Inspection on 18/08/09 for Southwold House

This is the latest available inspection report for this service, carried out on 18th August 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Southwold House 04/12/07

Southwold House 16/01/07

Southwold House 13/11/05

Southwold House 04/07/05

Southwold House 08/11/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Southwold House 16-18 Cliff Road Leigh-on-Sea Essex SS9 1HJ 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: Ann Davey Date: 1 8 0 8 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 38 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 38 Information about the care home Name of care home: Address: Southwold House 16-18 Cliff Road Leigh-on-Sea Essex SS9 1HJ 01702715240 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) : southwold@consensushealthcare.org www.concensusupport.com Consensus Support Services Limited care home 12 Number of places (if applicable): Under 65 Over 65 12 0 learning disability Additional conditions: Care and accommodation to be provided to persons between the age of 18 and 65 with a learning disability. Date of last inspection 1 7 0 2 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 38 A bit about the care home Southwold House is a 12-bedded establishment that provides personal care for 12 young adults with a learning disability. The home is situated within a residential area of Leigh on Sea and is within walking distance of the seafront, local shops and public transport links. The home has 3 floors and provides 12 bedrooms, all with ensuite facilities. There is a good-sized garden/patio area to the rear of the home, and to the front there are limited car parking facilities. The manager reported that the current weekly fee for the home ranged from £1616.70 to Care Homes for Adults (18-65 years) Page 5 of 38 £2083.34. The actual fee depends on individual residents assessed care needs and the funding arrangements of the various local authorities. There are additional costs for items of a personal nature. 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 Care Homes for Adults (18-65 years) Page 6 of 38 How we did our inspection: This is what the inspector did when they were at the care home This was a key inspection which started at 8.30am and finished at 5pm. The area manager and deputy manager helped us. The homes Annual Quality Assurance Assessment (AQAA) which is required by law had been returned to us within the agreed timescale. This document provided the home with the opportunity to recording what it did well, what it could do better, what had improved and its future plans for improving the service. We needed to discuss some aspects Page 7 of 38 Care Homes for Adults (18-65 years) of the AQAA with the manager as we felt some aspects were not accurate. They agreed that some information could be misleading. The owner of the home knows that the document has a legal status and any information within it must be supported by clear evidence. Following the last inspection, we sent the owner of the home a formal Warning Letter. This letter told the owner that the care and safety of residents must improve. We also met with the owner to discuss what we found at that inspection. We have also been to meetings with Southend Borough Council Safeguarding Unit. The owner attended these meetings. The owner wrote to us about how Care Homes for Adults (18-65 years) Page 8 of 38 they were going to put things right. We received nine completed surveys from staff and four completed surveys from residents who had been supported in completing them. The day was pleasant. We spoke with the area manager, manager, staff, a visiting social worker and spent time in the company of residents with a member of staff present. What the care home does well Staff were very friendly and helpful to us. Care Homes for Adults (18-65 years) Page 9 of 38 Staff encouraged residents to speak with us. The home was comfortable and clean. What has got better from the last inspection Medicines were now being kept in a safe place. Care Homes for Adults (18-65 years) Page 10 of 38 Staff had received a lot of training to help them give better care. Some areas of the home had been redecorated and provided new furniture. There was more opportunity for residents to make their views, opinions, preferences and wishes known. Communication throughout the home is much better. Care Homes for Adults (18-65 years) Page 11 of 38 Care plans were up to date so that staff knew what care and support everybody needed. What the care home could do better The manager should make sure that all records are in place and signed and dated. For example residents daily activities log and staff competency assessment records. Staff must not work in the home until all the legal recruitment checks have been carried out. Care Homes for Adults (18-65 years) Page 12 of 38 The owner of the home must make sure that they do regular checks to ensure that the quality of support provided for residents continues to improve. