Inspection on 15/06/09 for Rapkyns Care Centre

This is the latest available inspection report for this service, carried out on 15th June 2009.

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

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

Other inspections for this house

Rapkyns Care Centre 15/11/05

Rapkyns Care Centre 29/07/05

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Insight - Eastchurch

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Rapkyns Care Centre Guildford Road Broadbridge Heath West Sussex RH12 3PQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Webb     Date: 1 5 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 31 Information about the care home Name of care home: Address: Rapkyns Care Centre Guildford Road Broadbridge Heath West Sussex RH12 3PQ 01403276756 01403276757 rapkynscare@sussexhealthcare.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Dr Shafik Hussien Sachedina care home 41 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: 41 41 The maximum number of service users who can be accommodated is: 41 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Physical disability - PD Date of last inspection Brief description of the care home Rapkyns Care Centre is a spacious purpose built residential care home, located in separate bungalows, catering for forty-one adults with physical and learning difficulties. The home provides nursing care for younger adults aged 18 to 65 years. All the bedrooms are single occupancy, each with en-suite facilities, and each unit has its own sitting and dining room. The bungalows are separated by an activity centre, which includes an I.T. room, a swimming pool, a craft area and a video/cinema room. There is a central water feature, with sensory gardens to the back of the activity centre. Rapkyns Care Centre is equipped with all the latest technological aids, including an audio loop system, track hoisting, a hydrotherapy pool and four sensory rooms. Telephone points and internet access is available for residents who wish to have a Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home computer in their room, and environmental controls are available for residents wishing to access them. The entire home is wheelchair accessible. Current fees range from £1740.12 to £2833.46 per week. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited this home on Monday 15th June 2009, arriving at 8.45am and staying until 5pm. The purpose of this inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The registered manager and deputy were not present during our visit. We were informed that the lead nurse and administrator were responsible for managing the home in their absence. Both assisted us throughout our visit. During our visit to the home we had conversations with two residents and three care staff. We examined the care records of three residents and recruitment records of three staff. We also looked at other documentation maintained in the home such as health and safety records, monitoring forms for staff training and supervision and Care Homes for Adults (18-65 years) Page 6 of 31 complaints. In addition to this we looked around the home and indirectly observed interactions between residents and staff. Prior to our visit the home supplied us with a copy of its Annual Quality Assurance Assessment (AQAA). Also before we visited the home eight residents completed questionnaires with assistance from staff. Information from all of the above sources was assessed and used to help us form judgements on the quality of service provided to residents. What the care home does well: What has improved since the last inspection? The homes AQAA informs us that Over the year we have extended our vegetable garden and service users are encouraged to choose vegetables which are then taken to our Chef for preparation. The home has recently changed its medication system and medication is now provided by a different pharmacist. All nurses that we spoke with said that the new system is working well and that they have received training for the new system. The homes AQAA informs us that since our last inspection There have been continued improvements to the environment with bedrooms being personalised and service users choosing their own paint colours. New bath aids have been purchased for individual Care Homes for Adults (18-65 years) Page 8 of 31 service users and person centred slings for use in moulded wheelchairs. The homes AQAA also informs us that since our last inspection lead nurses have been introduced and team leader in each unit. During our visit to the home the lead nurse confirmed this information stating its good, helps nurses concentrate on mediation and induction of staff. What they could do better: 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the home can meet their needs by the assessment processes it undertakes before new residents move into the home. Evidence: With regard to assessment processes the home Annual Quality Assurance Assessment (AQAA) states We offer intensive pre assessments and transitional packages for all potential clients and families, an open door policy which allows families to stay over night in our purpose built flat for family use during transitional periods to support their potential service user. We offer tea visits, day visits and overnight stays all to try to support a person centered approach. During our visit to the home we spoke with the lead nurse and administrator, both of whom confirmed that the practises described in the homes AQAA are always applied. We sampled three residents files all of which contained evidence that assessments of need were completed before they moved into the home. The homes assessment process takes into account peoples level of mobility, self help skills, medical history and health care needs. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: Before this inspection eight residents completed questionnaires with assistance from staff and returned them to us. All state they received enough information to help them decide if the home was the right place for them before they moved in. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main residents are supported to make decisions about their lives and to be involved in planning the care and support they receive. Evidence: As at the previous inspection people living in the home have care plans in place that have been devised using information gained from the pre admission assessment and life history gained from families, advocates and other previous placements and schools. The plans give the staff team comprehensive information regarding the support needs of each person and are active person centred plans presented in pictorial form using photographs, pictures and symbols. The plans include detailed information about all aspects of individuals lives including family history, likes and dislikes, information on cultural identity and diverse communication methods. All three files that we examined included care plans for spirituality and religion. One states that the person is Hindu and that Halal meat is to Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: be provided. It did not give any further information regarding needs in this area. The other two plans stated that the individuals should be supported with spirituality and that their religion is church of England. No records were available to demonstrate any of the three residents are supported to visit places of worship appropriate for their religious beliefs. Staff that we spoke to informed us that Christian services are accessible to residents but no others. They agreed this should be explored further. Risk assessments, future goals and wish lists for future development form part of the care planning process for residents. In the main we found that these are being reviewed on a regular basis. We did draw attention to one residents pressure sore assessment as this was last reviewed December 2007 and identifies them at very high risk. The lead nurse and administrator agreed regular reviews of assessments should be undertaken for anyone identified at risk. Eight residents completed surveys with assistance from staff and returned them to us before our visit. Six state they always make decisions about what they do, one they sometimes and one person did not respond to this question. The people who live at this home have a wide range of communication needs. Information was seen displayed around the home in large print and with the use of symbols to aid communication. We viewed records of residents meetings. These were not in place for all four units that make up the home and we could not ascertain how frequently these have been taking place. One unit has had 3 meetings in an eight month period, another unit one meeting. No records were available for the remaining two units. We spoke to staff about the needs of residents they are responsible for key working. All demonstrated understanding of this role. Care plans for some residents state that either makaton (a form of sign language) or other forms of sign language should be used to aid communication. We did not observe any members of staff using these to communicate with people during our visit. We talked to three members of staff, all of whom said this is not used. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at this home are supported to make choices about their life style and supported to develop their life skills. Social, educational, cultural and recreational activities meet individuals expectations. Evidence: With regard to lifestyle choices the homes AQAA states We offer appropriate activities in line with their peers, we support college outreach and Day Centre. We offer individual packages of care and support service users in daily life. We access the local community for example the library, shops, ice skating rink and local theatres. Within our environment we offer home cooked fresh produce, we cater for all dietary needs including Halal meat and diabetes. Service users are encouraged to make a choice from the menu on a daily basis, snacks and meals with families are offered and always Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: available. Our chefs cater for social events such as 21st birthday parties, BBQs and we recently held a college certification presentation day. Over the year we have extended our vegetable garden and service users are encouraged to choose vegetables which are then taken to our Chef for preparation. During our visit we spoke with residents and staff, observed practises and examined records, all of which confirm the contents of the AQAA are accurate. For example each of the separate units in the home has an activities area. During our visit we observed people participating in arts and crafts, playing cards and enjoying a karaoke session with staff. Each unit also has a sensory room and the home has a swimming pool and two hydrotherapy pools. During our visit residents were seen being escorted to use these facilities. People also attend local colleges and day centres and access horse riding, use of community facilities including the local pub and parks Some efforts are being made to meet religious and cultural needs however as detailed in the care planning section of this report further work needs to be undertaken in order that all residents needs are met regardless of their beliefs. The home has two mini buses to facilitate outings and holidays. All surveys