Inspection on 07/07/09 for 14 Colne Road

This inspection was carried out on 7th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

14 Colne Road 21/10/09

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: 14 Colne Road 14 Colne Road London London N21 2JD     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: Gail Freeman     Date: 0 7 0 7 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 35 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 35 Information about the care home Name of care home: Address: 14 Colne Road 14 Colne Road London London N21 2JD 02083609988 02083609988 14colne@hillgreen.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hillgreen Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 6 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: 6 The registered person may provide the following category of service only: Care Home only - code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Date of last inspection Brief description of the care home 14 Colne Road is a detached house designed to meet the needs of its residents. It is situated in the Enfield area of North London within walking distance of local amenities. There are six bedrooms. The house has a lounge , dining room, bathroom, large kitchen, utility room, a total of eight toilets. Hillgreen Care aim to provide a home and normal life at 14 Colne Road for six adults between the ages of 18 - 65 years, with learning disabilities, challenging behaviour and autistic spectrum disorders, by enabling then to settle and integrate within their own community, to become accepted and Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 6 Brief description of the care home valued as individuals and to enjoy the facilities and amenities available to all people within the community, whilst also providing professional guidance and support to enable then to live independently. Each person is encouraged to exercise their right to choice and take responsiblity for their daily lives, also to do as much for themselves as possible within their daily routine. High standards of support are maintained so as to optimise each persons quality of life. Fee levels for 14 Colne Road range from £1500 to £2200 per week. Care Homes for Adults (18-65 years) Page 5 of 35 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 Inspection was carried out by two inspectors and lasted from 9:40 to 16:40. The lead inspector was Gail Freeman and she was accompagnied by Fay Bennett. Inspection included meeting individually with the acting manager, Pamela Small, Senior Manager, Dennis Yamah, one service user, a Senior Support Worker and a care worker; the lead inspector was given a tour of the building and was introduced to the other two residents. In addition three service users files, three staff files and other administration files were inspected. At the time of inspection there were four people living in the home, one of whom was on a respite stay whilst considering a permanent placement, and one of whom was in hospital. Before the inspection, Ms Small had submitted the Annual Quality Assurance Assessment (AQAA) for the home with some information about the service. At the Care Homes for Adults (18-65 years) Page 6 of 35 request of the Inspector, she had also sent out CQC surveys to staff, service users, service users family and three health and social care professionals. We have received completed surveys from two service user family members and two staff. Ms Small started at the home approximately four weeks before the inspection day. The previous registered manager left the home in March 2009. On the day of our inspection, the home was also inspected by representatives of the homes insurance company. Mr Goddard, Responsible Individual, managed this process for the home. The Inspectors would like to thank all the service users and staff for their hospitality and cooperation with the inspection on such a busy day. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 35 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 35 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. Admissions are not made to the home until a full needs asessment has been undertaken. This asessment includes consideration of the care planning of community health and/or social care professionals. Prospective residents are given the opportunity to spend time in the home. Evidence: All service user files inspected included care plans and risk assessments. Care plans include a detailed and accessibly presented profile of what you need to know about me as well as a detailed personal care description and a list of activities that are needed or aimed for. Files included preadmission information from the Commissioning PCT and/or Local Council. One survey response from a family member says that they always get enough information about the sevice to help them make decisions. The other family response says they sometimes get enough information. Both staff surveys say they are always given up to date information about the needs of the people they support or care for. In interview staff said they were given time in induction to study service user files. Care Homes for Adults (18-65 years) Page 10 of 35 Evidence: Ms Small talked about visiting a prospective resident at his previous home as part of the assessment before admission to ensure information in the assessment is accurate and complete. The AQAA states that they make sure that service users do a visit before they move in. There is a statement of purpose and service user guide for the home. The AQAA and files show that all admissions were planned. Care Homes for Adults (18-65 years) Page 11 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service understands the right of individuals to take control of their own lives and to make their own decisions and choices. However, this does not always happen in practice as the care planning process is, in some aspects, without adequate detail and without adequate follow up. Risk management is not good enough as risk assessments lack detail about physical intervention and do not provide the protection of the explicit agreement to practice by health and social care professionals. Evidence: The AQAA notes that all residents require support with personal care and that three people have mental health needs and two people have communciation difficulties. Care plan format is appropriate and enables a person focussed process. Each resident has a key worker although care planning does not include the identification of that person by name. One care