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Ann Davey CQC Eastern Citygate Gallowgate Newcastle upon Tyne NE1 4PA 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 13 of 38 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 14 of 38 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. Policies and procedures are in place to ensure that residents care needs are fully assessed before admission to make sure that they can be met by the home. Evidence: The home had a Statement of Purpose and a pictorial Service Users Guide. The documents had been reviewed and updated in March 2009. We asked the manager to alter some details. For example, the Care Quality Commission is now the regulatory body and not the Commission for Social care Inspection as noted and our current contact details need to be updated. The manager told us that residents had been involved in preparing the document which had been ratified by the owner of the home. Within the AQAA it was stated that Southwold House considers itself to be a transitional service. We asked for clarification about this statement. The area manager agreed that the word transition could be misleading depending on the interpretation put on it and would review the statement to ensure that a reader would be very clear about the service the home offers. The manager told us that no residents had been admitted to the home since the last inspection. We were therefore, unable to assess the quality of any admission process Care Homes for Adults (18-65 years) Page 15 of 38 Evidence: documentation that had been completed since the last inspection. We saw that there were polices and procedures in place to assist the home in ensuring that a full preadmission assessment is undertaken before a decision is made to admit a resident in the future. These policies and procedures had been reviewed and updated in July 2009. No residents are currently being considered for admission to Southwold House until the dayto-day management systems within the home are more robust. This decision had been made by the owners of the home. The overall judgement for this group of standards was based on the information within the policies and procedures and from discussion with the manager of what would happen should a resident be considered for admission . Care Homes for Adults (18-65 years) Page 16 of 38 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. Developing systems are in place to ensure that individual residents wishes, choices and preferences are recorded, known to staff and acted upon. Evidence: Residents living in Southwold House have complex and diverse care needs. We selected three care plans and their associated documentation such as risk assessment at random to look at. We also looked at some further elements within other residents care plans. Since the last inspection the manager had reviewed the process by which residents individual needs and choices are obtained, recorded and the action to be taken by staff to ensure that they are being met. The care files that we saw were well indexed, clear and current. The home demonstrated through documentation that considerable work had been undertaken in discussing with residents their choices, wishes and opinions about the care they wished to receive. This had been achieved through one to one conversions with residents, their respective families, named key workers and an independent advocate. We saw through the record and documentation trail, conversation with the manager and staff, and with individual residents that where individual wishes, choices and opinions had been identified which had been acted upon. This was confirmed within the surveys we Care Homes for Adults (18-65 years) Page 17 of 38 Evidence: received. The staffing levels within the home had been increased. This meant that where residents had expressed a wish to participate in an activity or experience, there were sufficient staff on duty to support them in achieving their desire. For example during the inspection one resident told us that they wanted to go up to the local fair that evening. The member of staff sitting with them said that it would be no problem and would be able to support them in this. Another resident had expressed the wish to go for a walk down to the seafront. We noted that within an hour of this wish being expressed, two member of staff were available to support this resident in achieving their desire. We were aware of another situation where a resident had asked to go out for lunch. This wish had been met and the resident told us about the very positive experience it had been for them. We were shown records of residents meetings. It was clear from the information within these records that residents are assisted and supported in voicing their views and opinions. Within the menu planning records we could see that there had been input from residents. Not all residents have the ability or capability of being able to express their precise personal wishes. The manager was able to demonstrate and show us how since the last inspection, contacts had been made with various health and social care agencies asking for assistance and guidance to improve communication skills. Through this the manager felt staff would be able to understand more about individual wishes. We noted that some records within residents files were not dated. These contained contained details about residents preferences, likes and dislikes. The manager agreed that this matter must be addressed. We acknowledged that since the last inspection there had been considerable improvements within this group of standards and asked the manager how the achievements were going to be monitored and further developed to ensure that standards would be maintained. The manager told us about the various management monitoring tools in place and we will assess this area again at the next inspection. Care Homes for Adults (18-65 years) Page 18 of 38 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. Residents are enabled and supported to experience a varied and developing lifestyle in line with their wishes and capability and are provided with a good diet. Evidence: The manager was able to demonstrate how the home had improved the lifestyle outcomes for residents since the last inspection. The social and health care needs of residents had been assessed on an individual basis and systems were beginning to be established ensuring that the wishes and needs of individual residents were known. This process has been described in other parts of this report. Some residents require more support and enabling than