Inspection on 01/04/09 for 2 Princess Close

This inspection was carried out on 1st April 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

2 Princess Close 08/04/08

2 Princess Close 13/06/07

2 Princess Close 12/01/07

2 Princess Close 11/01/06

2 Princess Close 26/09/05

2 Princess Close 03/03/05

2 Princess Close 26/08/04

2 Princess Close 11/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: 2 Princess Close 2 Princess Close Keynsham Bath & N E Somerset BS31 2NG     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: Paula Cordell     Date: 0 1 0 4 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 Older People 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 Older People Page 2 of 33 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 Older People Page 3 of 33 Information about the care home Name of care home: Address: 2 Princess Close 2 Princess Close Keynsham Bath & N E Somerset BS31 2NG 01179077222 01179699000 heather.hinton@brandontrust.org 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 Brandon Trust care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 5 The maximum number of service users who can be accommodated is 5 The registered person may provide the following category of service only: Care home ony - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home 2 Princess Close is a detached house, situated in a quiet cul-de-sac, in a residential area of Keynsham. The house has been extended to provide accommodation for five people with learning disabilities. There is one vacancy. On the ground floor there is a lounge, kitchen and dining room. Also on this floor are two bedrooms, a toilet, utility area, and a walk in shower. There is a stair lift to the first floor where there are three bedrooms, a large fourth room currently used as a staff sleep-in/meeting room and a small office space. There is also a bathroom with specialist bath and separate toilet. At the rear of the property there is a patio and small garden that can be accessed by means of a ramp. The home is within easy access of local amenities that include a leisure centre, shops and a park. There are accessible transport routes to Bath and Bristol by both bus and train, and there are bus routes to other local areas. The Brandon Trust operates the home with the day-to-day management being cascaded to Care Homes for Older People Page 4 of 33 Brief description of the care home a registered manager. A review of the management of the home has recently been completed and a new manager with addtional responsibilities has been appointed. The statement of purpose clearly details the staffing levels as two staff working during the day with one member of staff providing sleep in cover at nights. Charges range from 682.60 to 931.91 pounds per week. Care Homes for Older People Page 5 of 33 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit as part of a key inspection process. The purpose of the visit was to review the requirements and the recommendations from the last visit in April 2008. In addition to reviewing the quality of the care provided to the people living at 2 Princess Close. There have been no complaints received by the Care Quality Commission since the last visit. The visit was planned using the information received prior to this and the last visit. This included regulation 37 notifications of incidents that effect the wellbeing of the individuals, the annual quality assurance assessment completed by the provider and Care Homes for Older People Page 6 of 33 correspondence. The home was sent surveys to be distributed to professionals, staff and people who use the service none were returned. During the visit an opportunity was taken to review a number of records that are required in accordance with the Care Home Regulations, including care documentation. A tour of the home was conducted which allowed for discussions and observations to be made with both the staff and the people living in the home. There were three staff on duty during the visit, the newly appointed manager and the previous acting manager who visited on the afternoon of the visit. The visit was conducted over five hours. What the care home does well: What has improved since the last inspection? What they could do better: There has been a period of management change in the home. The registered manager left in December 2008. An acting manager has been in post during the interim period. The new manager commenced in post on the 1st April 2009. It is evident that the home has developed an action plan to address some of the areas where quality of the care can be provided. This action plan is being fully adopted by the new manager. Individuals would benefit from clear guidance being included in the care plan in relation to as and when required medication for the use of anxiety which would ensure a consistent approach. One individual would benefit from a review of their medication for as and when required to ensure it is appropriate. Individuals would benefit from having a larger medication cabinet ensuring that medication continues to stored in accordance with the Royal Pharmaceutical Guidelines. Individuals must be assured that a record of complaints are maintained. Individuals would benefit from a risk assessment conducted on the access to the front of the building and the appropriate action taken to make this more accessible and safe. Individuals must be supported by competent staff that have attended appropriate Care Homes for Older People Page 8 of 33 training based on the needs of the people living in the home. Staff training records should be kept up to date capturing the training that staff have completed. Individuals must be assured that staff have attended appropriate training in safeguarding. 