the knowledge, skills and training to meet the needs of the people they care for; We looked around the building/parts of the building to make sure it was clean, safe and comfortable; Checked what improvements had been made since our last visit. We told the manager and responsible person what we found. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well: What has improved since the last inspection? A new manager has been appointed who is qualified and experienced and keen to improve the quality of care and support that people receive. A full time Better Lives Co-ordinator has been appointed to advocate on behalf of Care Homes for Adults (18-65 years) Page 8 of 36 people who live in the home. Areas of the home are being redecorated and re-furbished for the comfort and enjoyment of residents. The staff team has been increased and rotas changed so that more staff are available at the weekend and so that people who act as key workers can spend dedicated time with residents when they are not expected to carry out any other duties. The laundry floor has been replaced for the safety of staff and to promote good infection control routines. What they could do better: Make sure that everyone has an updated service user plan, that is person centred, and lets staff know exactly how each person want their care and support provided. Use professionally recognised assessment tools to assess everyones nutritional, tissue viability and falls needs. Make sure that staff follow the organisations guidance and good practice procedures for the safe handling of medication and promotion of self-medication. The treatment room should also be cleaned and re-furbished to promote good infection control. Staff must receive training and support to help them understand the difference between incidents, accidents and events, and how they should be recorded and reported. This includes the reporting of events and incidents to CQC under Regulation 37. Bathrooms throughout Chipchase House must be cleaned and re-furbished for the comfort of residents and to promote good infection control. The heating in the flat identified during the inspection must be replaced. A programme of staff training must be clearly documented and supervision programmed, carried out and recorded to support people to do their jobs. About how the home could improve/what could be done better, people said: Want different staff instead of same faces all the time. Staff should be available at meal times and when I want my ironing done. Spend more time with people tidying wardrobes etc. More staff, better food, out more and more 1:1. Have more staff - kitchen and domestics at weekends. Better communication between day centre and residential. More staff to go out and Day Centre - too over crowded, noisy, and too close to residential. Care Homes for Adults (18-65 years) Page 9 of 36 Some of these comments were made before the new manager took up her post and she has already addressed them. 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 10 of 36 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 11 of 36 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. People are given good information to help them decide about moving into the home. Their diverse care and support needs and wishes are properly assessed so that everyone is sure they can be met. Evidence: The Foundation has policies and procedures in place to make sure that people are properly assessed before they move into the home and that their care and support needs can be fully met. There continues to be a waiting list of people who want to move into one of the Foundations facilities and the home maintains strong links with both day services and the school. The Residents Handbook tells people what they can expect from living at Chipchase House or Ferndene. The home does not provide nursing or intermediate care. Care Homes for Adults (18-65 years) Page 12 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are involved in planning their care and make choices and decisions about what they want to do. They are helped to be independent in their personal care and daily life, but records to support these decisions are not always well kept, and do not always reflect current best practice. Evidence: Sixteen residents and five staff returned our Have Your Say questionnaires. These were returned over a period of approximately two months so some of them reflect issues before the new manager took up her post, and what has changed since. One person said I am very happy, it is much better now with the new manager. Three residents took part in a project to write their own, more person centred, Essential Lifestyle Plans. This was done almost 18 months ago but these have not yet been introduced for everyone else who lives in the home. Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: Care and service user plans are currently a mixture of old and new documentation, they are kept in different ways and do not include the original assessment of the persons care and support needs, or any evidence that everyone has had assessments carried out to support tissue viability, nutrition, and falls risks. There is a programme of care plan reviews being undertaken for everyone who lives in the home. The Better Lives Co-ordinator is taking the lead on this and all reviews will be completed by the end of February 2010. We saw moving and handling assessments and information provided by the organisations Physiotherapist to support people with mobility issues. In one service users file we saw that the terms and conditions for living at Chipchase House and Ferndene had been provided on audio cassette. People who live in the home told us that they can have a bath or shower at least daily and some people choose to have one more frequently. Staff do not complete daily records. They have a system