Inspection on 22/01/10 for The Hurst

This is the latest available inspection report for this service, carried out on 22nd January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: The Hurst 124 Hoads Wood Road Hastings E Sussex TN34 2BA     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: Michele Etherton     Date: 2 2 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: The Hurst 124 Hoads Wood Road Hastings E Sussex TN34 2BA 01424425693 01424425693 ramtale@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hurstcare Ltd Name of registered manager (if applicable) Mr Kritanand Ramtale Type of registration: Number of places registered: care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service uses to be accommodated is 29 The registered person may provide the following category of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home 29 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: A first key inspection of this newly registered existing service has been undertaken. This has taken account of information the Commission has received from the home and about the home since its change of registration in September 2009. This has included an Annual Quality Assurance Assessment (AQAA) submitted by the service. The AQAA was not initially returned when we asked for it and upon querying this with the provider we have established that it had not been received, a further AQAA has been sent and this has been returned. The returned AQAA has not been completed to a satisfactory standard and we have discussed the shortfalls with the registered manager and registered person, and are awaiting a revised version. Our assessment of this service has also included an unannounced site visit undertaken on 22nd January 2010. Care Homes for Adults (18-65 years) Page 5 of 37 During our visit we met and spoke with residents and staff, in different areas of the home and spoke with the registered person and the registered manager. A range of documentation has also been examined including care plans, medication records,risk and complaint information, accident records and staff recruitment and training information. We acknowledge the short time in which the registered person and registered manager have had to implement the improvements they have identified need doing and this has been taken account of in our judgement of this service. Care Homes for Adults (18-65 years) Page 6 of 37 What the care home does well: What has improved since the last inspection? 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 on page 4. Care Homes for Adults (18-65 years) Page 7 of 37 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 37 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the service has been updated but this is not always made available to prospective residents. People referred to the service can be assured a full assessment of their needs is undertaken prior to admission to ensure these can be met. New residents receive terms and conditions of their stay but this needs amendment to clarify the room they have been allocated. Evidence: The provider informs us that Statement of Purpose and user guide information has been updated, and we noted a copy of this information displayed in the entrance to the home. Some thought should be given to locating this on the resident notice board for easier access and for those who are interested. When we spoke with people newly admitted to the service they reported that they had not been provided with any written information about the home, although one commented they had received some verbal information. It was apparent from our discussions that people who have recently come to the home felt they had been given no alternative options by the local authority and had little input into the decision, Care Homes for Adults (18-65 years) Page 10 of 37 Evidence: although they expressed no strong feelings about this. On this occasion we recommend that the service ensure that prospective residents are in receipt of information that may have been provided about the home, and that this can be offered in a range of formats to suit individual needs. From discussions with the new residents and the manager it is clear that residents are being assessed prior to admission, the registered manager reported that the assessment process has improved and that more information is gathered from and about prospective residents before decisions on admission are made. Examination of assessment information and discussion with two out of three of the most recent admissions would seem to indicate the home is admitting appropriately. The Home currently has only one privately funded individual, and a contract is in place.However, this needs amendment as it does not make clear which room the resident is residing in and has agreed to. There have recently been some room changes for the benefit of the residents concerned and which we are informed have been discussed with the residents and their representatives, these changes are not reflected in care plans or in contractual information. We recommend that contract/terms and conditions information is amended to ensure residents have the security of knowing which room is for their sole use. Care Homes for Adults (18-65 years) Page 11 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home need to progress more quickly the update of care plans and risk information to ensure changes in need are being suitably supported and monitored. Residents need to be more actively involved in personal decision making and in the routines of the home. Evidence: Since September 2009 when the home changed hands there have been three new admissions. We examined documentation for these residents and noted all have assessment and initial care plan information in place. The registered manager acknowledges that shortfalls exist within user plans inherited from the previous service, they are trying to remedy this by introducing a new care plan format to replace the present one which is unwieldy and for the most part uncompleted. New care plan formats have been introduced for new residents and we have commented that these would benefit from additional content and providing a more holistic view of the individual residents needs, they should also reflect individual Care Homes for Adults (18-65 years) Page 12 of 37 Evidence: resident preferences and wishes around the support they receive. The AQAA informs us that over the next twelve months it is the intention of the manager and staff to implement new