Inspection on 08/09/09 for 20 Talbot Street

This inspection was carried out on 8th September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

20 Talbot Street 08/02/10

20 Talbot Street 10/03/09

20 Talbot Street 24/11/08

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

Key inspection report Care homes for adults (18-65 years) Name: Address: 20 Talbot Street 20 Talbot Street Rugeley Staffordshire WS15 2EQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Capron     Date: 0 8 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: 20 Talbot Street 20 Talbot Street Rugeley Staffordshire WS15 2EQ 01217898889 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Care Services (UK) Ltd care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 4 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 (LD) 4 Date of last inspection Brief description of the care home The service is set up to provide support to four people with learning disabilities, who may have some challenging behaviour, speech and language disorders and who need a high level of support and guidance. The home is provided in a five bedroomed house in a residential area close to the town centre. Everyone has their own bedroom. There is a garden at the back of the home that provides an area for sitting and for activites. People are supported to help run the home completing such tasks as shopping and cooking. People can take part in activites both at the service and in the community. The service provides information to people about the service. Fees are based on each persons needs and people considering using the service should contact the service to Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 4 1 0 0 3 2 0 0 9 Brief description of the care home discuss the fees charged. The fees include transport costs and a contribution towards a holiday. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place over a seven hour period. The service did not know we were visiting. Prior to the visit we had information from the Annual Quality Assurance Assessment that the service sent us. This is a document that the service completes that tells us about the service they provide and how they intend to improve the service in the future. We also looked at information that the service sends us about incidents that have occurred. These are a legal requirement. We also looked at information we have about any complaints or safeguarding incidents that have occurred. At the service we looked at how the service is meeting peoples health and personal care needs. We also looked at whether people can live the life they want and whether choice is promoted. We looked at how the service is protecting people and whether there are systems in place to listen to the views of people. As part of this inspection we looked around the service including a sample of bedrooms. During the inspection we spoke to one person that lives there, staff and the manager. Care Homes for Adults (18-65 years) Page 6 of 31 Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: There are a number of areas that the service needs to address to provide people with a service that meets their needs. The service needs to continue to support staff to develop their skills and to gain experience in working with people with challenging behaviour so that it can meet peoples needs as outlined in the service user guide. Some aspects of the care plans need to be improved to provide information for staff to be able to meet peoples needs in a person centred way. There are some areas of risk that need to be assessed. The service needs to continue to develop the behaviour management plans that give staff the necessary information to support people that display aggression and violence in way that is safe and is based on good practice. The service needs to develop an appropriate policy for managing challenging behaviour that includes staff training, assessing behaviours and developing plans to respond to behaviours including where needed the use of physical intervention. The service needs to be completely confident that staff are aware of signs of abuse and know how to repsond. The service should review its staffing levels both during the night and day to ensure that there are always sufficient skilled and experienced staff on duty to provide people with the support they need. Care Homes for Adults (18-65 years) Page 8 of 31 The time provided for managing the service needs to be kept under review to ensure that sufficient management time is avaialble for the service to be effectively managed and developed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information provided by the service does not completely provide people with accurate information over what care it is able to provide. Although assessments are completed the service must only admit people if it has the necessary experienced and trained staff in place to meet their needs. Evidence: The Annual Quality Assurance Assessment states that staff visit anyone referred to them and that a full assessment is completed before anyone is admitted. It also states that people visit the service before deciding to move there. The service provides a Statement of Purpose about what the service offers. We did feel that this does not currently provide a completely accurate picture of what the service is offering. The service states it can provide a service to people who can display challenging behaviour but only the two senior staff have any experience in this area of work. It also states it is able to support people with autism. The two care staff on duty on the day we visited are new to care and have no experience of working with people with challenging behaviour or with autism although limited training has been Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: provided in the latter. We have also been made aware of concerns of the placing authority over the services ability to manage challenging behaviour appropriately. The service tells us that it has plans to provide staff with the necessary training to be able to meet these needs. The service has a service user guide in place. We would recommend that this is further developed into a format that is likely to be more accessible to people that live there. Examination of a sample of files confirms that people are only admitted following an assessment. These assessments include information from a range of health and social care staff. The service also completes its own assessments. Assessments include peoples health and social care needs, communication needs, spiritual needs as well as peoples preferences. The assessments identified areas of risk including the need for support in managing violent and aggressive behaviour. Although being aware of these issues the service agreed to admit people although staff do not have the necessary knowledge and skills to meet these needs. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning process needs to be further developed to make sure that comprehensive information is available to staff so they can meet peoples needs in a person centred and safe manner. People can be assured that they will participate in aspects of running the service and that their choices will be promoted. Evidence: The AQAA states that every person has an individual plan and that risk assessments are completed. Examination of a sample of care plans shows them to be basic and not providing sufficient information for care to be given in a person centred manner, for example in respect of hair washing the information in the plan was I wash my hair when I have a bath and for communication it said I use a combination of words and makaton. It is clear however that further information is available as the manager showed us a series of picture cards used for communicating with one person but these are not mentioned in the care plan. Also in another instance one person has a range of cards in his bedroom showing how he is supported to have his personal care needs met but this information is not in the care plan. People living at the service have Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: behaviours that require managing and supporting. Behaviourial management plans are in place but some are basic and do not cover all the areas of need. For example during our inspection the managers hair was pulled but there was no indication in the file of this behaviour although we were told that this is not an isolated incident. The plan for this person identified that the persons behaviour is unpredictable but the manager said that they could respond aggressively with visitors and the daily records show that a visitor had previously been slapped. Also staff we spoke to could identify possible triggers to the behaviour. The plan did not highlight any diversion techniques. The service is aware of the need to address this area of the care and to have proper plans in place and is due to meet a health care specialist to assess the staffs training needs. Subsequently we have seen that improvement to plans have been made and are confident that improvements will continue to be made. The service has a risk management system in place covering such areas as using kitchen equipment, cooking and using the trampoline. However some expansion is needed, for example, one assessment states that staff should assess one persons mood before they use the kitchen but there is no information about the specific behaviours to look for. There remain areas of risk to be covered including access to the community and risks relating to challenging behaviour. The service is including people in aspects of running the service, for example going to do the food shopping, helping to plan menus and assisting in keeping the service clean and tidy. The service is working to promote peoples choices. People when they moved to the service could choose their own bedrooms, people are supported to decide how to spend their money and choose the activities they wish to take part in. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that the service will support them to take part in activities they want to do. People are provided with varied meals that take account of their choices. Evidence: The AQAA states that the service supports people to take part in a range of activities and to maintain contact with family members. Examination of records and talking to one person confirms that the service is developing individual activity plans for the people that live there. These are based on each persons wishes. Activities include using the gym, going to the pub, the library, shopping, listening to music and watching DVDs. One person is due to start college two days a week. People can attend the local Gateway club. One person has been with staff on a short holiday. Currently one person does not leave the premises and the staff are supporting them to take part in activities within the service including gardening, playing football and using the trampoline in the garden. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: The service encourages people to keep in touch with their family. Records confirm that relatives visit and that people have regular telephone contact. Two people living at the service have their own mobile phones. The service provides people with individual schedules that are flexible. People eat breakfast when they get up and can eat their meals in their bedrooms if they wish. People can spend time where they wish either in the communal areas or their bedroom. The service provides people with a varied menu. Although there is a set menu in place this is developed with some of the people that live there and takes account of the peoples preferences. If people do not like a meal then an alternative is available. People if able are supported to be involved in meal preparation and in laying and clearing the table. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service are supported to have their personal care and health care needs met. The medication procedure is making sure people receive their medication as prescribed. Evidence: The services AQAA states that people have a plan that shows how they like their personal care needs met. It also states that people receive health support from a range of health professionals. Files show that peoples basic health and personal care needs are identified but that no Health Action Plans are yet in place. The service has since provided us with a copy of their Health ASction plans. These provide information in an accessible format. Records confirm that everyone is registered with a doctor and a dentist that people are supported to have eye checks. People receive specialist health care support from the psychiatric services, Community Nurses, a Speech and Language therapist and the Occupational Therapy department. Observation of one persons room shows that pictorial information is provided to support them with meeting their personal care needs. Observation shows that people are suitable dressed and are supported with their hair and oral care needs. Staff are alert to health care issues for example one person has had a mole checked out by the doctor and a Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: second person was seen by the doctor following staff noticing a lump on their stomach. The AQAA states that the service has a medication policy in place. We saw that medication is securely stored but due to the cabinet being in full sunlight we recommend that the temperature of the room is monitored. Checking of a sample of medication shows that records are correctly kept and a proper auditing system is in place. The service maintains the information leaflets of medication and has recorded the reasons for medication. Currently the manager and deputy administer medication as they are the only staff trained to do so. Training is due to be provided to other staff by the pharmacy in the near future. The service needs to put in place a system for the ongoing assessment of staffs competency to administer medication. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A complaints procedure is in place but could be more accessible to the people that live there. Training received by staff should now make people that need support with challenging behaviour more confident that their needs will be met in a way that respects their rights. Evidence: The AQAA states that the service has a complaints book and that people are given a list of telephone numbers they can ring if they are unhappy. The service has access to an advocacy service. The service provides people with a copy of the complaints procedure. This is completed in a pictorial manner but may not be accessible to the people that live there. We also advised that a copy of the procedure is provided for all relatives. One person we spoke to said they will tell the staff if they have a problem. The service has had no complaints. We, the commission, received a concern over the manner in which the service manages challenging behaviour. We agreed to consider this issue as part of this inspection. The service has a safeguarding procedure. The AQAA told us that staff training is provided in recognising symptoms of abuse and this was confirmed by the manager. Two staff we spoke to said they had not received any training but did have some understanding of the issues. We would therefore recommend that the service check all Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: staffs knowledge of safefguarding issues. The service offers a service to people that can exhibit on occasions physical and verbal aggression. Our discussions with staff shows them to have limited knowledge and training in this area. Subsequently the service has provided us with information that all staff have completed challenging behaviour training. A policy in respect of aggression towards staff was seen but this was inadequate. The service acknowledged this and has confirmed to us that they have engaged a professional to assit them in developing this. The service looks after the money of the people that live there. Checking a sample confirms that money is kept safely and that appropriate records are being kept. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service enjoy good private and communal accommodation that is well decorated and kept clean. Evidence: The AQAA states that the service is an ordinary homely house with domestic type furniture and decoration. We saw that the service is well decorated and furnished. The service has good communal areas with two lounges, a dining room and a domestic style kitchen. All bedrooms are for single occupancy and have en suite facilities of either a bath or shower, a toilet and a wash basin. Bedrooms seen have been personalised with lots of belongings including photos, DVDs, posters and ornaments. Everyone has a TV in their bedroom. All bedrooms are lockable. The service appeared to be clean and tidy. Staff and the people that live there work together to ensure that the service is kept clean. Most of the staff have received some training in infection control practices. Staff tell us that they use protective equipment including gloves and aprons. Care Homes for Adults (18-65 years) Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service cannot always be assured that staff have the necessary skills and experience to fully meet their needs. The recruitment process is generally protecting people. Evidence: The AQAA states that the service employs staff of all ages and experiences and in sufficient numbers to meet peoples needs. Examination of the roster shows that there are three staff on duty throughout the day and one person sleeping in at night. Currently due to the inexperience of staff either the manager or the deputy is on duty at all times and they are the only people that sleep in. Also due to the inexperience of staff neither of the senior staff are able to leave the service during the day. Although with three people living at the service this level of staffing should be adequate the manager needs to review the staffing levels in the light of the lack of experience and knowledge of some staff. The service should also review the level of night staff cover to consider whether this is adequate both in the event of the need to evacuate the premises or if a violent incident occurred. The service has been operating since May 2009 and therefore all the staff are newly appointed. Checking of a sample of files confirms that staff have been subject to the Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: required pre employment checks including two references and a Criminal Records Bureau (CRB) and Protection of Vulnerable Adult(POVA) check. We did emphasise to the manager the need to complete a risk assessment when people are starting work without the full CRB check. We also advised her of the need to record any decision making in relation to employing people if there are any issues resulting from the preemployment checks. Talking to staff and checking records confirms that staff receive in house induction and are in the process of completing the approved induction for working with people with a learning disability. Currently there is a low number of staff trained to NVQ level 2 but the service is putting forward all staff for the qualification. Following the inspection the service has provided us with information confirming that staff have received a range of training. This includes autsim, managing actual and potential agression, safeguarding as well as health and safety training. We would advice the service that it undertakes a training needs analysis to identify the training required to fully meet peoples needs and put in palce a training programme. Currently not all staff working at the service have the experience and skills necessary to provide people with the support they need particularly in working with people with autism and with challenging behaviour. As the service states in its Statement of Purpose that