of using occurrence sheets but this means that for some people there are a considerable number of recordings but for others nothing has been recorded for several months. We spoke to residents throughout the inspection and everyone felt much happier since the new manager came into post and feel they are being taken seriously and consulted about things that are happening in the home. Some residents access the day center on a regular basis, others choose to go out independently or with support. About what the home does well people said: Can get what you want. Manager nice. Made some good changes. I feel happier. Do as well as they can. Look after me well. Keep me informed of what is happening. Do everything well. Its a roof over my head. Look after us. Helps us to be independent. New manager - we have more of a voice and we are getting taken more notice of now. Safe and clean, and good range of activities. About how the home could improve/what could be done better, people said: Want different staff instead of same faces all the time. Staff should be available at Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: meal times and when I want my ironing done. More staff. Spend more time with people tidying wardrobes etc. More staff, better food, out more and more 1:1. Have more staff - kitchen and domestics at weekends. Better communication between day centre and residential. More staff to go out and Day Centre - too over crowded, noisy, and too close to residential. We spoke to all the people who asked to see us. Care Homes for Adults (18-65 years) Page 15 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are encouraged to be as independent as they wish. They access educational and social opportunities within the home and the wider community. Choices, rights and beliefs are promoted as well as healthy living. Evidence: People who live in the home are encouraged to take part in educational, work and social opportunities as they wish. A Better Lives Co-ordinator has been appointed on a full time basis to advocate on behalf of residents if they wish and to promote opportunities for them. Activities and social events are displayed on the noticeboard on the ground floor in Chipchase House and people are encouraged to bring their suggestions and ideas to the regular residents meetings. Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: People continue to be as independent as they wish and go out unaccompanied if they want and are able. Rountines are as flexible as each persons regular commitments to day services and college, or employment, allow. Contact with family and friends is promoted and encouraged. Some people have regualar visits to their family home and others go out to events or on holiday with their relatives. Ten residents had been to Great Yarmouth on holiday and they had recorded their thanks to the staff in the residents meeting minutes. Mealtimes are as flexible as each persons regular routine allows. Breakfast is available from 08:00 to 09:30, but a continental breatkfast s provided throughout the morning. Lunch is served between 12:00 and 13:00 hours, and the evening meal 17:00 to 18:00. People who live in Ferndene and the flats within Chipchase House can make their own meals if they wish. Everyone else can choose to have their meal in the small dining room on the ground floor or their own bedroom. There are also small, domestic style kitchens on each floor of Chipchase House where people can make a drink if they do not wish to come down to the dining room. We sampled lunch on the day of the inspection which was either smoked fish or chicken curry followed by trifle, yogurt or fruit. Both the inspectors and a resident we spoke to immediately after lunch thoroughly enjoyed the curry. During the inspection four ladies went out to meet friends for lunch. Care Homes for Adults (18-65 years) Page 17 of 36 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. People who live in the home are asked how they wish to receive support with their differing personal care needs. They are supported and helped to be independent with medication and can see health care professionals as they need but systems for auditing medication held within the home are not robust. Evidence: People have their personal and health care support carried out in a private and dignified way by staff they are familiar with and trust. Aids, adaptations and other electronic systems are in place that promote the independence of everyone who lives in the home. One person demonstrated the electronic atmosphere control system in their flat. Professionally recognised assessments tools are not being used to assess all the areas of care and support a person might need. This inlcudes nutrition, tissue viability and falls. People see a range of healthcare professionals as and when they need. Doctors, Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: District Nurses and other professionals visit the home, but some people choose to attend the local surgery, dentist, optician or chiropodist. Others have regular appointments and input from consultants based in the Newcastle Hospitals. We carried out a random check of medication systems and medication held in the home. Medication is recevied in weekly batches that are put up by the Pharmacist in dosette boxes which means there is no way of checking which individual tablets have been dispensed. Stocks are audited on a monthly basis but the system is not robust. It is just a list of drugs that are still in stock. The medication returns book does not include the strength and number of tablets being sent back to the Pharmacist. Refrigerator temperatures were not being checked and recorded. Staff have had medication update training this year and use Medication Administration Record (MAR) charts to show what has been dispensed and when. There are