Inspection on 11/05/09 for 1 The Glade

This inspection was carried out on 11th May 2009.

CQC found this care home to be providing an Adequate 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1 The Glade 23/11/09

1 The Glade 17/06/08

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

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Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 1 The Glade 1, The Glade Bromham Beds MK43 8HJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sally Snelson     Date: 1 1 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: 1 The Glade 1, The Glade Bromham Beds MK43 8HJ 01234827068 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Fremantle Trust care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care home Code PC to service users of the following gender: Either 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 The Glade is a home for up to six adults with learning disabilities, managed by Fremantle in conjunction with Bedfordshire Pilgrims Housing Association - who are responsible for the maintenance of the building. The home is a large bungalow situated on the outskirts of Bromham village, approximately 5 miles from Bedford town centre. There are six bedrooms, a dining room, 2 lounges, a relaxation room, and a family room. In addition, a staff office, laundry, kitchen, bathing and toilet facilities are provided. There are no facilities for people with a physical disability, apart from one toilet. The bungalow is set in substantial grounds, which includes a separate building, used as an activity room. Some of the people living in the home demonstrate behaviours, that Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home challenge, and to this end, access to the home is through a secure gate, controlled by staff. High fencing surrounds the home, meaning that the people living in the home are free to roam safely, within the bungalows grounds. Parking for several cars is available to the front, and side of the building. The homes Statement of Purpose sets out that the home aims to provide a specialist service for people with Autistic Spectrum Disorder, or associated needs. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out in accordance with the Care Quality Commissions (CQC) policy and methodologies, which requires review of the key standards for the provision of a care home for adults that takes account of information received about the service since the last inspection. Information from the home, through written evidence in the form of an Annual Quality Assurance Assessment (AQAA) has also been used to assess the outcomes within each standard. Evidence used and judgments made within the main body of the report include information from this visit. Sally Snelson undertook this inspection of 1 The Glade. It was a key inspection, was unannounced, and took place from 10:20hrs on the 11th May 2009. Care Homes for Adults (18-65 years) Page 6 of 32 Marion Gant, the manager, was present for the inspection and Liz Harris the Operational Manager attended the final feedback. Feedback was given to the manager throughout the inspection. During the inspection the care of two of the four people who used the service (residents) was case tracked in detail. This involved reading their records and comparing what was documented to what was provided. None of the residents were able to verbally participate in the inspection process. Any comments received from staff about their views of the home, plus all the information gathered on the day was used to form a judgement about the service. The inspector would like to thank all those involved in the inspection for their input. What the care home does well: What has improved since the last inspection? What they could do better: Since the last inspection the service had started to address some of the requirements from the previous inspection, but there remained some outstanding requirements. Normally we would consider enforcement action when a service does not address requirements made at a previous inspection. In this case we have accepted that the manager and the operational manager for the home have changed. We have therefore re-made some requirements and will visit to ensure that they have been met. We have explained to the manager that meeting requirements is not an option, and she is responsible for ensuring that those tasks assigned to other members of staff have been carried out. The requirements made include:- Care Homes for Adults (18-65 years) Page 8 of 32 The Service Users Guide must be completed. It must be apparent that care and support is delivered in a way that is acceptable to the resident. There must be evidence that support plans are kept under review. The manager ensures that the healthcare needs of the residents are recognized and procedures are in place to address them. The furniture must be suitable for the needs of the people using the service. The service must ensure that people working at the home are committed and suitably trained to undertake the tasks defined to their role. The manager must ensure that all policies and procedures are implemented by all the staff and that there are processes in place to audit and improve this. Polices and procedures must be kept under review. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 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 32 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 had some documentation which told people using the service, and their representatives, about the home, but it was not available in a format that could be suitable for the residents. Evidence: We were provided with a statement of purpose that had been reviewed three times since the last inspection and consequently included the most recent information. We were disappointed that the Service users Guide was still work in progress. The manager showed us a document that had been produced but needed some alterations. This requirement will be remade as some work had been undertaken, but the service must be aware that failure to met requirements within the given timescale could lead to us taking enforcement action. This will be discussed further in the management section of this report. There had been no new admissions to the home since the last inspection, in fact there had been no admissions under the new providers. The manager told us that she had Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: been asked by a social worker to consider an admission but had not proceeded as it was apparent that the prospective residents had conditions outside the registration categories. This meant that the staff team would not have the skills and experience to provide for this persons needs. Since the last inspection the staff team had undertaken a variety of training and were particularly focusing on training that enhanced their skills to care for those residents with a learning disability, especially autism. Residents had contracts, however the manager advised us that the contracts needed to be reviewed as they did not closely reflect what the service provided. She advised us that this was in hand. Care Homes for Adults (18-65 years) Page 12 of 32 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. There was little evidence to show how people living at the home had made decisions about their care and undated documentation could cause confusion when providing care. Evidence: We looked at the care plans (referred to by the service as support plans) for two of the residents. There were plans for most aspects of care. In most cases they had been written in detail and hand written notes suggested that some of the plans were being reviewed and that goals were being considered. However most of the paperwork, despite having the designated areas for dates and signatures, had not been dated and signed, so it was not always possible to know when it had been written and if, and when, it needed to be updated or reviewed. It was apparent that some plans of support had not been reviewed since they had been written. The regulations state that care plans must be reviewed at least six monthly, but the company expects to see monthly reviews. We discussed the need to show that plans had been reviewed when Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: no changes were made. The manager confirmed that she was aware that some plans had not been reviewed recently, but that other plans had been changed and were upto-date. There was no evidence that the plans had been written with the involvement of the resident or someone on their behalf. In an attempt to be person centred the plans had been written in the first person, but there was nothing to support how the residents had made the decisions that had been recorded. For example comments such as, I want staff to...., needed to be supported by documentation as to how staff knew this. The manager told us that until staff had worked with the residents on a comprehensive communication passport this would not be wholly possible. This had also been work in progress for some time. The manager was aware that residents had not had an annual review of their care by the placing authority and as a result had contacted the reviewing officers and secured dates for these reviews. Since the last inspection people living in the home were being supported to take more risks and staff were supporting them to do this. Most noticeably more areas of the home were open to residents. Appropriate risk assessments were in place, but once again if they were not kept under review, accurately documented, and agreed by the manager, or someone qualified to make the assessments they were not meaningful. The daily log was broken down into sections so that staff had to record something about a persons behaviours, sleep pattern and how and what they ate. The daily logs were well written. Care Homes for Adults (18-65 years) Page 14 of 32 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. Staff provided opportunities and support for people using the service to attend activities. However it was not clear how these activities met the needs of the residents. Evidence: Each of the residents had an individual activity plan. It was clear that since the last inspection staff were spending more time supporting people to learn skills and do activities that took them out into the community. For example residents went horse riding, swimming and visited the local pub. Three residents had enrolled in college courses. However most of the activities followed a rigid timetable that accommodated the staffing levels. For example the plan included a visit to the local pub that stated the activity would take place between 7pm and 8pm. When we asked about the timing of this we were told ..that is too long, he drinks his drink quickly and is ready to leave in minutes. This comment did not convince us that this was an activity that the Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: resident wanted to do, or appeared to enjoy. The manager had written in the AQAA we need to be creative and look at ways that service users can choose the activities they wish to attend, for example which film to watch at the cinema instead of it being chosen for them. One resident attended an Afro-Caribbean day centre for people with learning difficulties. This had been arranged to meet his cultural needs, but as currently there were no other people attending the centre the staff told us it was not that beneficial. Work had been done to improve the facilities in the kitchen and to allow residents to enter the kitchen at times when it was considered safe for them to do so. In addition a more user friendly kitchen