plan inspected was not signed or dated. One care plan made reference in the profile to the adherence to a particular culture and religion by that service user which is not followed up in action plans or any daily Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: recording inspected. The care plan includes a list of social activities that are needed or liked and the daily records showed some of those things happened; e.g. gardening and visits to the cinema. However other more developmental activities, like going to college, are not mentioned in action planning or in in daily records inspected. A recent accident involved a service user going through a skylight. There is currently an investigation underway by the local authority into this incident. In the meantime the provider has taken action to ensure the skylght window is secure and further checks of the premises to ensure safety and security. One service user file included a number of risk assessments which were detailed in some aspects and dated. These risk assessments included planned restrictive practices and guidelines for use of physical restraint that were not detailed enough and did not include any reference to health and social care community professional input. The guidelines included a description of a Primary Restraint technique. Although guidelines reinforced the need for this to be a last resort technique for trained staff it is of concern that they are within a service user care plan with no authority for such plans within the multidisciplinary professional review. The file of this same service user included a Positive behavioural Support plan dated 10/06/09 which is detailed and Ms Small said staff should be following for practice and reporting. However there was no evidence that such recording is used although feedback from staff does implicitly include reference to some elements of this plan. Another service user did have risk assessments about aspects of his daily life but not about significant behaviour that was noted in preadmission information. This service users file included a care plan and action plan signed by the service user but it had not been up dated since his admission to the home. All the actions noted were the same;i.e. I would like to be supported. To be supervised and supported by staff at ..... Risk assessments are detailed, dated and with review date also noted. Physical intervention information is unclear about if, what, and when to use. There is no evidence of multidiscipliary agreement or agreed intervention. The daily log records viewed for 23/06/09 to 06/07/09 show a basic record of personal care and how day was spent. Records do not correspond to the weekly/daily activity plan. Records do not show that those activities planned for are followed, offered or refused. Ms Small informed inspectors that a referral has been made to the local authority for an assessment of the service user to be carried out under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty (DOL). This was not done during the admission Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: assessment process. Family member survey responses varied about whether they felt the service met the needs of their relative. One ticked the box for always the other ticked sometimes. Staff verbal feedback seemd unclear about the issue of physical intervention although all noted that talking calmly to the service user was significant and what worked. Care Homes for Adults (18-65 years) Page 14 of 35 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. Service users are supported to go out into the community and to maintain appropriate personal and family relationships. Generally staff are aware of the need to support service users to develop their skills, including social, emotional, communciation, and independent living skills but improvement is needed in both planning and and following the plans. Whilst statement of purpose, policies and staff are clear about the need to respect the individual service user, practice needs to be improved in this regard. Evidence: On the inspection day three residents were at home. During the morning one service user went out to the GP with a member of staff to pick up a prescription for another sevice user. They then both went on to do shopping for him. He said he enjoyed that and was pleased with his purchases. Later, another resident went out to the local park with the two members of staff. This was part of his care plan. The television was on in Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: the communal lounge at times during the day. The numbers of service users in the lounge varied. There was always at least one member of staff in the lounge with service users. One completed survey from a service users relative ticked to say the home always supports people to live the life they choose. The other said they do sometimes. One relative noted in response to the question what could the service do better access to the community and activities programme amongst other things. Staff surveys ticked to say the home usually has enough staff to meet the individual needs of all the people who use the service. One staff says, about what the home does well, the home ensures every resident are well cared for and made comfortable by ensuring their care plan is adhered to in maintaining and rehabilitating them. Care planning was mainly appropriate re activities and social activity and opportunities for personal development. The record daily did not correspond to the weekly/daily activity plan for one service user. Records do not show that those activities planned for are followed, offered or refused. From talking to service users and staff and inspecting files, it was clear that contact with between service users and their families are encouraged appropriately. Daily records showed that one service user had been to a family party at the weekend. One relative survey had a tick to say that the home always helped the relative and service user to keep in touch. The other survey ticked for sometimes. At least two service users have a one to one or two to one staff to service user ratio contracted and maintained. Interaction between service users and staff observed by inspectors were appropriately respectful and informal. Staff know about each individual persons strengths and needs. However an incident record included the term naughty about a resident. When a member of staff was asked about how staff dealt with challenging behaviour the response included saying that the resident had to be