assessments in relation to nutrition, falls and waterlow assessment in addition to updating and developing the care plans. We have reminded the manager of the expected frequency of care plan review particularly for the majority of residents who would be considered older persons, and the home should be working to achieve this. There are some residents who could be more independent than currently. Examination of care plan information for one such resident indicated that although providing a more individualised record of resident preferences in daily routines, the care plan makes no reference to the promotion of independent living skills. Whilst management and staff indicate an awareness of the rights of residents to take control of their lives and make decisions and choices for themselves, this does not always happen in practise and there is not a clear understanding of how to do this effectively. There is a need for key workers to be actively having conversations with the residents they support to look at aspirations and how these can be achieved and worked towards, where residents lose independence at times through periods of self doubt and low confidence staff should be actively encouraging residents when feeling better to resume the levels of Independence they previously enjoyed and reduce the level of staff support needed. Staff spoken with generally demonstrated a good understanding of individual residents support needs and preferences and how this is delivered, they understood those residents who may be at risk or pose risk to others and manage situations competently , however with the admission of new staff it is essential that risk information is kept updated routinely and that all staff are working to agreed guidance and risk reduction measures. We recommend the home continues to progress the updating of this documentation. Some residents spoken with indicated that they lacked confidence in challenging staff decisions about their personal routine where this is considered in their best interest, an example given by a resident is staff actively discouraging residents from going out in bad weather. Although the resident concerned felt upon reflection that staff had probably been right, it is a concern that residents with capacity do not always feel in control of their day to day decisions, lack confidence in opposing staff advice or decisions thereby not experiencing risk and dealing with the consequences of their own decisions. We have discussed with the provider a need to move away from an Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: institutional model of care and to involve residents more in the running of the home. Although risk information for new residents had been drafted and implemented recently the majority of residents have not had risk information reviewed since January 2008 and this now needs updating. Care Homes for Adults (18-65 years) Page 14 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents would benefit from the development and implementation of an activities programme that meets both individual and group needs and takes account of their own expressed wishes and preferences. Staff should more actively promote the independence of residents who should take a more active role in the running of the home. Residents should be provided with information about menus and be able to make choices and decisions about what they eat. Evidence: The AQAA tells us that there are plans to offer different activities and increase opportunities for summer outings and tea parties in the garden, the registered manager has also indicated that he would like to introduce group work, but what this may consist of is unclear. The new provider acknowledges that they have inherited a service which was offering Care Homes for Adults (18-65 years) Page 15 of 37 Evidence: little in the way of stimulation or activity to residents and this will take some time to develop, although they have begun to provide opportunities for residents individually and in small groups to go out for coffee or shopping with staff, and this is to be expanded The present activities programme consists largely of relaxation as an activity but there is no indication as to what this means and whether it is facilitated by someone trained in relaxation techniques. Discussion with newer residents indicated that they felt they did very little in the home although one reported that they had been taken out into the town for a coffee and had enjoyed this. staff reported that they do try to undertake games with some residents, but this type of activity would be unsuited to some who would benefit from more one to one time with staff because of their lack of capacity and frailty. An individual activities record is maintained but this indicates only that residents have received some entertainment it does not record what and in most cases records activities provided only once or twice per week. For the majority of residents who are unable or unwilling to go out independently this is insufficient. We would recommend that the home develops in consultation with residents a more active programme of activities, taking account of the wide ranging needs of the different levels of ability within the home. Staff confirmed that increased opportunities for residents to go out with staff are being introduced, however, this places pressure on staffing in the home and needs to be properly resourced to ensure there are adequate staff to staff the home and to undertake activities outside. We require the service to establish a more stimulating programme of activities that takes account of individual needs,preferences and interests, this should also promote independence and skills development for those residents who have the capacity and motivation to do so. Systems are not yet in place that foster the ability of residents to influence the running of the home, promote independence or encourage residents to make decisions and choices for themselves beyond the normal day to day routines of getting up, taking meals and making personal decisions around what clothes to wear. The AQAA tells us that newspapers are to be provided but on the day we visited these were not in evidence yet. There is a need for the home to assess capacity of residents living at the home to Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: come and go from the home independently, and whether those who have lost the skills to do so could regain these and lead a more fulfilling lifestyle less dependent on