no photographs of residents with the MARs which means that there could be a risk of the wrong person being given someone elses medicine. Medication is kept securely within the treatment room on the ground floor. But the room itself needs to be cleared out and re-decorated so that surfaces are easily able to be cleaned, promoting good infection control. Care Homes for Adults (18-65 years) Page 19 of 36 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. People who live in the home are protected through policies, procedures and staff training. They know who to speak to if they are unhappy and that they will be listened to but staff do not always record issues correctly or make sure that they are passed to other professionals as required, which may compromise the safety of residents. Evidence: Residents told us that they felt they were being listened to, taken more seriously and had more say since the new manager arrived in the home. They were pleased about this. A copy of the complaints procedure is displayed on the notice board in Chipchase House and is included in the Residents Handbook. The Foundation employs a full time advocate for Chipchase House and another for the Day Centre. There is also information that residents can access if they wish to speak to an advocate from outside the organisation. There is an in-house rolling programme of Protection of Vulnerable Adults (POVA) training that all staff have attended. People who work in the home are required to have a Criminal Records Bureau (CRB) check carried out at an enhanced level before they can work in the home and are Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: employed in accordance with the General Social Care Council (GSCC) code of conduct. Residents have the chance to be a member of the Foundations Executive Committe where all major decisions are taken. They have full voting rights and can put forward the views of other people who use the service. Records of incidents showed that staff are not always clear about how they should record events that take place in the home, what should be dealt with as a complaint and what should be referred to the safeguarding team. Care Homes for Adults (18-65 years) Page 21 of 36 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. People live in a homely environment that promotes their independence and the chance to spend time privately. Lots of aids and adaptations are in place or provided but bathrooms in the main house are in need of refurbishment. Hygiene routines are generally good. Evidence: Everyone has their own bedroom, flat or bungalow, but can share if they wish and the accommodation allows this. Electronic entry and environmental controls are fitted so that it is easy for people to move around and to control the heat in their home. We walked around all parts of the home and visited some residents in their bedrooms, flats or bungalows. People have access to a wide range of equipment to suit their individual needs and helps them to be independent. On the ground floor there is a large area where wheelchairs and hoists can be stored and safely have their batteries charged. This leads to the laundry that has had new, easily cleaned, flooring laid. We looked in bathrooms, showers and toilets. Pull cords in these areas have been replaced to promote good infection control. Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: Bins in areas used by staff should be foot operated to promote good infection control and hygiene routines. Bathrooms need to be provided with storage facilities so that surfaces can be kept clear and clean. Grouting, tiles and soap holders in bathrooms are in need of a thorough clean, or replacement/refurbishment so that they are more comfortable for people to use and promote good hygiene routines. We were told about an on-going problem with heating in one of the flats. The residents were being provided with free standing heating whilst the problem was addressed. Care Homes for Adults (18-65 years) Page 23 of 36 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. People who live in the home are protected through recruitment and selection policies and procedures that are regularly followed. Staff are supported through training and supervision to provide the diverse care and support that people need but training and supervision may not always be up to date. Evidence: The organisation has policies and procedures in place that promote the proper recruitment and selection of people who want to work in the home. Everyone is required to have a CRB checked carried out at an enhanced level, provide references, identification and evidence of qualifications. New staff rotas were introduced with effect from the 2 November, that have changed the working pattern and availability of staff to better meet the needs of people who live in the home. This includes a two hour slot where staff are rostered to work, but are not part of the team on the floor. This is time to spend, undisturbed, with the person they are key worker for. Both staff and residents have welcomed this. The number of staff on duty has been reviewed and additional staff have been Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: rostered to work at the weekends, especially to cover food preparation and domestic duties. Five staff sent back our questionnaires. About what the home does well they said: Good quality care, good in-house training, clean, friendly, day centre - good activities. Since new manager - more staff, better information - good re-organisation of shifts. Good training and support to staff and residents. Good personal care. More time with residents. Proper handovers. About how things could improve they said: Poor communication but has improved since new manager. Too many changes all at once. We were told about the new team structure that is taking