good. Ms Small said that she had changed the menu management. At present shopping is done by supermarket Internet shopping. She aimed for service users to be involved and to shop more locally. Fridge food included quite a lot of value brands although there were appropriate items available; e.g. eggs, milk, yoghurt. There was also a good store of fresh vegetables and fresh fruit was accessible and displayed in the kitchen. The lunch of roast chicken and potatoes and mixed vegetables was cooked by staff. The food was from the freezer. A service user was seen to be eating alone in the kitchen with a member Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: of staff sitting with him. All service users looked well nourished. Care Homes for Adults (18-65 years) Page 17 of 35 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. Service users have access to local health care services in the home and in the local community. The service usually responds appropriately to the health needs of service uses but there have been gaps in following care plans in this regard. Medication adminstration records are up to date. Evidence: The family member survey reponses vary in regard to whether the care received is what they would expect or have agreed with one person ticking for always and one ticking sometimes. Observation on the day of inspection showed staffing levels required on trips out were followed. Staff practice respected service user privacy appropriately; e.g. knocking on doors, explaining actions and and obtaining the service users permision to enter their bedroom. Records inspected showed active involvement of health and social care professionals in the care of the service users and appropriate follow up by the service to events such as appointments and change of medication. The involvement has included visits to the home. However two residents should have had weekly weight recorded as stated in the care plan but no such recording was found. Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: The service user who is in hospital has a member of staff from Hillgreen Care with him at all times and Ms Small said she tries to visit him everyday. Medication has been transferred to the Boots dossette system. There is a returns book although there were no entries when inspected. Ms Small confirmed that there had been no returns as yet. Staff administer medciation to all service users that have prescriptions. Records for medication administration were up to date. The medication cabinet is appropriate from a safety point of view although Ms Small is awaiting a dossette storage box. Care Homes for Adults (18-65 years) Page 19 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although generally communication within the service and between the service and involved significant others is appropriate, service user safety is compromised by lack of staff knowledge and expertise in relation to recording, reporting and safeguarding procedures. Evidence: One service user when asked said he tells staff when he wants things changed or if there is something he doesnt like. He was observed to talk freely with staff. One completed family survey was ticked to say that they were always kept up to date with important issues affecting their relative, that they knew who to complain to and that the service always responded appropriately if they raised any concerns. Another relative said that they were sometimes kept up to date, knew who to complain to and the service sometimes responded appropriately. Staff said that induction included being told how the organisation was structured and that they were able to talk to senior staff. Staff surveys were ticked to say that they knew what to do if someone has a concern about the home. One ticked often and one ticked regularly in response to the question does your manager give you enough support and meet with you to discuss how you are working. There were no complaints in the complaint book. We had not received any complaints about the service before the inspection. Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: We had recently received two separate notifications from the home about two separate significant incidents involving different service users where their physical safety was compromised. One service user was admitted to hospital and one was unhurt. One notification had been timely but the other was not within expected timescales. The timecales for the homes notification to the local authorities had been the same as to CQC. The service is cooperating appropriately with the local councils Safeguarding Adults process. The daily log noted a recent incident stating a resident was restrained by staff for 20 minutes. The same log also noted for the same day and two days later incident when staff were physically attacked by a service user. The records were unclear; e.g. using words like restraint and agitation with out describing what that really meant. When asked about the above incidents, Ms Small said she hadnt known about them until that day and that she was in the process of investigating. She also said she did not know whether the restraint procedure had been approved by health and social care professionals. Ms Small stated that she would inform the social worker after her investigation. The lead inspector instructed her to do so immediately. After Ms Small had spoken with staff she told the inspectors that the staff in using the word restrained had not meant that the resident had been physically held. She said, in explanation, that English was not the staffs first language. A plastic wallet, labelled with a service users name, was found in an unlocked filing cabinet. Care Homes for Adults (18-65 years) Page 21 of 35 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 is clean, tidy and relatively well maintained although the lack of soap and towels in some areas could compromise health and safety. At the moment there is enough space and facilities for service users. If sleeping in staff continue to be used at night this may be compromised. Evidence: Service users spoken with said that they liked their bedrooms and were comfortable. Relative surveys did not raise any concerns about the comfort of the home although one person said the furniture was not of a good enough quality. On the day of inspection the home was seen to be clean, tidy and without unpleasant smells. The decor and furnishing was uncluttered but appropropriate. The kitchen also has dining space and furniture and is homely with good access and views of the garden. Resident