staff. It is important that the service moves away from an institutional culture where the service talks about allowing people to go out from the home,or undertake daily routines e.g medication administration for them self to one of encouragement and facilitation to enable those residents with capacity do so within a sound risk framework. Residents we spoke with reported regular contacts with family members, and there are no restrictions on visiting. Residents could not tell us where menu information is displayed, they were unable to inform us what was for lunch or what options might be available for tea. Hot drinks are provided at break times, but there is no facility for more able residents to make their own drinks or snacks when they wish or for a supply of drinking water or juice to be made available during the course of the day, this is particularly important bearing in mind the age of some residents and the need to ensure they remain hydrated. In discussion with staff we were advised that one resident has pureed food it would seem that the elements of meals are not separated out and tend to be pureed together, there is no indication from discussion with staff that the resident concerned would not eat the food if it was provided in more appetising separate elements and good practise dictates that this should be the way meals are presented to residents who require pureed food unless they indicate a preference otherwise and this is recorded. Care Homes for Adults (18-65 years) Page 17 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff demonstrate a good understanding of individual personal routines and would benefit from this information being recorded in more detail in resident files to inform new staff and ensure support is consistent. The physical and emotional health care needs of residents are being appropriately supported.Residents would be better safeguarded by improved recording of medication administration changes. Evidence: Care plans viewed give some personalised detail of individual routines and preferences around this. Discussion with staff indicated a sound understanding of individual residents personal care and daily routines, but their level of knowledge and awareness is not always fully reflected in support plans, The registered person commented that when they took over the running of the home in September 2009 they noted that a number of residents had missed health appointments, and that there was an absence of a system to ensure this information is not overlooked on a day to day basis, as a result a work schedule book has been implemented which also records all appointments to ensure staff work schedules can accommodate these. Resident files viewed provided evidence that routine health care Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: appointments are being supported and contacts with health care professionals recorded. Whilst care plans indicate that previously assessments of nutrition, falls and skin integrity (waterlow) assessments have been conducted these are incomplete and the previous providers had not introduced any risk reduction measures. The registered person has made clear the intention of revising this information and re-assessing the needs of all the residents to ensure any risks are highlighted and acted upon.Weights are routinely recorded, and a review of a sample of residents weights indicated weight gains for those viewed. We observed a medication round, this was being conducted methodically, only senior staff administer or those trained to do so are able to administer. We looked at MAR records and whilst those sheets viewed indicated that mar sheets are being appropriately completed, we noted some changes to administration instructions have been made for some clients, these changes are neither signed not dated by the person making the change. Good practise dictates that any changes in medication can be carefully tracked and audited to ensure residents have not been placed at risk, no such audit system currently exists and we therefore require that all handwritten changes to administration instructions are marked clearly by the person making the change. A number of residents are in receipt of PRN medication and would benefit from individual guidelines as to when such medication should be administered thereby providing a more consistent administration. The manager has reflected on the need to train more staff in medication administration and also recognises shortfalls in staff knowledge in regard to the psychotropic drugs used with some residents, their side effects, etc and should consider the development of individual medication profiles which record medication, what it prescribed for, side effects, and any diversity issues which may impact on administration which staff would find useful. Care Homes for Adults (18-65 years) Page 19 of 37 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. Complaints and safeguarding procedures are in place but the institutional culture of the home has not previously instilled confidence in residents to express their views or feel listened to, the new registered provider will need to address this and make residents feel more involved in the home and how it runs. Staff practise needs to be supported by good guidance to inform how they work with aggressive or challenging behaviour. Evidence: The AQAA tells us that resident concerns are dealt with immediately and at the time of complaint, no complaints are recorded as being received since the change of ownership in September 2009, The commission has not received complaints on behalf of the new service although one is outstanding for the previous service. There is a complaints procedure on display in the entrance hall this like other documentation needs to be in a more accessible place for residents to view it. It was agreed that in reality some of the residents at the home are unlikely to ever make a formal complaint and for some who have become increasingly frail they may not even have the capacity to express concerns. Staff are aware however of when less able residents are expressing happiness, distress anger through body language , noise or facial expression; the registered manager should ensure that information about individual residents method of communication is made clear within care plan information to inform all staff. Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: Staff should be proactive in making complaints on residents behalf where they become aware of an incident that would have precipitated complaint in a more able person. Consideration should also be given to encouraging staff to record residents every day grumbles and groans to ensure that genuine complaints are not being over looked or trivialised. The registered person has informed us that it has been necessary to implement a restriction on one resident accessing their bedroom during the day time because of behavioural/continence issues, it is important that any restrictions are clearly discussed with the person concerned and their representatives, and any agreed actions clearly recorded in care plan information, and these should be subject to review of their effectiveness. The home looks after the personal allowances of residents on their behalf, a system is in place to record the credit and debit of residents personal allowance accounts. We checked two randomly selected accounts during our inspection, the cash sums and written record were found to be accurate although there is a need for those staff recording financial activity to ensure that books are kept up to date to aid auditing. The home has been subject to a recent adult safeguarding alert in regard to a deprivation of liberty issue, this involved the locking of the front door which prevented more able residents from having free access to and from the home as they did not have keys. Keys have now been distributed to the most able residents and the provider informed that the deprivation of liberty issue has been addressed satisfactorily. We are advised that this safeguarding issue is now closed. We noted some behaviour issues for individual residents noted in daily log reports but could find no reference to behaviour either within care plan or risk information, there is also an absence of guidelines to inform staff how best to work with residents when they are exhibiting aggressive or challenging behaviour. Care Homes for Adults (18-65 years) Page 21 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents will benefit from the planned improvements to the home. Fire drill arrangements need strengthening. Evidence: The registered person has informed us within AQAA information that many of the health and safety checks and servicing have been undertaken, gas servicing is overdue however and we confirmed at our site visit that this is still outstanding. As this is a health and safety issue we have issued a requirement elsewhere in the report for this to be addressed. The AQAA tells us that the service provides a homely safe environment,our observations are that the home is maintained to a good standard of cleanliness, the main communal lounge is comfortable and homely in appearance and residents tend to congregate there, the dining area and small television and quiet lounge will benefit from planned upgrading and redecoration as these are not particularly appealing at present, the dining area has recently seen the removal of asbestos and a new ceiling has been installed as a result. A new digital TV aerial has also been installed.The registered person has discussed plans for modernising the home and has a range of ides for doing so and replacing furnishings and providing new facilities, with so much to do some consideration should be given to the drafting of a development plan with Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: realistic timescales for existing and prospective residents to see when the proposed changes may take place. Residents are encouraged to personalise their own space and the registered person informs us that it is the intention to try to maintain rooms at single occupancy levels, some thought needs to be given to the usage of the larger rooms which may provide bed sit type accommodation to some more able residents, and this has been discussed with the registered manager, and may feature in future plans. The front door is kept locked although some residents have recently been provided with keys to this. The registered person must ensure that fire and environmental risk information relating to this is updated in response to recent changes in regard to key holders, the key pad etc. Examination of the fire log indicates that in general checks of fire tests and emergency lighting are happening, although the service should be aiming at weekly tests of alarm systems and monthly visual checks of emergency lighting and equipment. The fire alarm has been serviced as has the fire equipment and we have seen servicing certificates for this. We could find no evidence that as yet any fire drills have been held, the registered manager has been reminded of the need to ensure that all staff the opportunity to participate in fire drills and we have recommended as good practise that all staff including night staff should attend at least two fire drills annually, a record of staff attendance should be maintained. There are plans to update the fire risk assessment soon and we have been provided with evidence of this being arranged with a local consultant. The home must ensure that any environmental risk assessments are updated or developed if new hazards have been highlighted. The home will benefit from an overall redecoration and refurbishment The registered manager informed us of plans to create a desk area for staff to sit at in the smaller downstairs television lounge which is underused by residents, this is not surprising as the room has some clutter stored on one side of the room and furniture within the room is not arranged in a manner that provides residents with a comfortable and homely space. The room is attached to the smoking room and tends to be used as a corridor to this area. Care will need to be taken to ensure that communal lounge space is not lost to residents, with the proposed changes. When we spoke with staff they said that they always have access to supplies of gloves Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: and aprons, and appropriate equipment is in place for the hoisting or moving and handling of residents. Two cleaners provide cleaning support during the weekdays, and at weekends staff provide cover. Care Homes for Adults (18-65 years) Page 24 of 37 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. The registered person has identified shortfalls within staffing arrangements,training and supervision within the home and the action that is needing to be taken however this now needs to be progressed without further delay. Evidence: Discussion with the manager and staff indicates there are usually three care staff including a senior available