completed by residents confirm they can join activities during the day and at weekends. Two additional comments were recorded of I would like go on more outings if the mini bus is free and Apart from when the buses are out, I do not get to go out. We discussed these with the administrator who agreed to pass these comments to the registered manager to explore further. The homes AQAA informs us of improvements made in the last twelve months stating We now have several more rabbits, also two chickens have joined us and the service users are very much looking forward to collecting the eggs. We now use the Day Centre kitchen for service users and baking and cooking are part of our social daily programme. Service users holidays including The Calvert Trust Adventure holiday and Butlins have also taken place within the last 12 months. One resident escorted us around the home and showed us the rabbits and chickens that residents help to care for. The resident appeared very happy when looking at these animals. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: The administrator informed us that the home also accesses a music therapist, aromatherapist and reflexologist. As at previous inspections families and friends are made welcome at any time and invited to all social occasions. Many residents have large screen televisions, sensory equipment, computers and computer games in their rooms and the home has Internet access. Observations during the visit showed that people are treated with kindness, dignity and respect and were very animated and happy when interacting with staff members. One resident informed us they like living at the home and have made lots of friends. A variety of fresh home cooked meals are available and individual likes and dislikes are recorded. Specialist diets are catered for and meals are also provided that support peoples ethnic identity. Meals feedback sheets are completed on a regular basis by families and residents to monitor that people are happy with the food provided. As with other documentation in the home the use of symbols form part of this monitoring process to aid communication. During our visit to the home we spoke with the chef who demonstrated knowledge and understanding of the dietary needs of residents. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are practised. Evidence: With regard to health and personal care support the homes AQAA states Every service user has a person cantered care plan and a health assessment plan which is overseen by our GP, they are supported with physiotherapy, speech and language, occupational therapy and individual epilepsy protocol. We support any psychology needs. All medication is given following NMC guidelines. Care plans are reviewed monthly. Service users are involved in their own care plan as much as possible. GP visits weekly. Optical checks, dental checks are 6 monthly. Chiropody and dietitian monthly, hairdresser 6 weekly, some service users choose to go out to hairdresser, personal choice is offered. Consultant visits home to support service users with epilepsy, as do the wheelchair services. Martyn Long Centre for any psychiatric needs. Service users are supported with consultant and hospital visits, as are families. We are liaising with Chailey Heritage at present and they are supporting us with environmental control for service users. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: In the main we found evidence that supports this information. For example all residents records that we examined detailed external professionals involvement for needs including epilepsy, diabetes and pressure care. Records show that the home works with a variety of health care professionals including dietitians, speech and language therapists, psychologists and local doctors and specialist support is also provided by the community learning disability team. We were unable to find evidence that all residents are given the opportunity to have annual hearing, dentistry and optical tests. We talked to the lead nurse and administrator regarding this who agreed to discuss this with the registered manager when she returns from leave. As mentioned previously in the individual needs section of this report greater care must be taken to ensure assessments that identify individuals at high risk from pressure areas must be reviewed on a regular basis. As at previous inspection the people living in the home have complex health care needs, use diverse methods of communication and are wheelchair users. To address their individual needs plans are in place for each element of care provided including personal care agreements, specialist equipment to be used and preferred routines. The home has recently changed its medication system and medication is now provided by a different pharmacist. All nurses that we spoke with said that the new system is working well and that they have received training for the new system. We sampled a number of residents medication administration records, all of which were in good order and up to date. We did note that the home maintains a stock of some medication such as pain relief. The lead nurse said that a stock record is not maintained and agreed this should be implemented to aid monitoring and safety. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main residents are supported to express their concerns and have access to a robust, effective complaints procedure. Safeguarding procedures and complaint management improvements must be imbedded. Evidence: With regard to complaints and protection the homes AQAA states All complaints are dealt with immediately and recorded in the complaints book. Reg 37 and Reg 26 are documented. All responded to within 28 days. Complaints notices in makaton including CSCI details, service users and families encouraged to discuss any concerns, trend analysis done. Residents meetings held regularly. Manager meets with families on a regular basis. During our visit to the home we examined records and spoke with staff finding some elements of the information detailed in the AQAA accurate and others not. For example there is a complaints procedure in place, which is also provided in an accessible format using pictures and symbols. There is a complaints folder that includes a log of complaints, actions taken and outcomes. This details ten complaints that have been received by the home from July 2008 to February 2009. Whilst we were looking at the care records for one resident we found written correspondence from the family of the resident regarding personal items that have gone missing. A Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: record of this was not maintained with the homes complaints records. We received eight surveys completed by residents with assistance from staff before our visit to the home. All state residents know who to speak to if not happy and how to make a complaint. Two additional comments were recorded. These being call someone and I have a key worker who I trust if I ever have any problems. The AQAA informs us that there have been no safeguarding referrals in the past twelve months. We discussed this with the administrator and lead nurse as information received by the commission from outside agencies informed us of one incident that resulted in a member of staff being referred to the Protection of Vulnerable Adults Register. We received a Regulation 37 notification from the home regarding this. This indicates the registered manager made an error when completing this part of the AQAA as she was aware of the situation. The minutes of a staff meeting dated 1st June 2009 seen were in draft and indicated that personal belongings of a resident had potentially been stolen. The evidence of a referral under safeguarding adults could not be supplied nor was the commission informed under Regulation 37. The lead nurse confirmed this had not been completed. Other records pertaining to the resident confirm that they have been reimbursed and that the family of the individual are satisfied with this. We informed the lead nurse and administrator that a requirement would be made with regards to raising safeguarding alerts and that we would make a referral retrospectively to West Sussex social services. A review has taken place led by West Sussex social services under safeguarding adults. The culture in the home needed to change to ensure that residents and their possessions are protected at all times. Actions were agreed with the registered manager. The actions needed as a result of the referral include training and ensuring staff know the boundaries of their relationships with residents including the restrictions of use of others personal belongings has been discussed between the commission and the registered manager. The manager has told us that the changes have now all been made to safeguard their residents. Records confirm that the staff team have undergone training in the protection of vulnerable adults from harm. During our visit we spoke with three members of staff regarding safeguarding and their responsibilities. All demonstrated some knowledge but this related to the environment. For example when asked how they safeguard residents one person said health and safety abuse, treat them as normal, give nice and safe environment. None of the staff explained about other forms of abuse and responsibilities they have to report. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: There are systems in place to manage personal finances of residents who are not able to do this. These include monthly account statements that detail income, expenditure and balances. All those that we sampled were in good order and up to date. Of the three residents files that we looked at two included a written inventory of personal possessions and one did not. We also noted that the inventory in place for one of these people was dated 27.08.02. No evidence of review could be found. Care Homes for Adults (18-65 years) Page 22 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables residents to live in a safe, very well maintained and comfortable environment, which encourages independence. Evidence: As at previous inspections Rapkyns Care Centre provides a very high standard of accommodation and an attractive, comfortable, purpose built home for the people who live there. The home is divided into four units and can accommodate forty one people in total. Each unit has a lounge area with attractive and homely furnishings and also a dining/kitchen area and a sensory room. All are open plan, light and airy and accessible to wheelchair users. Specialist baths are also in place and there is a craft centre, swimming pool and two hydrotherapy pools. There is also a day centre within the building that is not registered or regulated by the commission. This has a separate entrance so as not to impact on the privacy of people living in the home. Residents bedrooms have been personalised to suit their individual interests and hobbies and each room has a large ensuite wet room with hoist tracks built into the ceilings to facilitate easier movement and promote safety. Many people have Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: televisions, computers, sensory equipment and communication aids in their rooms and rooms are also decorated to individual taste. One resident asked us to view their bedroom and expressed satisfaction with the decoration and furnishings. The extensive landscaped gardens include a raised