Inspection on 10/11/09 for 1 Church Road

This inspection was carried out on 10th November 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1 Church Road 21/01/10

1 Church Road 02/04/09

1 Church Road 21/11/08

1 Church Road 23/11/06

1 Church Road 15/02/06

1 Church Road 13/10/05

1 Church Road 18/03/05

1 Church Road 24/11/04

1 Church Road 27/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 15/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: 1 Church Road 1 Church Road Wembdon Bridgwater Somerset TA6 7RQ     The quality rating for this care home is:   zero star poor 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: Jane Poole     Date: 1 0 1 1 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 31 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 31 Information about the care home Name of care home: Address: 1 Church Road 1 Church Road Wembdon Bridgwater Somerset TA6 7RQ 01278453635 01278456656 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Home First & Foremost Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 13. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability- Code LD Date of last inspection Brief description of the care home 1 Church Road is registered to provide care for up to 13 people who have a learning difficulty and/or additional physical disability. The house is set in its own grounds in a quiet residential area on the outskirts of Bridgwater. All bedrooms are for single occupancy and all have en suite facilities. The registered providers are Milbury Care / Voyage. There is currently no registered manager at the home. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 13 0 2 0 4 2 0 0 9 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: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commissions Inspecting for Better Lives 2 framework. This focuses on outcomes for people and measures the quality of the service under four general headings. These are:- excellent, good, adequate and poor. This inspection was carried out by two inspectors over a one day period. During this time we, The Commission, were able to meet with people living and working at the home, observe care practices, tour the building and view records. Two health and social care professionals were spoken with prior to the inspection to gain their views on the service. Care Homes for Adults (18-65 years) Page 5 of 31 Some records requested were not available at the time of the inspection but were provided after the inspection. Before the inspection the home completed an Annual Quality Assurance Assessment (AQAA) and returned it to the Commission in a timely manner. Since the last key inspection we have carried out one random inspection and taken part in a Vulnerable Adults Strategy meeting in respect of someone at the home, which was held by the Local Authority. At the time of the inspection there were 11 people living at the home. Current fees (November 2009) range from 1066 to 2000 pounds per week. Many of the people who live at the home are unable to fully express their views therefore much of the information gathered for this report was obtained by direct observation and speaking with staff. Due to unforeseen delays surveys, asking interested parties to share their views on the quality of the service, were not received by the home until the day of the inspection and therefore feedback from these has not been included in this report. Feedback from returned surveys may be included before the report is published. The following is a brief summary of the inspection and should be read in conjunction with the whole report. Care Homes for Adults (18-65 years) Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: There has been no registered manager in place for the past 12 months. Although the company has ensured that there has been a management presence this has not been consistent through the year. The Annual Quality Assurance Assessment (AQAA), completed by the home, identified this as a barrier to improvement stating The lack of consistent home manager has hampered our progress in developing the service as we would have liked. An experienced permanent home manager has now been appointed. Care plans in the home are still not reflective of peoples current needs. Personal information about people is kept in a variety of files making important information difficult to find. One person with complex healthcare needs had 5 separate files leading to confusion about what was the most up to date guidance for staff to follow. Care plans are not used as a working document for staff and one member of staff said We do not really use care plans. During this inspection we expressed serious concerns about how healthcare needs were being identified and monitored. Again records of healthcare needs were disjointed and some information was not recorded, some was not easily accessible and some was out of date. We were unable to ascertain how often one person had been seen by healthcare professionals, in another file there was evidence that appointments had Care Homes for Adults (18-65 years) Page 7 of 31 been attended but no information about the outcome of consultations or instructions for staff to follow. Although a pre admission assessment had been carried out for a person who had recently moved to the home there was no evidence to show that they were receiving the care that the assessment identified. The company that owns the home has its own quality monitoring systems in place and it is concerning that shortfalls in the care and record keeping had not been identified, and action taken to address, before this inspection. Issues about staff not using care plans as working documents and inconsistent healthcare support were raised at the last key inspection. Throughout the day it was observed that there was limited opportunities for people to take part in meaningful activities and no evidence was seen of individual activity programmes to provide structure and stimulation for people living at the home. 