to support residents during day time shifts, in addition to the registered manager or registered person, both of whom are experienced in working with people with mental illness. There are also ancillary staff including a cleaner, maintenance person and a cook. Staff report that there are usually enough staff although this can sometimes be pressured dependent on needs of residents. Plans to provide staff support for more activities will necessitate a review of staffing levels, to ensure an appropriate number are available to support residents in the home and also those who may be attending external activities or appointments. Since the change of ownership and registration last September 2009 there has been some staff changes and we looked at the recruitment process for new staff and examined their files. These contained all essential vetting and checks and most of the Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: information that should be contained within staff files was evident. However, the robustness of the recruitment process could be enhanced by clear evidence of interviews where gaps in employment, and verification of reasons for leaving previous care roles have been explored with applicants. Offer letters are not in place, and files lack start dates for new staff. We have discussed the need for the registered person to ensure these shortfalls are addressed. The registered manager highlighted plans for the recruitment of additional staff particularly night staff, to aid more flexible cover arrangements. New staff files revealed that staff are undertaking skills for care Common induction standards and work booklets are assessed by the registered manager who was unaware that staff can be issued with a certificate of completion and was asked to clarify this with skills for care. The Registered manager has undertaken an analysis of staff training, and has identified shortfalls in some areas which have been inherited from the previous service. There has been some assumption about the renewal dates for some training and we have asked the registered manager to revise these dates, a training matrix has been developed but is yet to be completed as a visual aid and reminder. Although the AQAA records that all staff are up to date with their mandatory training, we found from examining training information that most staff in fact now require updates for Fire and Moving and handling. With this knowledge in mind the registered manager had already arranged fire training for 26th January for staff. Most staff need updated Moving and handling training and we discussed the importance for health and safety reasons of staff being trained by an appropriately trained and qualified person to move and handle residents. One staff member we spoke with who was employed by the previous owners is still to receive Adult safeguarding training. We have required the provider to ensure that all staff have achieved updated mandatory training within the timescale given and that a rolling programme of training is established. AQAA information tells us more than 50 of the staff team has an NVQ 2 or above, in discussion staff reported they are undertaking a varied range of courses from NVQ2 to mental health training The registered manager has been proactive in identifying a lack of confidence and general knowledge amongst the staff team in respect of mental health, and as a consequence seven staff have been enrolled on a distance learning mental health course, it is hoped this will enable staff to become more aware, and competent in the support they provide. Some staff reported that they will be undertaking a medication Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: course. The registered manager has also identified a need for staff as a whole to understand the medications that residents in the home are routinely administered and will be seeking to provide training around the psycho tropic drugs usually prescribed to mental health clients. Since the change in registration, staff report that they have met once formally with the new owners on an individual basis, but find the new management team approachable and that opportunities exist for them to have informal chats and discussion with the registered manager or registered person. One staff meeting has been held since the change of registration and staff commented that they feel able to express their views and feel listened to. The registered manager is aware of the need to provide formal supervising to all care staff and has developed a staff supervision record sheet, he is keen to implement competency assessments of some areas of practise e.g medication and to meet more regularly with staff, however this is still to be implemented. We consider it is essential that staff receive an appropriate level of supervision and monitoring of their practise and opportunities for personal development, an element of observational supervision of work practise should also be incorporated into supervision programme. We have required the registered person to ensure care staff receive adequate formal supervision and appraisal. Care Homes for Adults (18-65 years) Page 27 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered person and registered manager demonstrate a good understanding of the needs of residents and the shortfalls within the current service that need improving, but currently lack a sense of urgency, forward planning and prioritisings to ensure these are progressed and outcomes for residents are improved. Evidence: The registered manager is suitably qualified and experienced in mental health, and he demonstrates a good understanding of the needs of residents and shortfalls within the present service. However we have found that returned AQAA information has not been completed to a good standard and have discussed our expectations with the registered person and registered manager, we are awaiting a revised version of this document. In discussion with the registered person and registered manager, both are clearly able to demonstrate an awareness of shortfalls in the service that they would like to address, but have not drafted a service development plan to illustrate how they intend to progress. Improvements made and plans for further improvement are not fully illustrated within AQAA information, and provide no sense of how things are improving Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: for residents or how residents may be becoming more involved if at all. Whilst some improvements