Inspection on 23/09/09 for White Lights

This is the latest available inspection report for this service, carried out on 23rd September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

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: White Lights 20-22 Chapel Park Road St Leonards-on-Sea East Sussex TN37 6HU     The quality rating for this care home is:   two star good 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 3 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: White Lights 20-22 Chapel Park Road St Leonards-on-Sea East Sussex TN37 6HU 01424437995 01424437995 sheahar.seesarun@sky.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Baldeo Seesarun care home 20 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 users to be accommodated is 20. The registered person may provide the following category/ies 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 White Lights is registered to provide accommodation for up to 20 people suffering from mental health issues and admits people with low to medium dependency needs. The premise is a well-maintained, large detached property in St Leonards on Sea with single and double rooms on the ground and two other floors. Residents have the use of two separate lounge areas (one is the designated smoking area), a small quiet room and a dining room with additional comfortable seating. The home has a good-sized well-maintained rear garden with seating areas for residents, lawn areas, fishpond and established borders. There is also a paved and lawn area to the front of the premises, which could be used for sitting. Car parking is available within the street outside. The Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 20 0 3 1 1 2 0 0 8 Brief description of the care home building is located a short walk from Warrior Square station and the sea front and shops. The Home was recently sold and has been re-registered under a new owner Mr. B. Seesarun who owns another home and has many years expereince in the health and social care field. The new provider is currently in day to day operational control of the home. The current weekly fee for the service is between £322.40 and £337.00. The service has no current e-mail address Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: A key inspection of this service has been conducted. This has taken account of information we have been told about the service and also information provided by the service itself including an Annual Quality Assurance Assessment(AQAA) received post inspection last year and again this year. This was returned when we asked for it and gave us some of the information we needed we have discussed with the manager some minor improvements that could further enhance content overall. People we spoke with in the home were friendly and were willing to speak about their experiences of living in the home and things they like to do. They indicated that in general they are satisfied with their placement at the home and their feedback has been taken account of in our evaluation of this service. During our visit we also met with the provider and two care staff and their feedback has also been useful in shaping this report. During our visit we also examined a range of documentation maintained by the home, this included: support plans, risk information , medication, accident and complaints Care Homes for Adults (18-65 years) Page 6 of 34 records. Staff recruitment, training and supervision records. In arriving at our judgement of the service we have been proportionate in considering compliance with regulation and outcomes for residents alongside overall risks and impacts of identified shortfalls. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? Since the last inspection the Provider has completed two Annual quality assurance assessments charting the progressive improvements made in the service since the change of ownership. Outstanding requirements have been addressed. From our site visit we have noted improvements to communal areas in the home including the main lounge which now provides a bright and airy quiet space for people in the home to sit, a smaller TV lounge has recently had replacement settees installed. The dining area has had remedial works carried out to the floor. The kitchen is in the process of refurbishment. Staffing levels have increased. The recruitment process for staff has been pursued more robustly and the content of staff files improved. A programme of training has been introduced for staff, new staff now undertake skills for care induction workbooks. Support plans now provide more detailed information about how individual people are to be supported around their mental health needs. All people living in the home have been issued either with contracts if they are privately funded or with terms and conditions if they are funded through their local authority, this information tells them about the terms and conditions of their stay. Care Homes for Adults (18-65 years) Page 8 of 34 Risk information has been improved upon to detail risk reduction measures in place where risks have been highlighted. All bedrooms are currently single occupancy. The provider has implemented a system for the annual quality assurance of the service 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. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 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. Prospective residents and people living at the home are provided with information about the service offered and the terms and conditions of their stay. They benefit from an assessment of their needs prior to admission to ensure these can be met. The provider has a clear understanding of the homes limitations in the range of needs it can support. Evidence: People receive information about the service and the terms and conditions of their stay to inform their decision about moving to the home.The provider indicated that there are some plans to review the type of service offered in view of the reducing number of referrals for more traditional residential care; he is aware that any changes to the service will need to be reflected in the Statement of Purpose and user guide information provided to prospective and existing residents. No new people have been admitted to the service since the last inspection and the provider has taken on board concerns raised at that time about admission of people whose needs may be linked more to accommodation issues than a need for a mental Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: health resource. The provider has assured us that since that time greater care is taken to ensure only appropriate placements would be accepted into the home, and there is a better understanding of the homes limitations in working with people whose needs may be changing, as a consequence one person has moved onto more appropriate accommodation. We confirmed with the provider that currently only two residents are privately funded, one of these confirmed to us that they had received a new contract when the new provider took over the running of the home, those people funded by the local authority also now receive terms and conditions information upon admission, and we viewed examples of this documentation during our visit. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported in the way they wish but this is not always made clear or reflected in support plan information to inform staff. Improved risk assessment has been introduced but needs expanding to incorporate additional risks not taken into consideration currently. Evidence: We spoke with approximately six people who live at the home during our visit, some in more depth than others and in keeping with their own choice nd decision to participate to the level they wished. There are mixed views in regard to support plans and how involved or aware people who live at the home are about them, three people said they did have support plans and they were spoken with about them by staff,two also reported they have care managers who are in touch with them and conduct reviews of their placement. The format and content of support plans has improved with detailed content recorded Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: in regard to the main mental health need for each individual and how this impacts on their day to day life. Whilst those we spoke with are mostly independent of staff for their personal care needs, support plans would benefit from reflecting a more holistic view of individuals and how they are supported however minimally in other areas of their daily lives. When we spoke with staff and some people who live in the home it became clear that there is some additional support given in other areas but there remains an over reliance in this type of information being verbally communicated between staff. Although health needs are attended to care plans do not reflect what specific health needs individuals have other than mental health and how these are supported. Support plan information is reviewed monthly and crisis plans are also put into place for specific issues. Bedrooms are now used as single occupancy and this has helped maintain individual privacy and dignity. At present there would seem to be no restrictions placed on anyone living at the home that require a deprivation of liberty referral. People we spoke with reported that they lead the life they choose coming and going from the home as they choose, some people need support when out from staff because of behaviour issues or physical mobility concerns. People in the home manage their own personal allowances and collect these weekly from the provider,some people self medicate but this is the exception rather than the rule, the provider is aware of the need to provide opportunities for people to take greater control of their medication regimes where they have capacity to do so and will need to be implementing assessments for those who are not deemed competent to do so. Since the last inspection risk information has been further developed and where risks are highlighted risk reduction measures are recorded. Risk information is reviewed, this would benefit from some expansion to include other risks e.g nutrition, moving and handling, medication. Care Homes for Adults (18-65 years) Page 14 of 34 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. People who live in the home can lead the life they wish, their quality of life and level of mental stimulation would be enhanced by a proactive promotion of skills development to enable them to take more control of their lives.They are supported to maintain links with family and friends where these exist. They are consulted about what they want to eat each day and this can be varied and nutritious Evidence: People who live in the home are encouraged to make use of community facilities and are provided with information about events that may be happening, some people make use of day centres but most lead unstructured days. There is no formal activity programme and in discussion people in the home did not express any particular wish for more activities in house, however two people said they would like to do some cooking from time to time, but had not been encouraged in this by staff. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: Up until now there has not been a culture within the home to promote independence amongst people living at the home only to maintain those skills and independence already in place. The present provider is aware of the importance of rehabilitation for people with mental health needs, enabling them to regain daily living skills. People already living in the home would benefit from being encouraged and supported to develop their personal living skills to enhance their lives in the home and provide mental stimulation. There is a need for the staff team to be proactive in promoting skills development with individuals to whatever level they feel comfortable with, and underlying concerns that this is preparation for moving into the community should be addressed so as not to undermine the confidence of individual residents. Where people in the home have active family links these are encouraged and supported by the home. People living in the home make their own decisions but this is limited to those areas of their lives where they have control, as the majority of the people in the home do not undertake any household tasks,and have no structured activity they are limited in the areas in which they might have to make decisions for themselves. The likes, dislikes and preferences of individual people in the home are taken account of in the development of a four week menu, specialised diets can be catered for. People are consulted on a daily basis about what they would like for lunch from a range of options, the main meal of the day is served in the evening. People who do not maintain a good diet are provided with food supplements, but how these are to be used is not made clear in support plans. Hot drinks and water and juice are available