others which had been achieved through the increased staffing levels. We saw that there had been a number of in house social events since the last inspection. Residents had also been on boat trips, individual holiday breaks and attended local community social events. There was an increased level of staffing and staff had a greater awareness of what residents like to do. There was evidence that the home had Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: therefore been able to support individuals to enjoy and participate in aspects of a lifestyle that is of their personal choice. Communication remains a little difficult with some residents and the manager explained the process in place to improve this. This has been explained in the previous section of the report. The manager demonstrated that the home had improved communication systems with various community agencies and clubs and was working with them to further improve and develop the lifestyle opportunities for residents regardless of their individual ability or capability.The manager was also able to demonstrate that communication systems with individual residents families had improved.This had been confirmed within relatives surveys. We noted that some entires within individual the residents daily record log about how they spent their respective day had not been completed by staff. The manager understood the importance of ensuring that a current descriptive log of all activity and how this impacted on the resident, such as pleasurable, too long, for example is noted. This would further enhance the monitoring tool in assessing what is pleasing to a resident and what is not. Some residents would have difficult in expressing emotions and by recording their emotion at the time about an event would help staff. The manager was able to demonstrate how residents were now more involved in the planning of menus. We saw records to support that residents had been asked about this within their regular meetings. We noted that individual preferences had been catered for. The records that we saw confirmed that residents were receiving a balanced diet. Care Homes for Adults (18-65 years) Page 20 of 38 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. Residents personal and health care needs were known to staff and recorded within a developing record system Evidence: It has been previously noted within this report that following the last inspection, the manager had reviewed the way in which individual residents personal and health care needs were being assessed and recorded. This was evident within the record keeping we saw. Individual residents needs had been assessed and recorded together with the action required by staff to ensure that these are met. We could also see that according to individual residents ability, their wishes about the way in which care is delivered was noted. For example, I can get my own breakfast with help and I dont like to eat x. We could see that the manager was developing systems to ensure that all aspects were being explored so that individual residents would have suitable provision allowing them to make their personal wishes known. With some residents, the system was already established. Staff were clear about these residents views and opinions as they had been recorded. Two residents were able to tell us about the process and how they had been involved. These residents demonstrated a good rapport between the members of staff supporting them at the time of our discussions. For other residents whose personal and healthcare needs were more complex, we could see that the manager was liaising with other social and health care professionals so that the home would be much clearer about all residents Care Homes for Adults (18-65 years) Page 21 of 38 Evidence: care needs irrespective of personal capability or ability. The information about residents personal and healthcare needs within care plans selected at random was clear and current. The care required, how it was to be met and the expected outcome was recorded. We acknowledged that some plans of care are still in the process of being developed to their full potential. The manager told us that all funding social care authorities have now sent social workers to assess and evaluate the care provided by the home to their respective residents. The manager told us that their input had been of benefit. We saw that individual residents risk assessments had been reviewed. The risk assessments in place allowed residents to participate in a lifestyle of their choice and remain safe. The manager reported that individual residents continue to receive a good standard of health care provision from the community health care team. One resident had been to see the doctor on the day of the inspection and told us about their experience. The support worker said that the resident had been consulted with by the doctor in a dignified way. Following the previous inspection, the medicines administration processes, recording procedures and storage facilities had been reviewed and the shortfalls addressed. We sampled various aspects of the administration of medicines records and the storage of medicines and noted no concerns. The member of staff who helped us look at the medicines told us about the training staff had received and the monitoring tool in place to ensure that good practice is maintained on a regular basis. The member of staff said that residents had benefited from the new arrangements as they can come into the medicines room and see where their medicines are kept, have a look at them and their personal records. Residents were able to take their medicines in a private area. The process of storage, administration and recording of medicines was safe. We acknowledged the improvement in the way personal and health care