bedrooms viewed were individual and included the personal belongings of the individual. One service users bedroom televison was not working properly because of the arial. He had complained to the staff about this. Usually night staff cover was waking staff only. During the week preceeding the inspection additional sleeping in night staff had been used. As the home is not up to Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: full occupancy, the staff used the empty bedroom. There was no soap and paper towels by the kitchen sink and the up stairs and downstairs toilet. Appropriate certificates were on view but the Care Standards Registration Certificate for the home needs to be up dated by the Care Quality Commission. The fire safety testing and drills are up to date as is the certification for the fire safety system, gas applicances, electrical installation and public liability insurance. The front door has a security camera and lock. There was evidence of appropriate strengthening of window locks/restraining devices in response to significant events. Care Homes for Adults (18-65 years) Page 23 of 35 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 recruitment is mainly carried out in a way that safeguards service user safety. Staff induction is appropriate. However The lack of experience and training in the new staff team does mean that the aim of all staff and management for the provision of good care is undermined. Evidence: Hillgreen Care is managed centrally by Hillgreen Care although they do bring in other training organisations such as the National Autistic Society. The week before the inspection, staff at 14 Colne Road undertook challenging behaviour training. Mr Yamah said that annual appraisals will identify what training staff need. There was an example on file of a care worker, who had worked for Hillgreen Care at another home before he came to 14 Colne Road, having NVQ 3 as an aim which was achieved. All staff talked about a good induction and files showed signing and dating on completion when policies/handbook were received. The content list was appropriate. Mr Yamah said that staff worked at other Hillgreen Care homes as part of their induction. Staff files inspected had not have any certificated training dated since the home opened. One person did have certificated training with HIllgreen Care before the opening of this home. Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: Talking to staff and looking at files, showed that staff experience in dealing with autism and challenging behaviour was limited or non existent before they had started at the home. After investigating the records about restraint, Ms Small said to the Inspectors that English is the second language for staff; that staff are new and still undergoing Hillgreen Training and therefore may not understand the terms used when reporting. One relative survey is ticked to say that the care workers always have the right skills and experience to support/care for their relative. Another is ticked to say sometimes they do. Both staff surveys are ticked to say that always they feel they have enough support, experience and knowledge to meet the different needs of people using the service. Ms Small said she has planned one to one supervison sessions with staff. One staff said she should have had one the week before the inspection but she had been off sick. There was another session planned. There were no up to date supervison notes in staff files. Ms Small said that Mr Yamah visited the home regularly and would provide her one to one session. Senior management were avaiable for contact, reporting and advice. Staff recruitment includes appropriate checks and files had evidence of this except in one case where the CRB on file was not up to date or with Hillgreen Care as the employer. Ms Small checked with her Personnel Department that a Hillgreen Care CRB check had been achieved for this person; later she confirmed that this CRB check was now on the staff file. Ms Small said that recruitment is managed and carried out by the Personnell Department . She was to follow up this gap with that Department. Staff rotas and talking to staff showed that some staff at times work excessive hours; e.g. 85hrs per week, and staff following a day shift with a night shift so that one person was on duty for three days. There was an example of one staff working for seven days with no day off. One relative survey response says that there are not enough staff. A staff response also says the home could do better with the numbers of carers available for night duty. Care Homes for Adults (18-65 years) Page 25 of 35 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 management team are aware of the need to promote safeguarding and the new manager has highlighted some areas where improvement is needed. This new home has appropriate quality assurance and management processes but in practice these have not been effective in identifying the shortfalls in practice. Evidence: Mr Goddard and Mr Yamah are known to service users and staff at the home. Ms Small explained that contact was easy and postive. It was acknowledged by Ms Small and the inspectors that there have been a number of events at Colne Road that have affected staff morale. This includes the unexpected leaving of the original registered care manager. Ms Small says she has applied to CQC to be registered as Manager of the home. Ms Small explained that she had experience of working with older people, disabled children, and younger adults in supported living and in Domicilliary Care. This includes management experience. Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: The AQAA states that Hillgreen Care plans evaluation meetings for the key people in the lives of service users to check out peoples view of the service. Mr Yamah explained that this will be chaired by an independent Hillgreen Care manager. Satisfaction surveys are also planned as is an annual report of the home. Mr Yamah explained that he carries out monthly visits to the home and produces a written report for the home. There is also a weekly managers report of the service. The report allows for communication about incidents, service user well being, staffing training targets, and review of staffing and management support. Mr Yamah also occasionally goes out with an individual service user to check out with that peron about how things are and to facilitate communciation. Mr Yamah reports directly to Mr Goddard. Hillgreen Care also keeps social workers up to date. Ms Small told inspectors that she is aware that staff need more training and is working to ensure service users are supported more effectively in developing independent living skills. It was not evident from inspection that the management process had identified the shortfalls in recording, practice, staff understanding and rota management identified within this report. This is of concern. Mr Yamah explained that the finances of the home are managed by the Hillgreen Care Financial Department. Roger Goddard is appointee for some residents. Service users have individual bank accounts. All benefits etc are payed into these accounts. Resident expenditure is mainly via the petty cash system and then the invoice for care fees and expenditure is submitted and paid out of the residents account. All records of spending is recorded, receipted, and forwarded to the Hillgreen Care accountant. This process is audited by an external accountant and financial statements are brought to the local authority care review meeting. If residents want to spend large amounts arrangements are made for this money to be available from the resident account. Hillgreen Care is in the process of opening accounts for residents at 14 Colne Road. A family member of one resident is the appointee for that person. The building and installations and policies were approved within the registration process which was completed in March 2009. Care Homes for Adults (18-65 years) Page 27 of 35 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 28 of 35 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 1 9 13 Physical interventionmust 22/07/2009 only be used when agreed at a multidisciplinary level. This is so that service users and staff are safe. 2 9 13 Risk assessments must detail 22/07/2009 the agreement about any physical intervention and what intervention must be used. .This is so that staff know what to do to make sure service users are safe. 3 23 37 All incidents must be followed up by management staff and reported without delay to the local authority and CQC as appropriate. This is to ensure service user safety 21/07/2009 4 23 13 Records about incidents must 21/07/2009 be detailed about what happened and by whom in an accurate way. This is to ensure service user well being and safety. Care Homes for Adults (18-65 years) Page 29 of 35 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 6 15 All needs and wishes expressed within the service user care plan must be followed up appropriately in the resulting action plan. This is to ensure that service users know that their assessed and changing needs and personla goals are taken account of in their individual care plan. 20/08/2009 2 9 13 A referral to the local 07/08/2009 authority must be made for an assessment of the service user to be carried out under MCA and DOL in the event and when the need for restraint is identified. This is so that the rights and safety of the service user are respected and assured. 3 12 15 Activity plans arising from care planning must be followed or if not followed reason recorded. This is to ensure that care plans are adhered to and any diversion is monitored and followed up appropriately. 28/08/2009 4 16 12 Communication about and with service users must be age appropriate and non judgmental. 23/07/2009 Care Homes for Adults (18-65 years) Page 30 of 35 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 This is to ensure service users rights are respected. 5 16 16 Opportunities must be given to service users to be involved in food shopping, preparation of meals and menu planning. This is to ensure service users are able to make choices in their daily life. 6 19 12 Weekly weighing must happpen and be recorded if it is identified in the care plan as being needed. This is to ensure that all needs of service users are met. 7 23 13 Staff must inform senior 28/07/2009 staff about significant events involving service users immediately. This is so that there is appropriate followup and notifications. 8 23 16 Service user property must be kept in a safe way. This is to ensure the service user can be sure be sure his property is kept from harm. 28/07/2009 30/07/2009 01/09/2009 Care Homes for Adults (18-65 years) Page 31 of 35 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 9 24 16 Arrangements must be made so that residents televisions work in their bedrooms if they want that. This is so that the service user is as comfortable as reasonably possible. 28/07/2009 10 24 16 Consideration must be given 02/09/2009 to allocation of a space for sleeping in staff that does not encroach on service user space. This is so that service users movement around the building is not affected by staff arrangements. 11 30 16 All hand basins must have soap and towels available. This is to ensure good hygiene practices. 28/07/2009 12 32 12 The hours worked by staff must be reasonable and in line with safe and noninstitutional working practice. This is to ensure service users and staff are safe. 28/07/2009 13 32 18 All staff must have regular one to one supervision sessions at least six times a year. 02/09/2009 Care Homes for Adults (18-65 years) Page 32 of 35 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 This is so that staff have appropriate support and evaluation. 14 34 19 All staff must have an up to date CRB check. This is to ensure staff are suitable for employment. 15 35 18 Staff must be trained to an adequate level in all basic health and safety and practice topics and their understanding of the training evaluated. This must include Safeguarding Adults, Food Safety, First Aid and Infection Control, Managing challenging behaviour. This is to ensure staff are competent to provide appropriate care for service users. 16 37 26 CQC must be sent a copy of each report of the monthly visit to the service by the responsible individual or other persons responsible for the management of Hillgreen Care. This is to enable CQC to monitor progress of the service in meeting requirements. 03/08/2009 02/09/2009 28/07/2009 Care Homes for Adults (18-65 years) Page 33 of 35 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 17 37 8 The proprietor must ensure the home has a registered manager. This is so that service users have the protection of a well managed service. 02/09/2009 18 42 12 Management processes must be reviewed to ensure practice is safe. This is to ensure service user safety. 02/09/2009 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 Care Homes for Adults (18-65 years) Page 34 of 35 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!