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 8 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home carries out pre admission assessments of people wishing to move to the home but care is not always provided in line with the assessed needs. Evidence: Since the last inspection one new person has moved into the home. This persons file contained a full assessment outlining their needs. The persons assessment stated that the person needed lots of activity/occupation, cooking cleaning etc. It also said that it was important that they keep busy and they enjoy helping with living skills around the home. There was no evidence of any structured activity programme for this person. Daily records showed that in the previous 10 days they had been out for coffee, to an evening club and to a firework display. Other entries stated that they had spent time in the lounge. During the inspection this person was observed in the lounge without stimulation or activity. There was no evidence that this person was being encouraged to take part in daily living skills and it was observed that drinks were bought to them, rather than them being assisted to make their own. There was no evidence that the needs of people already living at the home, or the Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: compatibility of new people with the existing group, are considered when assessing new people to move to the home. The home is extremely noisy at times and people moving in need to be made aware of this before they make a decision to make Church Road their home. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are disjointed and bulky meaning that they are not easy for staff to use. Care plans are not always kept up to date and are not always followed by staff. People are able to make some decisions and choices about their day to day lives but many decisions are made by staff on their behalf. Evidence: People living at the home have individual care plans. Care plans are very bulky and information is spread over different folders making them disjointed. For example one person has a separate folder containing a care plan and guidance for staff in respect of the persons epilepsy. This was been drawn up in conjunction with a specialist nurse in August of this year and there is no indication of how often it will be reviewed. The full care plan gives details of the assistance required with personal care, including bathing, which does not mention guidance around the persons epilepsy. One person had a care plan in respect of a specialist diet that was out of date and had not been up dated in Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: line with the changes made. One person had a protocol in place for the reduction of a restrictive practice. The protocol stated that daily records should be kept detailing when the restrictions were removed and the length of time. Records of this were kept in a separate folder to the main care plan. They were completed on the day of the inspection but previous to this the last record was over two weeks ago. This means that the effectiveness of this protocol can not be fully monitored or evaluated. Daily records which record significant events and activities are kept in a separate folder. The main care plans are kept in the main office and daily records are kept in personal folders in the lounge. Some staff said that they had a degree of input into care plans and one member of staff said We dont really use care plans. At the last key inspection a judgement was made stating Each person living at the home has an individual support plan. The plan is not used as a working document and does not consistently reflect the care and support that the staff deliver. This continues to be the case. Risk assessments had been completed in respect of all activities and were contained within the main care plan folders. In many cases these were not risk assessments but further care plans. Action for staff to take to minimise risk were recorded but there was little evidence that staff were aware of these assessments or used them in their daily work. Staff said that they assist people to make choices about their day to day lives and it was observed that some people were able to choose what time they got up and what they had for breakfast. Many of the people living at the home are unable to verbalise their wishes and choices and no alternative forms of communication, such as pictures or symbols, were seen in use during the day. For people who were able to verbalise their wishes these appeared to be respected by staff. Care Homes for Adults (18-65 years) Page 13 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are some organised activities for people living at the home but no structured individual activity plans. The home are planning to expand the activity programme to ensure people have opportunities to take part in a variety of activities. Visitors are welcome at the home and staff assist people to keep in touch with friends and family Evidence: Daily routines in the home are fairly flexible with no set times for people to get up or go to bed. There are some organised activities for people who live at the home but no structured Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: individual activity programmes were seen. No one currently living at the home attends college but the manager stated that they are planning to investigate appropriate courses that may be available locally. There are also plans to nominate one member of staff to take a lead role in the provision and co-ordination of activities. The AQAA states that the home is planning to introduce new activities for people in the coming 12 months. Some people attend a club outside the home on a weekly basis. On the morning of the inspection one person said that they had been out to town and two people went to a relaxation session. In the afternoon some people went out for a walk with staff. The home has two lounges that are attached to each other and noise levels at times were high. The TV was