needs had been assessed, recorded and were being met. We spoke to the manager about the systems that would need to be in place to further develop the system and sustain the good practice achieved. The manager told us about the management monitoring tools in place. The area manager reported that this practice would also be monitored during their monthly visits. We will review these standards again at the next inspection. The overall judgement for this group of standards was based on what we saw, what we read and what we were told on the day. Care Homes for Adults (18-65 years) Page 22 of 38 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. Management systems and processes continue to be improved to ensure that the wellbeing and protection of residents is established Evidence: There was a pictorial complaints procedure in place for each resident. Some residents would not have the ability to understand the process. We noted that the contact details for the Care Quality Commission was not current. The manager showed us a record where any complaint made to the home would be noted. The manager informed us that since the last inspection, there have been no complaints made. We asked two residents who they would speak with if they were unhappy about something. Both intimated that they would speak with their respective families or the college that they attended. Following the last inspection the manager had established links with an independent advocate. The advocate had visited the home twice and residents were seen as a group and also individually if they wished. We saw the records following these visits and it was positive to note that some of the recommendations made by the advocate following their meeting with resident(s) had already been actioned by the manager. The manager told us that these meetings were planned to take place monthly and it was envisaged that the advocate would become an integral part of the home. The manager understood that the advocate is independent but reported that staff are working well with them and they are liked by the residents. It is vitally important for the wellbeing and welfare of residents that this newly established link with residents continues. Care Homes for Adults (18-65 years) Page 23 of 38 Evidence: At the last inspection we noted that a safeguarding adults from harm matter had occurred but had not been referred and reported to the local authority. There was also an issue where the identified residents rights had been infringed and where the previous manager had not followed the correct procedure. This had impacted on the rights of other residents living in the home. For example, residents could not access communal toilets without a member of staff unlocking the door and some residents were too frightened to go into a communal area because of of others residents behavioural patterns which had been poorly managed by staff. This matter had not been noted by the owners representative who was undertaking monthly visits to the home at that time. Over the past six months there have been many meetings and visits arranged by Southend Borough Council in order to investigate the incident. We spoke with the Councils Safeguarding Co-ordinator about the outcome of their investigation as part of this inspection process. The allegation of institutional abuse on a number of levels was substantiated. These levels included physical and emotional abuse. In addition the home was found negligent in failing to follow the correct procedures as well as depriving residents of the rights and liberty. Following the investigation, staff have received training in safeguarding vulnerable adults from harm procedures, reporting procedures and DOLS (Deprivation of Liberty). Southend Council have undertaken monitoring visits and all funding authorities were asked them to review their respective residents care. Families of the residents within the home were notified of the situation. Southend Borough Council are containing to monitor the situation within the home. We have met with the owner of the home who agreed that there was corporate failing in not identifying the matter and managing it properly. During the inspection, we spoke with the manager, two senior members of staff and two support worker about their understanding of safeguarding and DOLS. The manager and the senior member of staff demonstrate an understanding of these two matters. They showed us where the safeguarding folder was and said that if the manager was not on duty they must follow the instructions within the folder and phone the local authority immediately. The support workers knew about safeguarding and DOLS and said they would inform either the manager or a senior support worker immediately depending on who was on duty. All those spoken with knew that there was a folder available which contained all the information they would need. Within the homes AQAA it was stated the home has a history of transparency in involving the safeguarding team when necessary. We spoke with the area manager about this as we felt the statement was not an accurate refection in the homes history. The area manager agreed that it could be misleading and said that they felt the home had worked well with the local authority following our disclosure. The overall rating for this group of standards was based on the current situation within the home and taking into account the situation at the last inspection as well as the intervention by various Care Homes for Adults (18-65 years) Page 24 of 38 Evidence: agencies since then to the current day. We will continue to liaise with Southend Borough Council and monitor the matter through the owners monthly management reports. The owner has agreed to send these to us for the foreseeable future. Care Homes for Adults (18-65 years) Page 