patio area and pond with raised flowerbeds and tables, chairs and umbrellas. There is also an area of the garden that is home to rabbits and chickens. This is accessible to residents who use wheelchairs. The whole of the home is bright and cheerful with lots of residents art work and photographs on display. The homes AQAA informs us that since our last inspection There have been continued improvements to the environment with bedrooms being personalised and service users choosing their own paint colours. New bath aids have been purchased for individual service users and person centred slings for use in moulded wheelchairs. Specialist equipment is well maintained and gloves, aprons and hand wash gel was available to address infection control. The home was clean and hygienic throughout on the day of our visit. All residents surveys that we have received state the home is always fresh and clean. Care Homes for Adults (18-65 years) Page 24 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main staff in the home are trained, skilled and in sufficient numbers to meet the needs of residents. Evidence: The administrator informed us that one nurse and three care staff are allocated to each unit morning and afternoons. They also informed us that an activity assistant is allocated to each unit and that housekeeping, chefs, maintenance, physiotherapy and hydrotherapy staff are also employed. Rotas that we looked at confirmed this information. The hours of the manager and deputy are in addition to the staffing rota. With regards to recruitment the homes AQAA states All staff teams have CRB checks, proof of identity, two references, passport photos, badge, next of kin details. We examined the recruitment records for the three newest staff to commence working at the home. All contained the required documentation as detailed in the homes AQAA. Current PIN numbers were also recorded for trained nurses. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: The homes AQAA also informs us that since our last inspection lead nurses have been introduced and team leader in each unit. During our visit to the home the lead nurse confirmed this information stating its good, helps nurses concentrate on mediation and induction of staff. Records indicate that the frequency of one to one staff supervision varies. None of the files we examined contained evidence that staff receive six sessions per year as recommended in the National Minimum Standards for Younger Adults. This has already been identified as an area that needs improving by a representative of the responsible individual within Regulation 26 reports. Minutes of group staff meetings were in place with the lead nurse informing us these take place every three to six months. She also informed us that unit communication books are in place as an additional tool to support staff. The administrator informed us that thirty two care staff are employed, seven who have completed a National Vocational Qualification (NVQ) and thirteen others who are in the process of undertaking this. The AQAA informs us that no care staff hold an up to date food hygiene certificate. The administrator informed us this has been arranged to take place in June and August 2009. The majority of staff have undertaken manual handling and fire training. There is a training overview document in place but this does not detail all training that have undertaken. We discussed this with the administrator who explained we would have to look at each member of staffs individual records in order to identify numbers of staff who have been trained in all areas. The administrator agreed the current system would benefit from review. Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Apart from safeguarding processes the home is well managed and meets the needs of residents safely. Evidence: The registered manager and deputy were not present when we visited the home. We were informed that the administrator and lead nurse were responsible for managing the home in their absence. Both were present during our visit and assisted by providing written documentation and answering questions relating to the inspection process. Quality monitoring processes include obtaining the views of residents and their families in the form of questionnaires. Regulation 26 Registered Providers visits are undertaken. We found records in place for February, March and April 2009. No records were available for January or May 2009. The homes AQAA informs us that premises electrical circuits were serviced November Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: 2004, portable electrical equipment March 2009, hoists including portable February 2009, fire detection and alarm March 2009, fire fighting equipment July 2008, emergency lighting February 2009 and heating systems and gas appliances August 2008. During our visit to the home we sampled a number of health and safety monitoring records including those for equipment and risk assessments for water, infection, spillages and moving and handling. All were in good order and up to date. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 23 13 In line with Regulation 13(6) 17/06/2009 the registered person must ensure referrals are made to the local authority safeguarding team for any allegations of abuse. This must happen to ensure residents are protected from harm. 2 23 13 In line with Regulation 13(6) 10/07/2009 the registered person must ensure staff understand their responsibilities with regard to safeguarding of vulnerable adults. This must happen to reduce the risk of harm to residents. 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 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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