it provides care for people with these needs sufficient staff should be competent in these areas. The manager tells us that she is aware of these needs and is putting a programme together to provide relevant training. Staff tell us and records confirm that staff receive individual supervision and that staff meetings take place regularly. Care Homes for Adults (18-65 years) Page 23 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the service is improving leading to a better service for people. The health and safety arrangements are generally protecting people but there continues to be areas that need to be addressed. Evidence: The manager has lengthy experience of working with people with a learning disability having managed for several years a good service. She has previous experience of working with people with challenging behaviour but needs to have her training updated. The development of a new service involves significant management tasks and the service has admitted people to be cared by inexperienced staff who had not had the required experience and training. This resulted in the manager needed to devote the majority of her time to care and staff support rather than to managing the service and devloping the service. This could account for the issues raised in this inspection. However the manager acknowledges the services shortcomings and we are confident that they will be addressed. The service has subsequently provided us with information that it has recruited an experienced staff member who can lead a shift thereby providing the manager with time to manage the service, has provided a Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: range of training to staff including working with people with aggressive behaviour and people with autism and has improved the care plans. Although the service sent us an AQAA when we asked for it the contents were limited and we have provided the manager with advice on how to complete this so that it gives us comprehensive information about the service. The service has a policy for reviewing and monitoring the service but due to the newness of the service this has not yet been fully implemented. We did see that the service has a system for auditing medication and had a development plan in place. The service tells us that it will be gaining the views of the people that live there and significant other people. We also saw that the responsible person is not completing records of his visits although this is a legal requirement. The services AQAA states that it is completing checks on its equipment and checking a sample including fire confirms this. A fire risk assessment is in place but individual fire risk and evacuation assessments need to be completed. The service is undertaking fire drills monthly but needs to have one during the evening/ night. Care Homes for Adults (18-65 years) Page 25 of 31 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 26 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The service must only admit people when it can demonstrate that it can meet peoples assessed needs. This will make sure that people can be assured that the service can meet their needs and aspirations. 14/10/2009 2 6 15 Comprehensive care plans that include all peoples needs including support needed as a result of challenging behaviour must be put in place. This will make sure that information is available to the staff to be able to provide people with the support they need in a person centred and safe way. 14/10/2009 3 8 12 Where risks exist for example risks associated with peoples behaviour and 14/10/2009 Care Homes for Adults (18-65 years) Page 27 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action risks associated with accessing the community a plan must be put in place. This will ensure that people are kept safe. 4 23 13 If people using the service need to be physically restrained this must only be undertaken by staff that are properly trained. This will ensure that if physical intervention is needed it is carried out safely. 5 32 18 Staff must be competent and have the skills necessary including an understanding of autism, understanding of physical and verbal aggression and working with people with challenging behaviour. This will make sure that staff have the knowledge and skills to provide people with the support they need. 6 34 13 When staff are working without a full CRB a risk assessment must be put in place. This will improve the protection of people living at the service. 14/10/2009 01/12/2009 14/10/2009 Care Homes for Adults (18-65 years) Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 7 42 13 Staff should be competent in 01/12/2009 all areas of safe working practices including moving and handling, food safety and first aid. This will enable people to be supported in a safe way. 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 1 Information provided by the service must accurately reflect the care that is offered. This will ensure that people know what they can expect if they move to the service. Care plans should be person centred and accessible to the person concerned. Health action plans should be put in place that gives staff comprehensive information about peoples health care needs and how they are to be met. A system should be put in place for checking staffs competency to administer medication. A record should be kept of the temperature of the room where medication is stored. Complaints information should be provided in an accessible format. The service must check that staff have adequate knowledge of safeguarding issues. This will ensure that they are able to respond appropriately and keep people safe. A review of the level of staffing must take place to confirm that there are sufficient experienced and competent staff on duty during the day and night. When staff are recruited there should be evidence available to show how decisions over their suitability has been made. 2 3 6 19 4 5 6 7 20 20 22 23 8 33 9 34 Care Homes for Adults (18-65 years) Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 10 37 The amount of time provided for managing the service should be kept under review. This will make sure that there is time for management tasks to be completed and for developing the service. A system for reviewing and monitoring should be put in place. This should include the views of those that live there and other significant people. Fire drills and evacuation practices should be undertaken at night 11 39 12 42 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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 31 of 31 - 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!