shape. This will give people clear direction, leadership and accountability. New job descriptions are in place and a second deputy manager will be appointed in the New Year. Senior workers have just received training in supervision and will be responsible for the programme of supervision and support for their team of workers and for the delivery of care to the people they are key workers for. The key worker system is being updated and most staff will only be responsible for one resident. In some circumstances they may have two but that will be a maximum. There is an Away Day planned in the New Year to give staff the chance to clearly understand their role and what is going to be expected of them. It will also be made clear what impact their behaviour has on CQC inspections. Training records are kept in a number of ways and it is not easy to get an over all view of the current needs of people who work in the home. The manager and administrator are working to put together a new, electronic training matrix, that will show clearly what courses people have attended, what qualifications they have achieved and when refresher training is needed. They expect to have this in place by April 2010. Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: Recent training has included supervision, PEG feed, diabetes, epilepsy, and continence. Every Friday an external provider does a full days training (usually as two half day sessions). Infection control and health and safety are the current topics that will be followed by fire and risk assessment. The Physiotherapist employed by the Foundation carries out a rolling programme of moving and handling training and will put additional sessions on if specific training needs are identified for a particular resident. The day centre manager supports a rolling programme of POVA and Non-abusive Psychological and Physical Intervention (NAPPI) training. All staff recently attended this. There is no current programme of regular supervision but seniors have had training and in the New Year will have identified responsibilities for this area. Care Homes for Adults (18-65 years) Page 26 of 36 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 home is run in an open and inclusive way that promotes the choice and independence of the residents. They are asked about what goes on in the home through surveys and meetings but records are not always fully completed, or incidents and events properly reported, which could compromise the safety of both residents and staff. Evidence: A new manager has recently being appointed to run the home and has quickly identified and started to deal with issues that needed to change to improve the quality of care for people living in the home. At a recent staff meeting the responsible person gave a presentation to staff that outlined the results of the most recent quality assurance survey. Accident records seen are kept in date order, and each record is accompanied by a supervisors investigation report. We saw a number of reports of accidents that should have been reported to CQC under Regulation 37. Each of the incidents had Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: necessitated the resident visiting either hospital or the Walk in Centre for treatment. Incident reports are kept separately. When we looked at these we saw one that should have been treated as a complaint and another that should have been referred to the safeguarding team. It was evident that staff are not clear about their responsibilities for reporting accidents, events and incidents to the appropriate professionals. There is a complaints register in place but no entries had been made in it. The fire logs for both Chipchase House and Ferndene were seen. Checks and recordings for Chipchase House were up to date with the exception of a three week period in August 2009 when fire alarm checks had not been carried out in the absence of the handyman. For Ferndene, only fire alarm checks had regularly been carried out and recorded. The premises are owned by Nomad Housing who do the checks on emergency lights and fire equipment. They do this bi-annually. Monthly checks still need to be carried out by staff of the Foundation to discharge their health and safety responsibilities to both residents and staff. The Fire Officer last visited the home in September 2008. All residents were positive about changes for the better and hope the new manager will stay. The new manager has held resident and staff meetings and these are being repeated at regular intervals. We saw minutes of each of the meetings. Both residents and staff are encouraged to bring issues and ideas to the meetings for discussion promoting and open and inclusive atmosphere. The minutes included information about an open day the Community Safety Officer was holding, changes to staff rotas, the introduction of new staff and physical changes and improvements with the houses. We were able to see that residents had been consulted about the re-decoration of communal areas and the purchase of new furniture. People we spoke to were also keen to tell us about the changes that were taking place. The manager is reviewing documents used in the home and has already introduced a pre-review form for residents to complete and has revised the review form. By the end Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: of February 2010, each resident will have had a review that has been led by the Better Lives Co-ordinator. The manager has spoken to staff about the content of reviews, the key worker programme, and care plan expectations. Key workers will be leading on reviews after February 2010, by which time a new policy and guidance will be in place to help them. We discussed with the manager and responsible person the need to send CQC an action plan of events covering the implementation of the