have already been made since the change of registration these have not significantly improved outcomes on a day to day basis for residents at this time. At present no quality assurance system is in place, we discussed with the registered manager the need to establish a system of internal audit and review that encompasses some of the stand alone audits already conducted. The implementation of any quality assurance system must also incorporate opportunities for residents and other stakeholders to give feedback, and influence service development. We have issued a requirement for the registered person to develop and implement a quality assurance system suitable for this service. The registered manager advises that policies and procedure information inherited from the previous provider are being updated, with key procedures being identified first for update. We have examined the accident book which records a low level of incidents and accidents, the home has been proactive in notifying the Commission through regulation 37 notifications. We are informed through AQAA dataset information that the majority of health and safety servicing and checks have been undertaken, however we note that Gas servicing is now overdue and the provider has been required to arrange for this to be undertaken within the timescales given in the report. A current certificate of insurance is displayed in the home. Care Homes for Adults (18-65 years) Page 29 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 37 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 14 16 We require the service to establish a more stimulating programme of activities that takes account of individual needs,preferences and interests, this should also promote independence and skills development for those residents who have the capacity and motivation to do so. This should be suitably staffed to ensure that residents are enabled to access the local community. Regulation 16(2)(m)(n) So that residents have opportunities to develop social and emotional communication and independent living skills, are provided with opportunities to exercise and provide stimulation and interest in their every day lives. 30/03/2010 Care Homes for Adults (18-65 years) Page 31 of 37 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 2 20 13 The registered person must ensure that any handwritten changes to prescribing instructions recorded on MAR sheets are accompanied by the signature and date of the person making the change In order to ensure consistency of administration in regard to PRN medication the home must establish individual guidelines of when it is appropriate to administer this medication to inform administering staff. The Registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. To better safeguard residents from medication errors 28/02/2010 3 35 18 Registered manager to ensure that a programme of training is established and that all mandatory training including moving and handling, fire training,infection control, 28/02/2010 Care Homes for Adults (18-65 years) Page 32 of 37 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 food hygiene, first aid adult safeguarding and medication are kept updated for all care staff, in addition to relevant specialist training to inform knowledge and skills Regulation 18 (1)(c) ensure that the persons employed by the registered person to work at the care home receive- (i) training appropriate to the work they are to perform so that staff acquire the necessary skills and knowledge to support residents effectively and safely. 4 36 18 The registered Provider 28/02/2010 must ensure that care staff are provided with formal supervision to assess their work practise and identify personal development needs and training Regulation 18(2) The registered person shall ensure that persons working at the care home are appropriately supervised. So that an assessment of staff performance and Care Homes for Adults (18-65 years) Page 33 of 37 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 competencies is routinely monitored 5 39 24 The registered person is required to establish a system of quality assurance that enables the service to undertake the periodic internal review and audit of systems, opportunities must be provided to seek the views of residents and the service must demonstrate evidence of how residents views can be influential in the development of the service Regulation 24 (1) The registered person shall establish and maintain a system for-(a) reviewing at appropriate intervals(b) improving the quality of of care provided at the care home including the quality of nursing provided at the care home 6 42 13 The registered person shall 28/02/2010 undertake to ensure that the Gas supply and any fittings are serviced within the timescale given and thereafter a minimum of annually Regulation 13(4)(a)The registered person shall 28/02/2010 Care Homes for Adults (18-65 years) Page 34 of 37 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 ensure that- all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. So that residents are safeguarded from injury and harm 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 Prospective residents should routinely be provided with copies of the Service user guide and SOP summary to inform their decision to live at the home, consideration should be given to making this information available in a range of formats to make the information accessible to residents with varying needs. Contract/terms and condition information should have the room number/location which the resident has been allocated recorded on this documentation at the time the document is signed. The home should continue to progress the planned update of care plan and risk information for the majority of residents. Residents are to be provided with accessible information about menus to enable them to make informed choices about what they would prefer to eat. All staff (including night staff) should participate in a minimum of two fire drills annually and the frequency and names of those attending should be recorded. The registered person should evidence that gaps in employment and verification of reasons for leaving previous care roles have been explored with applicants through the interview process. Page 35 of 37 2 3 3 6 4 17 5 24 6 34 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Recruitment files should make clear start dates of employment. Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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