and dining room had been installed in the activity room. This allowed one resident to go with one member of staff and prepare a meal, or part of a meal. This provided uninterrupted one-to-one time and gave staff the opportunity to assess the progress of the resident and achieve some quality key working time. One resident in particular was responding well to this. The manager was aware that this needed to be more structured. Most of the meals were prepared by the staff and residents were encouraged to help with preparing the table and clearing up. The menus were planned in advance knowing the likes and dislikes of the residents. There was a choice of two main meals each day. The majority of the residents had access to an advocate and some were in contact with family members. Last year three of the four residents had a break from the home; the break was supported by staff. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to health care services both within the home and the local community. Evidence: All of the residents required support with their personal care. The help required was documented in the care plans, but would benefit from more detail, particular for one resident whose needs were changing quickly. The staff told us of the support they had given to a resident who was undergoing medical tests and had required a hospital admission. This resident had been supported to manage weight loss with advise from the dietitian who prescribed nutritional supplements. However another residents records indicated a 4kg weight loss in the four months between being weighed. There was no explanation or evidence that this had raised a cause for concern with staff and despite the weight loss this resident had not been weighed again since January 2009. The manager was unable to provide any records of regularly weighing and told us that it was apparent that this resident was not losing weight so one of the weights must be incorrect. We would have expected a more pro-active approach to this situation. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: The manager had acquired some aids for the residents whose general care was deteriorating and had requested assessments for additional equipment. Since the last inspection there had been a number of medications errors that had resulted in referrals to the safeguarding team. In response the manager had instigated additional training and set up an audit of medications which had been daily in the first instance, but was now less frequent. Practises had not improved immediately, but it had allowed the manager to identify any problems promptly. During this inspection we checked the Medication Administration Record (MAR) sheets for each of the residents and found no problems with the recoding of the medications. Staff were using omission codes correctly and recoding variable doses on the reverse of the MAR sheet correctly. Medications were appropriately stored in a cabinet. Monthly deliveries were signed into the home, but rather than using the MAR sheet to record the medications that were carried forward from the previous month, staff used the book that was used to record the audits. It was therefore time-consuming, but not impossible, to reconcile all of the medications (whether provided in a blister pack or not). At the time of the inspection no residents were needing Controlled drugs (CDs). However there was a cabinet available for these to be stored in. There was evidence that staff spoke to residents families about end of life wishes. Care Homes for Adults (18-65 years) Page 18 of 32 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. Staff were aware of the procedures for keeping people living at the home safe. Evidence: There was a complaints procedure as part of the Statement of Purpose, but it was not in a suitable format for the people living at the home. Fremantle had produced a leaflet in words and picture encouraging people living at the home to speak out if there was a problem. The manager told us that there had been no complaints made to, or about, the home since the last inspection. She was aware of the need to document any complaint investigation and keep a record of how a complaint was dealt with. There was evidence that incidents were correctly reported under the safeguarding of vulnerable adults (SOVA) policy, and to us via Regulation 37, and to the safeguarding team at the Local Authority. Service users monies were being appropriately held on their behalf and used correctly. Staff were now only checking the balances of service users monies daily. Staff undertook Non-Aggressive Physical and Psychological Intervention (NAPPI) training so as to not have any need to use any form of restraint on residents. This Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: training had resulted in staff using deescalation techniques to manage residents challenging behaviour. There had been some confusion as how staff should prevent residents harming themselves during medical procedures. This had resulted in a SOVA referral and staff updating the NAPPI training and reviewing their understanding of the procedure on restraint. Care Homes for Adults (18-65 years) Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean and tidy, but it could be made more homely. Consideration should be given to the type of furniture needed by people as they became older and frailer. Evidence: The home was operated in conjunction with Bedfordshire Pilgrims Housing Association who were responsible for the maintenance of the building. At the last inspection we were concerned that the kitchen was locked and not accessible to any residents and that the kitchen units needed to be replaced and a larger cooker provided. This had been completed and we witnesses residents entering the kitchen area at times. As already stated a kitchen that could be