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 Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. Individuals have sufficient information to enable them to make a decision on whether to move to 2 Princess Close. Individuals can be confident that the home completes a thorough assessment of their needs which is kept under review ensuring that the home remains suitable. Evidence: The home has a statement of purpose and a service user guide. These were seen during the last visit. Individuals have been given copies of the information. There has been a major management review within the Brandon Trust which has meant that the management of the home has changed. The Brandon Trust are in the process of putting forward a proposal where by Princess Close and another home will share the same manager. Discussions are still taking place with the Care Quality Commission. The Commission that has superseded the Commission for Social Care Care Homes for Older People Page 11 of 33 Evidence: Inspection. Brandon Trust have started the management changes and the new manager has taken up post from the 1st April 2009. The changes must be clearly documented in the statement of purpose including the role of the manager and the expectations on how many hours they will work in the home and where they will be based. As part of these changes a senior post has been introduced to assist the manager with the day to day responsibilities. The four individuals have lived in the home for many years. The home has one vacancy which the new manager said has been difficult to fill due to changes in services being provided to people with a learning disability. Placing authorities are looking to place in supported living rather than residential care. There was documentation in place that evidenced that the home had completed a thorough assessment of need including obtaining the local authoritys assessment and care plan of the individual prior to them moving to Princess Close. Information about the assessment process is clearly described in the Statement of Purpose and in the organisational policy. Individuals would be offered a trial period prior to making a decision to move to the home. From reading care records it was evident that the needs of the individuals were being continual reviewed. This included the home liaising with other professionals in respect of the suitability of the home and advice on the changing care needs of the individuals. Contracts were in place detailing the fees and what was and not included in the price of the placement. Contracts were available in an accessible format. It was evident that where individuals are able they have signed these. Care Homes for Older People Page 12 of 33 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Individuals personal and health care needs are being met. Gaps in documentation could put an individual at risk in relation to medication as there is no guidance for staff to follow which could lead to an inconsistent approach. Evidence: Two care plans were looked at as a means of determining the processes the home goes through to support the individuals living at 2 Princess Close. Individuals have a service user plan containing valuable information about the person to enable the staff team to support them. Documentation was being reviewed on a six monthly basis. Monthly key worker reviews were being completed for one person, whilst the second person had not had a review since January 2009. The new manager said that this would be addressed. Reviews were clear and demonstrated that they linked to the persons care. Care records included support for the individuals in respect of challenging behaviour, it Care Homes for Older People Page 13 of 33 Evidence: was evident that the staff positively support the person, including talking about what is concerning them with some diverting tactics in place. However, one person had an as and when required (PRN) medication to assist them. Reading daily records it was evident that this was given on a regular basis. One of the records said that this was not having the desired effect. This must be reviewed and discussed with the appropriate professional. The use of the PRN medication was not clearly documented in the plan of care relating to supporting the person with their challenging behaviour. This must be rectified. Good records were maintained in respect of health care. All individuals were registered with the local GP surgery. In addition individuals are supported to attend regular check ups with an optician, dentist and chiropodist. Records were maintained of the visits. Individuals are referred as required to the local Community Learning Disability Team. Professionals involved in the care of the individuals include speech and language, consultant psychiatrists, occupational therapists and a physiotherapist. Information from their visits had been included in the homes care plan. Risk assessments were in place covering a wide range of activities in the home and the local community, including falls. It was noted that it was strongly recommended by a professional that staff complete an eating and drinking course. There was no evidence that this has been completed. Staff stated that three of the four individuals are prone to choking. Risk assessments and guidance were in place in respect of prevention. Medication Administration met with the National Minimum Standards. Records were complete and contained appropriate information and signatures. The home has responded