25 of 38 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. Residents live in an home which is functional and pleasant. Evidence: Together with a member of staff, we viewed all communal areas within the home. We did not view any bedrooms on this occasion as we looked at them six months ago. We noted that many of the communal areas of the home had been redecorated and refurbished. The entrance hallway was very pleasant with a pictorial staff rota and photos of residents enjoying various social events. The outcome of the refurbishment and redecoration had created a very pleasant homely environment for residents. The member of staff told us that improvements had been made in some residents bedrooms which had been pleasing to the respective occupant. We noted that residents had been involved in the redecoration and refurbishment plan. The areas of the home we saw were clean, fresh and comfortable. The area manager told us about a planned programme of full recreation and refurbishment which was due to be finalised and agreed by the owner. At the last inspection we noted that toilet doors were all locked and could only be accessed by a member of staff letting a resident in. It was positive to note that this practice had ceased and residents had full access to toilets. We noted there were plans in place to develop the rear garden and patio areas. This will create a much more pleasant area for residents. Already some work had begun as there Care Homes for Adults (18-65 years) Page 26 of 38 Evidence: was an established vegetable plot which staff had supported residents in developing. The kitchen and laundry areas were secure. Both facilities were clean and orderly. At the last inspection we noted that there were broken floor tiles in the kitchen, these had been replaced. One resident told us that they are supported by staff to do their personal laundry and in preparing for their lunch. At the last inspection we noted that the passenger lift was out of action. At that time we were told that a part was on order. We recorded there were no risk assessments in place on behalf of staff or residents who may use the lift under normal circumstances, for example, carrying heavy loads up the stairs. At this inspection the lift was still out of action and there were no risk assessments in place. We accepted that maybe no residents required the use of a lift at this continuing time, but there was a safe working practices issue for staff. This had not been addressed. Care Homes for Adults (18-65 years) Page 27 of 38 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. Residents continue to be at some risk because the home does not have a robust staff recruitment process in place. Evidence: On the day of inspection, the home accommodated eight residents. This group of standards was assessed by us based on that number. Following the last inspection, areas of improvement around staffing issues took place. These improvements had benefited residents. Staffing levels were increased from 7 to 8 support workers on duty during the day. In addition, the deputy manager and manger are supernumerary. This increased level of support for residents has meant that staff have been able to provide more person centred care to each resident. This has resulted in residents behaviour patterns being more manageable and has lessened the disruptive and sometimes aggressive behaviour resident to resident. Staff told us that the atmosphere is less charged, calmer and nicer place to work in and a much better environment for residents. These improvements had been reflected within the completed surveys. The staff rota we saw was clear and current. Staff told us about their positive experiences of the regular team meetings and their supervision sessions. They said that communication was much better and everybody knew what was going on which wasnt happening before. They told us that they felt more confident because of the increased training sessions. We were shown the training Care Homes for Adults (18-65 years) Page 28 of 38 Evidence: schedule for the home and could see the increased activity. The manager told us that they now undertake a competency assessment for individual staff after a training session, but was unable to produce any documentation to support this. We advised the manager to put a recording system in place. The manager also acknowledged that individual staff training records needed to be updated and kept current. There had been training sessions attended by staff since the last inspection and it is important that current records are maintained and made available to demonstrate what sessions individual staff had attended. The home operates a key worker system and staff were knowledgeable about their respective role and function within it. Staff reported that their working environment was now more pleasurable because there was order and structure. They told us that they felt more positive about their work because of the changes since the last inspection. We acknowledged that the culture among staff since the last inspection had improved. Staff communally used terminology such us we support x, I enable x, we are looking at ways to improve xs communication skills and x no longer has so many aggressive outbursts because we deal with things before it gets to that, we know how to do that now and its better for x. We observed care practices during various parts of the day. All residents during those periods were supported by a member of staff on a 1:1 level. Staff were actively engaging with residents and we noted a good rapport. The relationship between resident and member of staff impressed us as being supportive, enabling and friendly. Residents able to voice a view to us about staff intimated that there were no issues. We did not speak to any residents without