used by residents had been installed in the activity room, which was separate to the main building. A tour of the premises indicated that the there had been some improvements to the environment, including redecoration of the home, and push taps in all the bathrooms so that the water did not have to be kept turned off because one resident might turn on the taps and cause a flood. A representative from the housing association met with staff and residents monthly to discuss any future repairs. At the time of the inspection there was a need to replace some of the flooring in a way and with a material that a Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: resident could not pull up. We did not see much evidence that residents had been encouraged to personalise their rooms and some rooms did not appear to have all the recommended furniture. The manager was unsure why there were no handles on the wardrobe and chest of drawers in one resident room. We also noted that there were diagrams on the drawers to indicate what should go in each drawer, however the manager told us that these would be meaningless to the particular resident and did not look homely. Two bathrooms had been redecorated and it appeared that the blinds had not been replaced in these areas. Although we appreciated the glass at the bathroom window was opaque, it would not be when an electric light was needed. Residents were accessing the gardens which were surrounded by fences but there was still a need to make it more user-friendly. We were told that some residents had been involved with some planting in a vegetable patch. One service user who was becoming unsteady and frail was finding it difficult to get comfortable in the low communal chairs that were in the lounge. He had a higher backed chair in his bedroom, and although staff spoke of it being more suitable for him it was not moved. A family room had been created, but to date it had only been used by staff for meetings. The home was clean and generally free from offencive odours on the day of this inspection. At the time of the inspection the main washing machine was out of action, but this was not causing problems, as all the washing was being taken to the washing machine in the activity room. Care Homes for Adults (18-65 years) Page 22 of 32 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. Staff files were well kept and the recruitment practices ensured that residents were kept safe. A variety of training was available to all staff, however further monitoring of staff performance was needed to ensure all staff carried out their responsibilities in full. Evidence: The home had a staff team of 12 care staff. They now only used staff from the bank or an agency in exceptional circumstances. The staff rota indicated that sufficient staff were employed to cover the needs of the residents. As already mentioned activities were also dependent on the staffing levels. However throughout the inspections we discussed with the manager areas where staff had not completed documentation and had not carried through processes and we were told that there were some capability issues with some of the staff team. This was discussed at the last inspection and we would have expected a strong management team to have addressed it by now. However we appreciate that much of the management team has altered over the last year. Fremantle offered staff a variety of training. Training included that which was considered mandatory and that which was specialist to the role. The manager kept a Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: good training record that clearly identified the training that staff had undertaken and the training that needed to be reviewed. The manager was aware of the need to explore additional ways to offer training. For example following the concerns raised about the administration of medication, additional training had been provided, but it did not immediately rectify the problems. It was then followed up with a theory exercise to ascertain that staff had understood what they had been told. To date there had been improvements. The manager attended any training that was newly provided to ensure that it was as she expected and was in-line with Fremantles policies, if it was delivered externally. The area manager reported that recruitment had not been a problem recently and that the staff team were becoming established. This was particularly important as it was known that some of the residents took time to adjust to new staff. During this inspection we examined the files of two existing members of staff and two staff who had been recently recruited. All contained fully completed application forms, including an employment history, Criminal Record Bureau (CRAB) and POVA first checks, and various forms of identification including, passports work permits if necessary. There were references in place, which had been obtained from appropriate referees, and there was a record of the interview kept on file. The company also randomly audited recruitment files. Since starting to manage the home the new manager had reintroduced staff supervision and appraisals on a more regular basis. The manager was addressing issues of training and competency with staff as part of the supervision sessions. At the time of the inspection less than 50 of staff had an NVQ level 2 or above. Care Homes for Adults (18-65 years) Page 24 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager had the necessary experience to run the home and was developing systems to monitor practises, but there was a need for more work in that area. Evidence: Since the last inspection the registered manager for the home had moved to a different post within the company and a registered manger from another Fremantle home had been asked to take responsibility for 1 The Glade. She had started the process to become the registered manager for the home. Throughout the inspection we reminded the manager that she had the overall responsibility for the home, and although she believed that she was not supported by some of the staff team, it was ultimately her who had to ensure that regulations were met. Although the manager did not feel completely supported by every member of the staff team the staff appeared to be receptive to her. One carer said, we have come a long way since Marion came. We now have a purpose. We now need to see this reflected in the standard of documentation that supports the care provided. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: The manager had completed an AQAA and had been open and transparent in this document. However we were concerned about the number of areas that she believed needed to be improved, given that she was responsible for these improvements. We accepted that when dealing with staff who were not completing the processes that were expected of them there had to be a clear audit of how these had to be addressed, but we also expected the task to be completed by someone. For example where weights needed to be recorded monthly if the manager was aware that staff were not doing this she needed to insist they were done and documented as ultimately she was responsible for providing the evidence that this resident has been given the correct care. It would also show that she understood the responsibility of being the registered manager. As already stated if requirements are not met we have to consider enforcement action and this reflects on the management of the home. The company carried out its own audit that included some stakeholder involvement and we were told that the manager was working to an action plan produced from the audit. Policies and procedures were stored in the office but we we were disappointed to read in the AQAA that some had not been reviewed for a number of years. For example, physical intervention and restraint had not been reviewed since 1999 and this area had been the subject of a safeguarding referral, because staff were unsure of their position. It has been reported throughout this report that during the inspections we saw documents that had not been dated and signed and had not been correctly reviewed. The manager must have processes to monitor this. Care Homes for Adults (18-65 years) Page 26 of 32 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 1 5 There must be a service 01/09/2008 users guide that provides the service users with information about the home. There must be a written plan 01/08/2008 for all aspects of care. The plan must be detailed and involve the resident where possible. The registered person 01/08/2008 ensures that the healthcare needs of service users are assessed and recognised and that procedures are in place to address them. This refers to the decision to regularly weigh people and then not act on the information. The homes premises must 01/09/2008 be suitable for its stated purpose; accessible, safe and well maintained; and meet the individual and collective needs of the people living in the home in a comfortable and homely way. This is a re-stated requirement in relation to the kitchen and the fittings and furniture within the home. 2 6 15(1) 3 19 12 4 24 23 Care Homes for Adults (18-65 years) Page 27 of 32 Care Homes for Adults (18-65 years) Page 28 of 32 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 1 5 The Service Users Guide must be completed. This ensures that people living at the home have information about the home. 01/09/2009 2 6 15 There must be evidence that 01/08/2009 support plans are kept under review. This ensures that staff are providing a consistent approach when delivering all aspects of care and support. 3 7 12 It must be apparent that 01/08/2009 care and support is delivered in a way that is acceptable to the resident. This ensures that the person using the service receives the care he wants and is happy with. 4 11 12 There must be clear documentation to support that the activities that residents participate in met their needs. 01/08/2009 Care Homes for Adults (18-65 years) Page 29 of 32 To show that what staff plan for people using the service is what they want to do. 5 19 12 The manager ensures that 01/06/2009 the healthcare needs of the residents are recognised and procedures are in place to address them. This relates to the documented weight loss that was not followed up. This requirement is restated. This ensures that peoples healthcare needs are met at all times. 6 32 19 The service must ensure 01/08/2009 that people working at the home are committed and suitably trained to undertake the tasks defined to their role. This ensures that all the staff are completing the roles expected of them. 7 37 17 The manager must ensure 01/07/2009 that all policies and procedures are implemented by all the staff and that there are processes in place to audit and improve this. This ensures that people using the service receive the correct care. 8 40 17 Polices and procedures must 01/09/2009 be kept under review. Care Homes for Adults (18-65 years) Page 30 of 32 This indicates that the home is working to current good practise. 9 41 15 Staff must ensure that all documentation is correctly recorded. This must then be audited by the manager. This ensures that the correct care is provided at all times. 01/07/2009 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 2 3 9 32 33 There should be evidence that staff continue to support residents to take risks. The service should encourage and support more staff to complete NVQ training Continued consideration should be given to staff team reflecting the gender composition of the service users. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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