to a requirement to ensure that medication is stored appropriately as it was noted at the last visit a prescribed medication had been left in the kitchen. It was noted that the medication cupboard was full to capacity which meant that topical creams were stored in a bedside cabinet. The home must ensure that the storage is appropriate. The manager said they could obtain another cabinet from a home that has closed. Staff competence on the administration of medication was routinely checked and further training was being provided to ensure that staff had the appropriate knowledge. Brandon Trust has recently purchased an on line medication training package. The manager has identified as part of her action plan that staff will complete a National Vocational Qualification in the administration of medication. Observations of staff demonstrated that they were more aware of ensuring that discussions of a confidential nature should be discussed in privacy in the office upstairs but not in communal areas. The home has responded to a requirement from the last Care Homes for Older People Page 14 of 33 Evidence: visit to ensure that confidentiality is maintained. As previously staff were openly discussing individuals in the dining area which links to the lounge where individuals were watching television, this included general conversations, handovers and telephone conversations. Staff confirmed that this had been discussed with them shortly after the last visit. Care Homes for Older People Page 15 of 33 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a lack of structured activities for the individuals both in the community and in the home which could mean that the people are not being stimulated which can lead to boredom. Individuals are encouraged to maintain contact with relatives. Individuals have access to a healthy diet. Evidence: Care documentation included what the individuals liked to do with their time. Three out of the four individuals have retired and rely on the care staff or day care workers to support them in taking part in meaningful activities. One person attends a day centre for people with a learning disability. From reading social workers reviews it was evident for two of the individuals that there was an expectation that the home would explore how individuals would like to spend their time with an increase in activities. This remains outstanding. During the last visit staff said they were exploring the local area for drop in groups and lunch clubs again staff said that this has not really been fully explored. Care Homes for Older People Page 16 of 33 Evidence: The acting manager said that two of the individuals have been poorly during the winter months and this has meant that they have preferred to stay in the home rather than going out in the community. This was confirmed in health documentation. From speaking with the new manager it was evident that meaningful activities has been identified as an area for further action. The plan is to develop a pictorial resource to enable individuals to have more choices on how they would like to spend their time and look for social groups in the local area that the individuals may like to join. One member of staff said that each person is offered to go out on a weekly basis. This may be shopping or a trip to the local garden centre. One person likes to go out daily to get a magazine and other personal items. Staff were observed supporting this person on the day of the visit to go to the local shops. Another person is supported to visit a relatives grave as this was identified as important to them. Staff said that activities are often offered to the individuals but this is often refused by two of them. Staff said that activities are organised in house including an entertainer visiting every six weeks and games evenings. Again during this visit it was evident that two of the individuals prefer to sit and watch television, listen to music and relax in their home. Staff said that there has been a culture change in the home that has meant that staff feel more comfortable engaging with the individuals in the home rather than the emphasis being on household chores. A member of staff said that the acting manager has addressed this balance and it was evident from talking with the new manager that this was to continue. Individuals may benefit from a more structured plan to their activities so that there is planned activities both in the home and in the community. With staff documenting how successful the activity was or whether the individual refused. There was a lack of documentation on activities being offered. During the visit three of the individuals were sat in the lounge watching television. Staff were busy doing household chores or meeting with professionals. There was a period of three quarters of an hour where there was no staff in the lounge area with three of the individuals. One person was being particularly noisy, other than the television there was no other stimuation for the individuals. Three of the individuals use non-verbal communication to vocalise, so it was difficult to determine their opinions on what it was like to live at 2 Princess Close. Staff in the past have completed makaton training but there was no evidence that this was being used during this visit. Care Homes for Older People Page 17 of 33 Evidence: The manager said that she was planning to review information in the home to ensure that it is more accessible including the complaints procedure, duty rota and resources for the individuals to make more choice including activities and menu planning. This will be followed up during