in the dining room during the day and there are two formal break times also when people in the home know that a drink will be available to them. People we spoke with said they thought they had enough drinks available and could ask for more. Records of individual food intake are maintained. Care Homes for Adults (18-65 years) Page 16 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal care and health needs of people in the home are well supported and would be enhanced by further improvements in the management of medication. Evidence: People living in the home are generally self caring with minimal input from staff around personal care regimes. Discussion with residents and some staff highlighted minor but important interventions are happening, when we spoke with people who received support from staff with some of their personal care they told us that they are satisfied with the way it is provided, it is important however, that this information be recorded within care plans to reflect the personalised nature of the interventions,these omissions have been discussed with the provider. People we spoke with felt in control of their daily routines and able to lead the life they wish to within limitations. We looked at the files of four current service users. These informed us that people in the home are being supported to access routine and specialist health care, with records maintained of contacts with health professionals. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: One person during our visit indicated they were awaiting new glasses following an opticians appointment. We noted routine optical and dental appointments on the files viewed. Another person living at the home reported that they had been in receipt of a range of health interventions recently and is waiting for further tests and assessments. Intervention by the continence nurse has been sought in regard to another person at the home. Examination of documentation and discussion with the provider indicates that he is proactive in seeking appropriate health interventions for individual residents as needed. When we spoke with staff about medication arrangements we are advised that since the last inspection medication keys are handed over from shift to shift to the staff member administering. Staff tell us that only staff who have received training administer medication. Eight of the current staff team have received medication training, and the provider has also initiated medication competency assessments for administering staff, the frequency of these assessments is still to be decided upon. When we looked at medication storage we were concerned to find trays of pill pots with lids labelled with the names of people in the home who receive medication, although staff thought otherwise this implies pre-preparation of medications and is viewed as poor practise and is to be discouraged. We have discussed this with the provider and a staff member and have made clear this practise is to be discontinued. We found that creams, and boxed medications are not dated upon opening and discussed the importance of doing so to aid medication audits. We also noted that some people who are not deemed able to administer their own medication are given prescribed creams to self administer without appropriate risk assessments being in place. When we looked at MAR sheets we found that whilst there has been some improvement, handwritten entries are still not routinely being signed and dated by staff making changes to entries. We have issued a requirement for action to be taken to address these shortfalls. We have discussed with the provider that it would be good practise to consider the development and implementation of individualised PRN guidelines and medication profiles, these would aid staff consistency in administering this type of medication and improve their awareness of individuals specific medication needs and preferences. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: At present only two people self administer medication. The majority of people in the home have lived there for many years and a culture has existed that medication is to be administered by staff, The new provider understands the need to enable individuals to take greater control where they have capacity and we discussed the need for care plans to make clear individual medication arrangements including where individuals have made an active choice for staff to administer which is subject to review. We noted some examples of individual people refusing medication on a regular basis which is also not made clear within support plan information or how staff should deal with this. When we spoke with staff about this they demonstrated a good awareness of specific individuals and their behaviour and will consequently re-offer medication later in the day if necessary but this should be clearly recorded in plans to ensure all staff respond in the same manner. Care Homes for Adults (18-65 years) Page 19 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home feel able to express their views and approach staff with concerns. Improving levels of training and guidance to inform staff practise is helping to raise awareness and improve safeguarding but further improvements are needed Evidence: When we spoke with people in the home they said they felt able to approach the provider and staff if they needed to. A review of the complaints record indicates that people in the home are actively making use of the complaints process, mainly in settling disputes with other people in the home or staff. The current complaints recording system needs revision as this breaches confidentiality and this is a recommendation. The provider has an awareness of adult safeguarding issues and there have been two alerts raised since he took over. One has been closed and another is nearing completion and has resulted in very positive outcomes for the residents concerned. The provider advises us that all but one of the people currently in residence manage their own finances, collecting their personal allowance weekly from the office. One person has by choice their personal allowance converted into cigarettes by the provider and these are distributed at agreed frequencies, in this way the person concerned is helped to manage their addiction with a few pounds left each week for any incidentals. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: Guidelines have been developed for staff around the kind of behaviours that some people living in the home may experience, however, the guidelines give insufficient practical advice to staff to inform them how to manage these behaviours in an agreed and consistent manner and this needs to be progressed. Discussion with staff indicates that whilst they may have an understanding of their reporting responsibilities if they become aware of abuse, their knowledge of the adult safeguarding process is weak and could compromise any potential investigation, it is important, therefore, that all staff receive adult safeguarding training as a matter of some priority and this has been discussed with the provider and we have issued a general requirement in regard to shortfalls in training. Care Homes for Adults (18-65 years) Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and homely environment and are benefiting from planned and progressive investment to upgrade the premises. Some improvements in facilities are needed to help foster good hand washing and personal hygiene routines Evidence: The new provider is making steady investment in upgrading the premises, and outstanding works to the decoration and refurbishment of the main lounge and repair of the dining room floor have been achieved. Currently all bedrooms are single occupancy, so issues of privacy and screening in shared rooms no longer exists. A range of smaller improvements to bathrooms and toilets identified previously will need to be progressed as part of the ongoing upgrade to the premises. The accommodation offers a comfortable and homely environment to people living in the home, and who are now benefiting from the upgrades to the main lounge, dining area and currently the main kitchen. Cleanliness of the home is generally maintained to a good standard but it is important that facilities to encourage good hand washing and personal hygiene are maintained, we visited one ground floor toilet and noted this had only one working cold water tap, liquid soap had run out and only a cloth towel was available for hand drying. We would Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: recommend that the provider reviews arrangements in all bathrooms and toilets to ensure that people living in the home and staff are provided with liquid soap and paper towels at all times to foster good hand washing routines. Care Homes for Adults (18-65 years) Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home welcome increased staffing levels and improvements in the recruitment of staff better safeguard them. Mechanisms for the training and performance assessment of staff remain in need of further development. Evidence: When we spoke with people who live at the home they reported that there are now more staff available if they need them. In discussion staff and the provider confirmed that there had been a recruitment of additional staff, resulting in two care staff being on duty during weekday daytime shifts in addition to the provider who undertakes day to day operational control of the home and ancillary staff. We noted a current staff rota and this confirmed the staffing arrangements. Only four of the present staff team have achieved NVQ2 qualification todate although the provider expresses a commitment to building a qualified staff team. We looked at a sample of recruitment files for those staff newly appointed to the home. In general examination of files indicates an improvement to the robustness of the recruitment process and the content of individual files, in that all four files viewed contained the necessary vetting and checks including two references. Only one file however contained ID and none contained a current photograph or details of start Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: dates. Interview notes were visible in all files, but, there is a need to formalise these and ensure that gaps in employment and verifications of reasons for leaving previous care roles are explored with applicants at interview. Judgements to employ staff who may have an unsatisfactory CRB check should be clearly recorded in the relevant staff file. We discussed with the provider the absence of staff contracts at this time and the need for these to be developed to ensure staff are aware of the terms and conditions of their employment and their performance can be monitored against this. When we spoke with staff they confirmed that they have received an initial induction to the home and are also completing Skills for Care induction workbooks, as one staff member we spoke with had already been in post for more than one year there is a need for the provider to ensure that this programme is implemented for new staff as soon as they commence employment. There is currently no training matrix and records are not kept of individual staff training history other than recent certificates. It is unclear when pre-existing staff last updated their training. When we looked at the certificates we noted that whilst there has been a catch up programme implemented of training organised for staff, the majority are still to complete all mandatory training. We have discussed with the provider the need for this to be progressed for all staff with a rolling programme of updates established, and this is a requirement. The provider has developed a resource information pack reflecting the range and type of mental illness that staff will experience amongst the present people living at the home which staff are expected to read. The provider has the intention to assess individual staff competencies and understanding of this but no formal system to do so has yet been established. It is important that the provider formalises the training offered to demonstrate that the professional development of staff and their skills to work with people with mental health are being appropriately developed. Whilst staff reported that they feel able to approach the provider they indicated that they would welcome opportunities to have more one to one time and feedback about their performance, at present no system of formal supervision and appraisal is in place, and this should incorporate an observational element. The provider is required to evidence that staff are in receipt of appropriate supervision that enables their Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: practise and work competencies to be monitored, and for them to be able to meet in private with their manager. Care Homes for Adults (18-65 years) Page 26 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are benefiting from progressive improvements made to the standard of accommodation and support they experience. Evidence: The provider has the necessary skills and knowledge to undertake the day to day operation of the service. Since the last inspection which highlighted a range of shortfalls, the provider has concentrated on ensuring that the primary mental health needs of the people in the home have been supported and as part of this has sought to build relationships with health and social care professionals. For some people in the home their physical care needs have overshadowed mental health needs and appropriate referrals and interventions have been made accordingly. Whilst this inspection has highlighted where current practise can be further enhanced and developed, we acknowledge that there has been a clear trend of improvement since the last inspection both to the physical environment and also in the care support provided, and we have taken this into consideration in our overall judgement of the service. Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: People we spoke with had a good understanding of what the current situation is in regard to upgrading of the premises and staff cover arrangements, but there is no formal system for informing people living in the home about forthcoming current events, or changes in the service. Whilst some people commented that they are approached individually and asked about aspects of the service from time to time, this may not be applied equally across all the people in the home and a resident forum needs to be established to ensure everyone receives the same information and can express their views. The provider has implemented an annual quality audit of the service, people living in the home tell us that they are asked for their views about aspects of service quality and some said they had been surveyed, there is no record of the analysis of such feedback and it is not currently incorporated into quality assurance information, an overall annual report of the findings of quality assurance audit and feedback is still to be developed. We have discussed these issues with the provider and recommend that action is taken to address the shortfalls. The provider has informed us that all health and safety checks and servicing have been carried out or are scheduled to be, we have noted servicing contracts for gas and electrical installations. Fire alarm, emergency lighting systems have been serviced recently and fire equipment is scheduled to be checked. We noted some omissions in recording in regard to the visual checks and testing of emergency lighting,fire equipment and the recording of fire drills involving staff and people living in the home, we have discussed the need for improvements in this area with the provider. Accident records indicate a low level of accidents is experienced. Where an accident has led to hospital admission the service has notified the Commission appropriately. Care Homes for Adults (18-65 years) Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 34 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 20 13 All handwritten entries and changes to the MAR records must be accompanied by a signature of the person making the change and the date of the change. The use of relabelled pots for the administration of medication to specific people is to be discontinued, no pre-preparation of medications should be undertaken by staff at any time. Prescribed cream, liquid or boxed medications should be dated upon opening for auditing purposes Risk assessments should be completed to support judgements around self administration or all prescribed medications by people living in the home. 10/10/2009 Care Homes for Adults (18-65 years) Page 30 of 34 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 13(2) The Registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. 2 35 18 The provider must ensure 30/12/2009 that all staff complete the full range of mandatory training in a timely manner this includes Moving and handling, infection control, food hygiene, fire, first aid, adult safeguarding and medication, and that a programme of refresher training is established. Specialist mental health training must be available to ensure staff have the appropriate knowledge ands skills to support people in the home effectively 18(1) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users- (c) ensure that the persons employed by the registered person to work at the care Home receive- (i) training appropriate to the work they Care Homes for Adults (18-65 years) Page 31 of 34 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 are to perform; so that staff have the necessary knowledge and skills to fulfil their role 3 36 18 A framework should be established for the formal supervision of staff to be provided a minimum of six times per year and these should be recorded. Staff should also have access to regular team briefings and these should be minuted for the benefit of absent staff 18(2) The registered person shall ensure that persons working at the care home are appropriately supervised. to monitor staff performance and practise through 1-1 supervision sessions which should have an element of observation, appraisal and use of team meetings to disseminate information 30/10/2009 Care Homes for Adults (18-65 years) Page 32 of 34 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 13 Opportunities should be provided to individuals living in the home for the promotion and development of their independence and skills with the active support of staff. Complaints recording should be revised to ensure confidentiality of information is not breached People in the home and staff should be provided with liquid soap and paper towels in bathrooms and toilets to foster good personal hygiene and hand washing regimes The provider should maintain accurate and individualised records of staff training, and develop a staff training matrix to gain an overview of gaps in skills and knowledge. Specialist mental health training should be formerly structured People in the home should be provided with a forum for expressing their views and being kept informed of changes. The provider should develop and publish an annual quality assurance report of the findings from annual quality audits and feedback from people using the service to evidence what action has been taken to address findings and how people using the service influence change and development 2 3 22 27 4 35 5 39 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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