a member of staff being present. We spoke with a visiting social worker who told us that the staff they had spoken with were knowledgeable about the resident who was being assessed. The social worker had spoken to the respective resident on their own and reported to us that the resident had raised no negative issue about staffing arrangements. At the last inspection we noted that staff recruitment records we looked at were not in line with regulatory requirement. On the three files assessed we noted that not all the professional and personal references had not been received by the manager. These members of staff were working in the home. We made a statutory required that these shortfalls be addressed quickly because of the potential risk to residents. Within the owners action plan we were told that this would be addressed at the latest by 10th August 2009. It was of concern that this shortfall had not been addressed. There were no assessments in place to minimise any potential risk this might pose to residents. We raised this as a issue of concern with the area manager. Arrangements were made by the area manager for a Representative from the company that owned the home would visit on 25th August 2009 to address the outstanding shortfalls and to review all recruitment records. We require a report following this visit to confirm their findings.We were assured that the area manager and the homes manager would put risk assessments in place until then. Care Homes for Adults (18-65 years) Page 29 of 38 Evidence: We viewed the recruitment records of two members of staff appointed since the last inspection. These were selected at random and various aspects were assessed. On one record no references had been provided and on the other, only one reference had been provided. This was a repeat occurrence of what we had found at the last inspection. Both members of staff were working in the home. We noted on the staff rota that they were on induction. The manager told us that neither member of staff is left alone with a resident whilst they were undergoing their induction period. We asked to see their induction record. These records were not available to us as the deputy manager who was on holiday had one set of keys, and the manager had left his set of keys at home. Due to shift arrangements we were not able to speak with either member of staff. The area manager acknowledged the seriousness of the situation and arrangements were made to suspend both members of staff without prejudice until satisfactory references had been received. The area manager telephoned us two days after the inspection and confirmed that the references were now in place. We were not able to speak with these respective members of staff during our inspection because of shift arrangements, however, we did speak with two other members of staff who had been recruited since the last inspection instead. These members of staff told us about their month long comprehensive induction programme and confirmed that they did not have unsupervised access to residents during this period. We did not issue a statutory Immediate Requirement on this occasion because of the immediate action taken by the area manager. It is of concern that the shortfalls identified at the last inspection regarding incomplete staff recruitment files had not been addressed in accordance with the owners action plan which had been sent to us. Care Homes for Adults (18-65 years) Page 30 of 38 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents who live in this home will benefit from the improved day-to-day management systems but may still be at some risk because not all aspects of the current management processes are robust. Evidence: Following the last inspection the current manager at that time resigned. The current manager had been in post since May 2009. We understood from the manager and area manager that an application for them to be registered with us was pending. Since the last inspection there had been a high level of input, support, review, implementation and interaction from the owner of the establishment to the home. We had a formal meeting with the owner and Southend Borough Council also had meetings because of the safeguarding vulnerable adults matter. We have worked closely with them. Following our last inspection, we sent a statutory Warning Letter to the owner detailing what needed to be put right and the consequences of not achieving it. At this inspection, we saw evidence of a more robust leadership system in place. Staff spoke positively about the better management and expressed feelings such as they (the Care Homes for Adults (18-65 years) Page 31 of 38 Evidence: manager) are good, they show us what to do and tell us why we should do it, (the manager) is always on to us about the outcome for residents now and says things need to be done for their benefit not just because its a good idea. We were told we know what were doing now, things are much clearer, he (the manager) checks up on us, he (the manager) doesnt just sit in the office they are working with us....its so much better now....things are very different.....residents come first now. Information within this report supports that management systems are more robust. Records relating to the care and support of residents had developed well, staff training had improved and the ethos of the home had become more resident focused. The area manager told us that the owner of the home through a representative, will remain very active within the home through regular visits, reviews and supervision. This would be to ensure that not only improved standards are maintained, but further development work is continued. The area manager acknowledged our view that the home must be developed further for the wellbeing and benefit of residents. We