on in both lounges and staff were available in the main lounge but there was limited social stimulation. People who are able to, access their bedrooms throughout the day. The home has two vehicles, one is able to accommodate wheelchairs, to enable people to access community and leisure facilities. Visitors are always made welcome in the home and there are no set visiting times. The home support people to keep in touch with friends and family. The main meal of the day is at lunch time with a lighter snack in the evening. One member of the care staff team is nominated each day to cook and this person does not perform personal care. There are set menus in the home which have been bought from another home owned by the same providers. This means that people living at Church Road did not have input into them, although it was noted that food was discussed at a recent residents meeting. The kitchen was viewed at it was well stocked with good quality food products. The dining room is divided into two sections and there is space for everyone to be seated. One person chooses to eat in a separate room and this wish is respected. The main meal of the day was seen, it appeared well cooked and portions were ample. People are able to eat at their own speed and staff eat at a separate table after the majority of people have finished their meal. People asked said that they enjoyed the food at the home. Care Homes for Adults (18-65 years) Page 15 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff do not have easy access to guidance on peoples physical healthcare needs, meaning that healthcare needs are not consistently addressed or appropriately monitored. There are no care plans in place to address weight loss. Medication practices in the home are generally safe but some improvements could be made. Evidence: Everyone living at the home has single bedrooms with en suite facilities so that personal care can be carried out in private. Appropriate aids and adaptations have been put in place to meet individual needs. During this inspection we raised serious concerns about how healthcare needs were being documented and monitored. One person had sustained a head injury 3 days before the inspection which had resulted in them being taken to hospital. An incident and accident report had been completed at the time of incident but no information was Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: given about them being taken to hospital. Therefore there were no recorded guidelines about the aftercare this person should receive and no care plan was in place for the observation and monitoring needed. (Assurances were received from the home on the day after the inspection that all staff had been made aware of the hospital information sheets about concussion.) At the time of this inspection the person still appeared unwell and was lying on the sofa in the main lounge which was being used by other people who live at the home. Staff said that they were monitoring the persons condition but when asked what the monitoring involved they were unclear. No one said that they had been made aware of the hospital guidelines on concussion. This person was vomiting at times and being in the main lounge did not promote their dignity. We observed that some people appeared slight in statue. The recording of personal weights was erratic. The weight record for one person showed that they had last been weighed in March 2009 however in October 2009 an entry in their personal file stated that they were to be weighed regularly and snacks were to be increased to improve their BMI. A referral had been made to a dietitian. There was no recorded rationale for this. One person had lost half a stone but there was no care plan in place to address or monitor this. It was unclear whether the home had sit on scales or if they only had scales to weigh people who were able to stand. There was no evidence that staff had received training in nutrition or increasing the calorific value of food for people. As previously stated one person had a care plan relating to a specialist diet that was no longer relevant. The home have created new files to record healthcare appointments. Historic information has not been transferred into these files and in the case of one person with complex healthcare needs we were unable to track appointments with healthcare professionals or the recommendations of these consultations. In another file there was evidence that blood tests had been carried out but there was no indication of why, or the results of these. Some people at the home are wheelchair users and there are no care plans in place regarding pressure area care. As with care plans, information about healthcare needs and support received is located in different places making it difficult to see an overall picture of the persons needs or to ensure that these needs are fully met. Some records seen demonstrated that people have access to healthcare professionals such as GPs, Dentists and Chiropodists. At the last key inspection a judgement was made stating People have access to a variety of healthcare professionals. Peoples healthcare needs are not consistently assessed and recognised to ensure that procedures are in place to address them. This Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: continues to be the case. The home uses a monitored dosage system for medication. No one at the home currently administers their own medication. Medication is administered by staff who have received training in this area and have had their competency assessed. The names of staff who are able to administer medication are listed in the front of the administration records. This list needs to be up dated to ensure that it only contains names of people who still work at the home. The senior carer on each shift administers medication and assurances were given that all night staff had received training in this area. All medication is signed for when it arrives at the home and when it is administered or refused. This gives a clear audit trail. One person who was prescribed medication on an as required basis did not have a protocol in place to state when this medication should be given. Protocols were in place for other as required medication. Guidelines are in place for the use of as required medication for people who have epilepsy. It was noted that there was an error in the dosage instructions for this, which were displayed in the medication room. This potentially places people at risk of serious harm and was pointed out to the staff and manager at the time of the inspection. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has systems in place to investigate complaints. Evidence: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. The Annual Quality Assurance Assessment (AQAA) states that everyone living at the home, and/or, their representative has received a copy of the complaints procedure. A copy is also available on the noticeboard in the home. The home has received three complaints since the last key inspection. All have been investigated using the homes complaints procedure. Staff receive training in the protection of vulnerable adults as part of their induction and there are up dates in this training available to all staff. The home are aware of how to contact independent advocates and these have been used to support people. There is evidence of a robust recruitment procedure which minimises the risks of abuse to people who live at the home. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: As detailed in the previous section, serious issues relating to the monitoring of health were noted which potentially places people at risk. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 1 Church Road is comfortably furnished and decorated. Some people living at the home may benefit from a quiet lounge where they can spend time away from the busy areas of the home. Evidence: 1 Church Road is an older style house which provides accommodation on two main floors. All bedrooms are used for single occupancy. Everyone living at the home has their own en suite bathroom and equipment has been put in place to meet their individual needs. Bedrooms are spacious and all seen had been personalised to reflect the tastes of the individual. Bedrooms are locked by keypads, which not everyone living at the home is able to use. Communal areas are on the ground floor and are accessible to people with all levels of mobility including wheelchair users. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: At the time of the last key inspection one lounge was being used as a bedroom but this has now been reinstated as a lounge giving people more communal space. In the last 12 months some communal areas have been decorated and re carpeted making the home appear brighter and fresher. The two lounges are next to each other. On the day of the inspection the television was on in both lounges and at times noise levels were high. There is no lounge where people can spend time quietly. Care staff are responsible for cleaning and laundry in the home. At the time of the inspection all areas seen were clean and tidy. Care Homes for Adults (18-65 years) Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment practices minimise the risk of abuse to the people who live at the home. Staff are happy with the improved opportunities for training and formal supervisions have begun. Evidence: The home employs 25 care staff, 14 have a National Vocational Qualification (NVQ) in care at level 2 or above. (Figures taken from AQAA) Staff spoken with felt that morale in the home was improving and all felt well supported by the new management structure. Staff said that there were usually enough staff on duty and duty rotas seen confirmed this although staff numbers sometimes appear to fall at weekends. There are usually 6 or 7 members of staff on duty in the morning and 4 - 5 in the afternoon. Overnight there are 3 waking night staff. In addition to their care role staff in the home are responsible for cleaning, cooking and laundry. The home is currently recruiting an additional 2 members of staff. In the AQAA the home highlighted a high staff turnover as a barrier to improvement. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: One person is assessed as requiring one to one support and it was observed that this was provided throughout the day. Staff seen appeared task focused and although there were always staff available in the communal areas they did not constantly interact with the people living at the home and there was limited evidence of meaningful occupation for people being initiated by members of staff. People living at the home appeared very relaxed and comfortable with all members of the staff team. Staff said that training was improving and there were several training courses booked. Whilst a training programme has commenced, and has been welcomed by staff, it was evident that some staff required further training to fully meet the needs of the people who live at the home. Records of training were not always clear and up to date but a training matrix has now been put in place to ensure everyone receives appropriate statutory training and training in other appropriate subjects. We looked at the recruitment records of the three most recently appointed members of staff. These gave evidence of a robust recruitment procedure that minimises the risks of abuse to people living at the home. One new member of staff told us that they had received a good induction and had been supported well by more experienced members of the team. The home has begun to provide formal supervision to all staff and the manager stated that this is ongoing. Care Homes for Adults (18-65 years) Page 24 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been inconsistent management in the home meaning that shortfalls in the service have not been identified and acted upon. The Quality Assurance systems in place are not robust enough to ensure that weaknesses in the service are identified and addressed to