the next visit. Individuals in the past have been supported to go to church. Staff said in the winter months, individuals have chosen not to attend but this will be offered again now the warmer weather is here. There was no documentation to support this in daily records that individuals had been offered. Individuals are supported to maintain contact with relatives and friends as confirmed in care records. The home invites another home over on a regular basis for social evenings. Care planning documentation included information on the support needs of the individuals during meal times. The home has sought guidance from a speech therapist on aids and adaptations that are required to support the individuals and to reduce the risks of choking. Risk assessments were in place minimising the risks of choking. It was a recommendation from a professional that all staff attend an eating and drinking course but from staff training records there was no evidence that this has been completed. The menu demonstrated that individuals had a varied and healthy diet. A large fruit bowl was available to individuals living in the home. Throughout the visit individuals were being offered a choice of refreshments. Staff stated that the menus are planned around the preferences of the individuals living in the home. A daily record is maintained of meals prepared, which demonstrated that there was an element of choice. Care Homes for Older People Page 18 of 33 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. Individuals can be confident that their concerns would be listened too. Funding of the vehicle is not equitable with one person covering the majority of the costs. Good systems are in place to protect individuals however, this could be enhanced if staff attend appropriate safeguarding training. There is a risk that if staff do not attend training they will not follow appropriate procedures. Evidence: The home has an organisational complaint policy that indicates the timescales to respond to complaints. This is available in an accessible format. The individuals living at 2 Princess Close have varying abilities to communicate. It was difficult to determine whether the individuals knew how to complain. However, staff gave reassurances that the where an individual uses non verbal communication this is monitored and staff would act appropriately if individuals were distressed. The Annual Quality Assurance Assessment made reference to the home having one complaint and that this had been resolved within 28 days. However, the new manager and the member of staff on duty were unable to locate the complaint book and had no knowledge of the concern. This must be rectified with the complaint book being accessible to staff so that if a complaint is raised this can be promptly recorded and Care Homes for Older People Page 19 of 33 Evidence: appropriate action taken to address the concern. Policies and procedures relating to safeguarding were seen at a previous visit and linked with the Department of Healths No Secrets. The new manager had a good awareness of the process and was in the process of ensuring that she was aware of Bath and North East Somersets Policy as previously she worked in Bristol. Training records were incomplete and poorly evidenced training for safeguarding. From the records only two staff have attended this training. However, from conversations with staff it was evident that some of them have recently attended a refresher course in January 2009. All staff must attend this training with periodic updates. The home has policies and procedures relating to the financial affairs of the individuals as seen at previous visits to the home. All money held by the home corresponded with the records, with receipts being retained for all expenditure. The home has responded to a recommendation to ensure that all financial transactions are supported by two staff signatures and where possible the individual and individual inventories of belongings are kept up to date. Concerns are still raised about the funding for the homes vehicle. One person has a car under the motability scheme and this is then used by the other three individuals in the home and for shopping. Individuals then contribute 20 pence per mile for any journeys that they complete. This is clearly documented in care files and follows the Brandon Trusts policy. There would appear to be two areas of concern one relating to the mental capacity of the individuals to consent to the cost and that 20 pence may not sufficient reimburse the owner of the vehicle for the petrol in light of raising costs. This should be reviewed and consultation must take place with the individuals representative on whether this is appropriate expenditure for the person and in their best interest. Care Homes for Older People Page 20 of 33 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, 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. 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. 