received assurances that regular robust monitoring and review would continue. With the recived surveys we recived, the matter of mainating the improbemnts was noted. We saw evidence to support that the manager had developed better communication systems with residents families. We were shown a letter from a relative expressing their appreciation on this matter. We saw how the manager is developing ways of ensuring that the views of residents, staff and all other stakeholders are being obtained and assessed. The area manager informed us that the owner of the home plans to produce their Annual Quality Development Plan late autumn. We asked for a copy of the document.We saw that the homes policies and procedures had been updated. Staff we spoke with knew where they were. We selected at random various service and maintenance agreements. Those we saw were current. The home had records to demonstrated that the fire alarm and the emergency lighting system had been checked on a regular basis to make sure it would be effective in an emergency. The home was looking after residents personal monies. The system for the financial transactions had a good audit trail in place. A member of staff told us that the system had recently been reviewed to make sure it was working well. We did not carry out an audit ourselves. We acknowledged the day-to-day management improvements. We felt that the improvements had improved the delivery of care and support for residents. We were concerned about the management of staff recruitment records. The shortfalls identified at the previous inspection had not been addressed and the same shortfalls were noted in the files of staff recruited since the last inspection. This should have been noted during the owners monthly visits and addressed. The other areas where management systems should be developed include ensuring that residents care and support documentation is signed and dated, staff induction records are made available and staff training records are in good order. Care Homes for Adults (18-65 years) Page 32 of 38 Evidence: The overall judgement for this group of standards has taken in account the matters till under development, the improvements made, areas not addressed from the last inspection and the further developments required. Care Homes for Adults (18-65 years) Page 33 of 38 Are there any outstanding requirements from the last inspection? Yes  No  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 1 34 19 Staff must not work in the home until all the statutory recruitment requirements have been met. 30/03/2009 This is to ensure that residents are safe. Care Homes for Adults (18-65 years) Page 34 of 38 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 Description 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 Description Timescale for action 1 34 19 Staff must not work in the home until all the statutory recruitment requirements have been met. The timescale to meet this requirement reflects the text within the body of this report. This requirement was made at the previous inspection and had not been addressed. 26/08/2009 This is to ensure that residents are cared for and supported by staff who have been subject to thorough satisfactory recruitment checks. 2 39 19 Action must be taken by the 27/08/2009 owner of the home to address the staff recruitment record shortfall identified at the last inspection . The timescale set by us and the Page 35 of 38 Care Homes for Adults (18-65 years) Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action owner had not been met. This matter should have been noted through the owners monthly visits to the home. This is to ensure that where timescales to address shortfalls had been agreed are met for the welfare and safety of 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 1 1 The contact details for the Care Quality Commission within the Statement of Purpose and Service Users Guide should be correct so that anybody wishing to speak with us has the right information. Records containing information about residents wishes, needs and preferences should be signed and dated by the person making the entry. This process should be monitored by the manager. Daily records should be kept to ensure that the home can demonstrate how individual residents were supported in spending their day and what the outcome of the activity meant for them personally. The current contact details for the Care Quality Commission should be on the complaints procedure. Arrangements should be in place to ensure that the current advocacy service becomes established provision to which all residents have access. 2 6 3 12 4 5 22 23 Care Homes for Adults (18-65 years) Page 36 of 38 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 6 24 Action should be taken to ensure that the passenger lift is fully functional. Risk assessments for residents and staff should be put in place to minimise any risk of injury, discrimination or inconvenience during the period of time the lift remains out of action. The Care Quality Commission should be made aware of developments as this matter was raised at the last inspection and had not been addressed. Arrangements should be made for there to be reasonable access to all staff induction records. Arrangements should be made for individual staff training records to be current. All records help in the home about residents support and care must be current and up to date. Arrangements should be made to ensure that a risk assessment is in place concerning the lift being out of order and that staff induction records are made available upon request. 7 8 9 10 34 35 41 42 Care Homes for Adults (18-65 years) Page 37 of 38 Helpline: Telephone: 03000 616161 or 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. 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