new staff structure, the away day, new role and responsibilities of staff, looking at policies and procedures, review of medication systems and the appointment of a new deputy manager. Events and incidents that affect the running of the home or the well being of residents are not always properly reported to CQC under Regulation 37 of the Care Homes Regulations 2001. We carried out a random check of monies held on behalf of residents. Approximately 50 of residents have some money looked after. Each person has an individual cash tin kept in the safe with their name on it. The keys are kept in separate cash box but both copies are together. Almost daily checks on the amount of money in the safe are carried out but not all entries or checks are double signed. There is a separate recording sheet for each person. Cheque books and cash cards kept in locked filing cabinet in staff office but it is not secured to the floor. Keys are held by senior person on duty. Staff were not sure how much money their insurance arrangements allowed them to keep for each person. Amounts varied between £50 and £328. We checked the monies for five service users and found that the amounts were correct. Care Homes for Adults (18-65 years) Page 29 of 36 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 30 of 36 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 6 15 Everyone who lives in the 30/04/2010 home must have a person centred service user plan in place that includes their original assessment, copies of professionally recognised assessments covering tissue viability, nutirition, falls risks and daily records. This will mean that there is evidence everyones care and support needs have been properly assessed and that they have been consulted about how care and support should be provided to promote their health and well being. 2 18 13 Staff must make sure that each person has their individual needs properly assessed in relation to nutrition, tissue viability, and falls risks This will mean that any 30/04/2010 Care Homes for Adults (18-65 years) Page 31 of 36 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 issues are properly identified, recorded and care planned helping to promote the health and well being of the resident. 3 20 13 The treatment room where medication is kept must be thoroughly cleaned out and re-decorated so that walls and floors can be easily cleaned. This will mean that good infection control can be practiced, promoting the health and well being of people who live in the home. 4 20 13 Staff must follow the 26/02/2010 organisations and good practice guidance for the ordering, receipt, dispensing and disposing of medication in the home. This will promote the safe and proper dispensing of medication to people who live in the home in a timely way. 5 22 22 Staff must receive training so that they properly understand the difference between an event, incident and complaint, how and where this needs to be recorded and investigated. 30/04/2010 26/02/2010 Care Homes for Adults (18-65 years) Page 32 of 36 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 This will mean that people in the home know they are safe, taken seriously, will have their concerns properly investigated, promoting their health, safety and well being. 6 23 13 Staff must be reminded of 30/04/2010 their responsibilities to identify and properly refer issues of safeguarding to the appropriate professionals for investigation. This will promote the health, safety and well being of people who live is the home. 7 24 13 The heating pipes in the flat 31/12/2009 identified during the inspection must be replaced for the comfort and safety of the people who live there. This will mean that the people who live there are safe, warm and comfortable. 8 27 13 The surfaces in all bathrooms must be cleared, storage provided and all tiled and grouted areas thorough cleaned, refurbished or re-decorated. This will mean that people are using an area that is safe and clean and where 30/04/2010 Care Homes for Adults (18-65 years) Page 33 of 36 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 good infection control and hygiene routines can be followed. 9 35 18 CQC must be provided with a copy of the new electronic training matrix when it is completed. This will mean that everyone can see what training has been done and whether there is any need for refresher training to promote staff and resident safety and well being. 10 36 18 A programme of regular supervision and support must be carried out and recorded. This will mean that people who work in the home get the support they need to do their job. 11 42 37 Events and incidents that affect the running of the home or the well being of residents must be reported to CQC. This means that CQC are kept up to date with events in the home and that the well being of residents is promoted 31/12/2009 30/04/2010 30/04/2010 Care Homes for Adults (18-65 years) Page 34 of 36 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 12 42 13 The arrangements for the safe keeping of money on behalf of residents must be reviewed. This will mean that everyone is sure how much money should be kept and that money, cheque books and cash cards are safe at all times. 31/12/2009 13 42 37 Accidents and incidents that 31/12/2009 affect the well being of a resident must be reported to CQC. This will promote the safety of people who live in the home and keep CQC up to date with events. 14 42 13 Regular checks must be 31/12/2009 carried out on fire alarms, emergency lights and fire equipment, at a frequency that meets the requirements of the Fire Officer. This will promote the health and safety of everyone who lives and works in the home. 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 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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