2 Princess Close provides a safe, clean and homely place for people to live. However, access by the front door could put individuals at risk due to the step. Evidence: The home is in keeping with the local neighbourhood and is near to local shops and amenities. There are bus routes available to neighbouring Bath and Bristol. The home provides a suitably furnished environment that meets the needs of the individuals however this will need to kept under review, as the individuals get older. Great attention has been taken to personalise the home. All areas of the home were clean, hygienic and odour free. However there was some staining in one of the downstairs bedrooms. A member of staff said this is routinely cleaned and the staining was permanent. Consideration should be taken to replace this carpet. Suitable aids and adaptations were available to assist the individuals with their personal care including a walking in shower (wet room) and a high low bath with a built in hoist. Evidence was provided that the equipment was routinely checked and maintained. Occupational therapists had been involved in the assessment of equipment as evidenced in care records. Care Homes for Older People Page 21 of 33 Evidence: It was noted that the step to the front door was not accessible to one of the individuals living in the home and could potentially pose a trip hazard. The individual was trying to go through the door with a zimmer frame. This must be reviewed and a risk assessment completed with access to the front of the building improved. Each person has a single bedroom, which has been decorated and furnished to reflect the taste of the individual. There are two ground floor bedrooms. There is a chair lift to assist people reaching the first floor. Individuals have access to a communal lounge and dining area. This is open plan for ease of the individuals to access these areas. Individuals were observed making full use of all the areas of their home including their bedrooms for quiet time. The kitchen was well organised. Policies and procedures were in place to guide staff on food hygiene practices ensuring the safety of the people living in the home. Individuals have access to a small enclosed garden to the rear of the property, with established planting and a seating area for the individuals. The front of the property provides parking for three cars. The manager stated that there have been recent changes in the way the home responds to repairs with an external contractor now taking on this responsibility. From conversations with staff and the manager it is evident that this has improved the response time for repairs. The home has separate laundry facilities. These are well organised and meet the needs of the individuals living in the home. Clothing looked well cared for. Care Homes for Older People Page 22 of 33 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Adequate staff support the individuals living at 2 Princess Close. However, this must be kept under review as the individuals get older and their needs change. Lack of staff training could mean that they do not fully understand the needs of the individuals and care is not delivered based on current good practice guidelines. Evidence: The home is staffed with two members of staff during the day and one member of staff providing sleep in cover at night. This was evidenced in the homes duty rota and in conversations with staff. The home has one staff vacancy which means that the home is using bank to cover the shortfall. It was noted from care documentation that the sleep in member of staff is frequently woken up, due to two of the individuals needing support. Staff said that the sleep-in finishes in the morning for this reason. However, consideration should be taken to discuss with the funding authority to see if waking cover would be more appropriate. A member of staff said that it would appear that the disturbed nights occur in the main when bank staff are working in the home with more settled nights when regular staff are working. Consideration should be taken to ensure that where possible that bank staff do not cover the sleep in. The new manager said that the home has recently recruited to the vacant post and this should be resolved. This must be kept under Care Homes for Older People Page 23 of 33 Evidence: review. From conversations with the staff it was evident that the staffing is adequate when all the individuals are in the home. However, all the individuals require support when out in the community and three require one to one support due to mobility issues. Staff said this can be restrictive if all the individuals want to go out. However staff said that it is rare for everyone to want to go out together. One member of staff said that when new bank staff work in the home this can be restrictive as it is not good practice to leave a bank member of staff in the home alone. On reviewing the staff rota it was found that the home uses familiar bank or the staff team pick up the additional hours. Recruitment information is held at Brandon Human Resource Department and will be subject to an inspection to ensure that an appropriate and thorough recruitment process has taken place. The new manager was aware of the checks that needed to be in place prior to a new member of staff taking up a position within the home. The home has an organisational induction, which includes elements of health and safety training, aims and values of the service and safeguarding. Newly recruited staff complete the learning Disability Qualification as part of their induction. This was not explored on this occasion as there have been no newly appointed staff. One member of staff has been transfered temporarily to the home and they had worked for the organisation for a number of years. They confirmed that they had an induction to the home and the care of the individuals and staff had been supportive. The new manager said that new staff work in a supernumerary capacity for a couple of weeks to enable them to understand their role and get to know the people living in the home. Four out of the seven staff have an National Vocational Qualification in care. One member of staff was meeting with their assessor on the day of the visit. The home has exceeded the governments