ensure the safety and wellbeing of people who live at the home. Evidence: There has been no registered manager for the past 12 months but the company that owns the home has ensured that there has always been a manager allocated to the service. Under the section in the AQAA Barriers to improvement the home wrote The lack of consistent home manager has hampered our progress in developing the service as we would have liked. A new manager has now been appointed and they were available throughout the Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: inspection. The new manager has the experience and skills to manager the home and demonstrated a commitment to improving the quality of the service provided. Although the new manager has only been at the home two weeks they were able to share their observations and some plans for the future with us. Staff spoken with said that the manager was open and very approachable. In addition to the manager there is a deputy and 3 senior carers. Throughout the day there is always a senior member of staff on duty who co-ordinates the shift. Overnight there is a senior member of staff on call and contact details are available on the duty rota to ensure that people are able to contact them easily. The company has quality monitoring processes in place which include formal monthly visits by the area manager. At the time of this inspection records of these visits were not available and therefore we were unable to see if any areas for improvement had been highlighted or any action planned to address shortfalls. It is concerning the shortfalls identified in this report, particularly those in respect of healthcare monitoring, have not been identified and addressed by the companys own quality assurance systems. Particularly as similar issues were raised at the previous key inspection. Staff stated that staff meetings were held and this was an opportunity to share views and ideas. Minutes of staff meetings were not available at this inspection. The minutes of a recent meeting for people who live at the home was available on the notice board. The home is maintained to a good standard and all equipment is regularly serviced. A fire log is maintained and this shows that all fire detection equipment is regularly tested by staff at the home and serviced by outside contractors. All staff have received up to date fire safety training. The home has a system for recording accidents but at the time of this inspection all accident records could not be easily found. The home informs the Care Quality Commission of significant event in the home. A up to date certificate of insurance is in place. Care Homes for Adults (18-65 years) Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 6 15 The home must ensure that support needs and plans are reviewed This is to ensure that peoples individual and changing needs continue to be met appropriately or to assist the home in identifying when it is no longer able to meet an individuals needs. 27/02/2009 Care Homes for Adults (18-65 years) Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 (1)[d] Care plans must be drawn up in line with the needs identified in pre admission assessments. All staff must be familiar with individual care plans. To ensure that people receive the appropriate care and support to meet their assessed needs. 30/11/2009 2 6 15 (1) [2] Care plans must be kept up to date and give clear guidance for staff. Staff must be familiar with the care plans for each person. To ensure that people receive care in line with their assessed needs and wishes. Also to ensure that the effectiveness of planned intervention can be monitored and evaluated. 31/12/2009 Care Homes for Adults (18-65 years) Page 28 of 31 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 3 19 12 (1) The home must ensure that people receive the care they require to meet their healthcare needs. To ensure that people receive the healthcare support that they need and that peoples conditions are monitored and any concerns addressed. 20/11/2009 4 35 18 (c) The home must ensure that all staff have the skills and training to meet the needs of people who live at the home. To ensure that people receive appropriate care and social stimulation. 26/02/2010 5 37 8 (1) [a][b] A manager must be registered with the Care Quality Commission. To ensure that the home has consistent leadership and is able to improve and develop the service. 01/03/2010 6 39 24 Quality Assurance systems must be more robust. To ensure that shortfalls in the service are identified and action can be taken promptly to address issues raised. 31/12/2009 Care Homes for Adults (18-65 years) Page 29 of 31 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 3 It is recommended that before people are admitted to the home the skills required by staff are reviewed to ensure people receive skilled care and management from the point of admission. The home should ensure that all personal information relating to people who live at the home is securely stored. The home should explore alternative communication methods to enhance decision making for people who live at the home. Risk assessments should clearly identify the risk to the person and all staff should be familiar with these. The home should ensure that meaningful activities are in place for everyone living at the home. There should be an up to date list of people who are authorised to administer medication. The home must ensure that clear individual protocols are in place for the everyone who is prescribed medication on an as required basis. To promote privacy the home should ensure that bedroom doors are fitted with locks that people living at the home are able to use easily. The home should consider the provision of a seating area away from the busy areas of the home to enable people to spend time quietly. 2 3 6 7 4 5 6 7 9 11 20 20 8 26 9 28 Care Homes for Adults (18-65 years) Page 30 of 31 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). 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