target that 50 of the workforce have an NVQ in care. The training matrix seen provided evidence that staff have attended training in manual handling, food hygiene, first aid and fire. However, there were no certificates supporting this. Individual staff training records did not fully capture training that had taken place. As already mentioned it would appear from the records that only two staff have attended safeguarding training. There was no evidence that staff had attended training in mental health which was a requirement from the visit in April 2008. From care records it was evident that the staff have to support individuals that at times can challenge with physical aggression noted. There was no evidence that staff have attended training in supporting individuals that challenge. Care Homes for Older People Page 24 of 33 Evidence: During the last visit it was noted that a professional recommended that all staff attend an eating and drinking course to enable them to support the individuals. There was no evidence in staff training files stating that they had attended this training. Although at the last visit it was evident that staff were applying for this course. It was noted that three staff had attended a bereavement and loss course from a letter in a persons care file. This had not been recorded in staffing training files. Training records were poor. One member of staff has worked in the home for over a year and the only training that was recorded was fire training. Other staffs records provided evidence that they had attended statutory training but little evidence of training linked to the needs of the people living in the home as described above. Consideration should be taken to provide staff with training in supporting people as they get older and dementia in addition to what has already been discussed. Staff spoken with during this visit said they had been through a period of change with a temporary manager for three months and now another new manager. Staff stated that the temporary manager had made some positive changes and it was felt that the team were now cohesive and although apprehensive about the management changes viewed this as positive. One member of staff said that they have more confidence and feel more valued than they had previously. From the Annual Quality Assurance Assessment it was noted that some of the Policies had recently been reviewed. However, it was noted that the smoking policy was dated October 2001. This policy would benefit from being reviewed to ensure compliance with the new legislation. Other policies are dated 2003 and could equally benefit from a review for example access to staff and care files. Again this may benefit from a review taking in to account the Freedom of Information Act. Other policies may benefit from a review due to the recent changes in management and the area manager role being no longer in existence. Care Homes for Older People Page 25 of 33 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is going through a period of management restructure and it is not certain how this will impact on the support to the individuals or the staff team. Individuals benefit from 2 Princess Close being a safe place to live. Evidence: The home as already mentioned in this report is going through a period of management change. The registered manager left in December with a temporary manager taking up post from January to March 2009. The new manager commenced in post on the day of this visit. Brandon Trust are reviewing all management posts with managers taking on additional responsibilities. The new manager said they will be managing 2 Princess Close, another residential care home in close proximity and two supported living services. The new title is Locality Manager. As part of this management restructure a senior carer will be employed to assist with the running of the home and based in 2 Princess Close. From talking with the new manager it was evident that there was still a lot of uncertainties about the role, including how they will Care Homes for Older People Page 26 of 33 Evidence: be supported and supervised and who will complete the monthly regulation 26 visits on behalf of the provider. This also included how many hours she was expected to work at 2 Princess Close or where they would be based. This has not been fully agreed by the Care Quality Commission. There is an expectation that each manager will go through a registration process, where discussions will take place on how this will impact on each service that falls in the remit of the Commission. Due to the manager only commencing in post from the 1st April the management standard has not been assessed. However, it was clear that the manager has an action plan that was developed by the temporary manager. This included reviewing plans of care making them more person centred and accessible to the individuals living in the home, moving all documentation into the sleep in room, developing an accessible rota and complaints board and an activity folder. It was evident that a good handover had taken place between the two managers. Staff said that the management changes have been positive and the balance of roles has changed with the emphasis being on the individuals, rather than lists of chores that need to be done. From conversations with the new manager it was evident that this was planning to continue with a more person centred rather than a task orientated approach being adopted. A member of staff said that this has been both positive for staff and the individuals living in the home. Individuals appear more relaxed and one person has started to speak out a lot more. Quality Assurance was not looked at during this visit as the manager was new in post. However the Brandon Trust has clear policies and procedures in relation to the monitoring of quality. It was evident from talking with the manager that they were going to complete a full review of the service provided. Individuals finances has already been discussed and it is evident that the home has good systems in place to protect their finances. It was noted that from reading care documentation that it had been identified that one persons appointee is reviewed in light that they have received money from a beneficiary. Staff said that this remains outstanding. This should be reviewed and the appropriate action taken to protect the interests of the individual. Staff said that the communication between team members is good and daily handovers take place. In addition staff have all had a supervision with the temporary manager. The new manager intends to meet up with all staff on a regular basis in line with the Brandon Trusts Policy on Supervision. The manager is planning a team Care Homes for Older People Page 27 of 33 Evidence: building day in May 2009 to develop the team and look at the new roles that are being developed within the home. The fire logbook provided evidence that routine checks on the equipment have been completed, staff take part in regular drills and fire training. It was noted that one member of staff had not attended a fire drill since commencing in post since January 2009. Reassurances were given by the new manager that this would be completed promptly after this visit. A fire risk assessment was in place and had been identified by the new manager as requiring a review. As seen at the last visit risk assessments were in place for manual handling, fire and care of substances hazardous to health (COSHH). These had been periodically reviewed. Other areas that demonstrated that health and safety was paramount, was the routine checks on aids and adaptations, the landlords gas certificate, electrical equipment testing and the routine environmental checks. Staff complete routine checks on hot water supplies and food temperatures. These were satisfactory. The provider is completing the monthly visits in respect of regulation 26 and copies are being sent to the Commission for Social Care Inspection. However, the manager was not sure how this was to be completed within the new management structure. In addition the home is informing the Commission for Social Care Inspection of events that affect the wellbeing of the individuals living in the home. Care Homes for Older People Page 28 of 33 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 12 16 (2) (m) To review the activities that are regularly taking place to ensure they remain suitable for the people living in the home. For staff to have mental health training. 08/05/2008 2 30 18 (1) (c) (i) 08/06/2008 Care Homes for Older People Page 29 of 33 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 7 12 Ensure that there is clear guidance on the use of as and when required medication in the plan of care for supporting an individual with their challenging behaviour. Ensuring a consistent approach. 01/05/2009 2 9 13 For the home to purchase a suitable medication cabinet that will meet the needs of the individuals living in the home. Ensuring medication is being stored securely. 01/05/2009 3 12 16 For each person to be 06/05/2009 consulted on activities that they would like to undertake and a structured activity plan to be developed. So that individuals diverse needs can be met. Care Homes for Older People Page 30 of 33 4 16 22 Ensure that the complaint book is accessible and available to staff and other stakeholders. Ensuring that there is a record of all complaints demonstrating that the service is open and transparent and responsive to concerns and complaints. 02/04/2009 5 18 13 For all staff to attend safeguarding training. Ensuring individuals are protected and staff are knowledgeable about the procedures to follow. 25/06/2009 6 19 24 Risk assess access to the home via the front door ensuring this area is accessible. A ramp would assist individuals accessing their home safely. 01/05/2009 7 27 18 Keep under review the staffing at night to ensure meeting the needs of the individuals. Ensuring continuity of care. 01/05/2009 8 30 18 For each member of staff to have a training analysis completed based on the needs of the individuals to include mental health and supporting individuals that challenge. Ensuring staff have the skills and knowledge to support the individuals. 03/08/2009 Care Homes for Older People Page 31 of 33 9 30 18 Ensure staff attend statutory 01/05/2009 training including first aid, manual handling, food hygiene. Ensuring staff are competent to support the individuals. 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 9 For the home to consult with the individuals GP re the use of the as and when required medication for reducing episodes of anxiety to ensure that it is appropriate. For the home to consult with placing authorities and the individuals representative to ensure that the expenditure on the vehicle is in the best interest of the person. In addition review the amount payable for use of the vehicle by three of the individuals to ensure that it fully covers the cost of the journeys taken into consideration other running costs and the inflation. Ensure staff training records are kept up to date. 2 18 3 30 Care Homes for Older People Page 32 of 33 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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