Inspection on 24/09/09 for 27a Old Kenton Lane

This inspection was carried out on 24th September 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

27a Old Kenton Lane 19/01/10

27a Old Kenton Lane 07/11/08

27a Old Kenton Lane 30/05/06

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: 27a Old Kenton Lane 27a Old Kenton Lane Kingsbury London NW9 9ND     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: Julie Schofield     Date: 2 4 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 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: 27a Old Kenton Lane 27a Old Kenton Lane Kingsbury London NW9 9ND 02089593965 02082010213 unuwatte@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Integrated Care Services Limted 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 who can 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 - Code LD Date of last inspection Brief description of the care home 27a Old Kenton Lane is a registered home. The registered manager is Mr Percy Bamunuwatte. Mr Bamunuwatte and his wife jointly run the Integrated Care Services company. They provide a similar service at one other local home. The home is located in a residential area of Kingsbury. The property is detached. There is one bedroom, a bathroom, a toilet, a lounge/diner, an office, and kitchen on the ground floor. Three more bedrooms, and a bathroom with toilet can be found on the first floor. The home has a self-contained back garden of medium size. There is parking space for two cars in the homes own drive and free kerbside parking on a road around the home. Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 4 0 7 1 1 2 0 0 8 Brief description of the care home There are a few shops in walking distance. More shopping facilities are in Wembley or Harrow, which can be reached through public transport. The home is registered for four residents and is currently fully occupied. Fees for the home depend on the assessed needs of the prospective resident and information about current levels of fees can be obtained, on request, from the manager of the home. The service user guide and a copy of the most recent inspection report can be obtained from the owner of the home. The inspection report is also available on the internet at the CQC website. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The inspection started at 8.10am and finished at 4.45pm. While in the home we met the manager, members of staff on duty and the residents. We were able to speak with people, although comments from residents about living in the care home were few as the residents verbal communication skills are limited. We did observe residents relaxing in the home after their return from holiday and we observed the interaction between residents and members of staff. We carried out a site visit. General records and those relating to residents were examined. We looked at policies and procedures and case tracked the care of selected residents. We reviewed compliance with the statutory requirements identified during the previous key inspection in January 2009. Prior to the inspection we sent survey forms to the home to distribute. Three staff survey forms, 2 forms completed by either a health or social care professional and 3 forms completed by residents (with the assistance of a key worker or a relative) were returned to us. We would like to thank everyone for their assistance and comments during the inspection. Care Homes for Adults (18-65 years) Page 6 of 35 Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A thorough pre admission process assures residents that they are admitted to the home on the basis of their assessed needs and the ability of the home to provide them with the appropriate care to meet these. Evidence: The manager confirmed that the most recent admission to the home took place in 2007, which was prior to the last key inspection in November 2008. He said that there have not been any changes to their pre admission procedure since 2007. At the last key inspection the file of each resident was examined. There was evidence that as part of the pre admission procedure the home obtains the necessary information about the prospective resident, both from the placing authority and during their own visit to the person to carry out an assessment of need. A decision is then taken by the manger about whether the home is able to meet the needs of the prospective resident and whether the needs identified are compatible with those of the residents already living in the home. The service has already told us as part of an annual quality assurance assessment (AQAA) that Our home carries out a thorough and complete needs assessment of the service user, prior to admission, by a qualified and experienced Care Homes for Adults (18-65 years) Page 10 of 35 Evidence: member of staff and we always confirm in writing whether we can or can not meet the prospective residents assessed needs. The AQAA also confirmed that new residents are provided with detailed information about the services and facilities available at the home before they are admitted. Care Homes for Adults (18-65 years) Page 11 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive care plans, that are subject to regular review, and risk assessments assure residents that their needs are identified and addressed. However, some case files lack evidence of regular reviews and lack risk assessments for key areas of the residents life. Evidence: When we asked the carer that had carried out the sleeping in duties for the night of the 23rd/24th September to provide us with the residents case files she was unable to because she did not have a key to the cupboard where they were kept. When the manger came to the home he opened the cupboard and made available the case files. We selected 3 residents case files to examine. We saw that each file contained a recent care plan in a person centred format. Care plans were detailed and the care plan and the placement had been subject to review. Reviews were carried out by the care home and external reviews were convened by the placing authorities. The last review meeting minutes on 1 case file were dated January 2008 and the care manager confirmed that an external review meeting had not taken place this year. One of the Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: other case files contained the minutes of a review meeting held in 2009 and the manager said that a meeting had taken place in respect of the 3rd resident but they were waiting for a copy of the minutes to be received. The manager is the appointee for 3 of the 4 residents living in the home. Comments regarding residents finances are included in Standard 23. Files contained risk assessments, that are reviewed on a regular basis. Although risks and management strategies are recorded there is no information about situations or circumstances that might trigger a certain response. We discussed an issue involving 2 of the residents that had been identified during the previous key inspection. We are satisfied that appropriate support and advice has since been obtained from health care professionals and following changes in the medication prescribed to 1 of the residents we saw that the number of incidents has decreased. However, a detailed risk assessment in respect of socialising with other residents in the home and spending time with them was absent from the files of the residents concerned. A risk assessment for a resident that has epilepsy was also absent from their file. Enforcement action is being considered. Care Homes for Adults (18-65 years) Page 13 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Taking part in activities and using community resources gives residents the opportunity to enjoy an interesting lifestyle. By maintaining contact with their family and friends the residents need for company and fellowship is met. Residents are encouraged to become more independent by taking part in the daily routines of the home. A varied and balanced diet assures residents that their dietary needs are met. Evidence: Only 1 of the 4 residents attends a day centre. They do so for 5 days per week. The remaining residents each had a daily activity programme included in their case file. We were not able to see what activities 2 of the 3 residents took part in during the day as they returned from a short break holiday in the latter part of the inspection. We noted however that activities listed on the programmes included ones taking part inside the home and activities taking place outside the home. Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: Residents names are included on the electoral roll although residents have not chosen to vote. They use facilities and resources in the community including parks, restaurants, libraries, leisure centres, pubs and shops. They have the use of the companys transport and 1 of the residents has a mobility car. They enjoy parties, going to clubs in the evening and at weekends and going to discos. In the home they like to listen to music or to watch television and trips have been organised to the park, to Golders Green and to Birmingham. Three of the 4 residents went on a short break holiday to Hastings immediately prior to the inspection. The resident that did not go on the holiday went to stay with their family. Some of the residents have made friends with the residents in the other care home owned by the company and residents make visits to the other home and have a meal there. They receive visits from the other residents in return. Some of the residents receive visits from their relatives and go to stay with their relatives overnight. When relatives are visiting the resident in the home, the resident can choose to entertain visitors in their room, in private. We discussed how residents are encouraged to be independent and the manager gave examples of residents taking part in the daily routines in the home. Under supervision residents are supported to make a cup of tea or a snack. Residents may bring down their clothes to the laundry room, help with the shopping or set the table and clear their things away after eating. We saw a copy of the menu on display. It provided a varied and healthy programme of eating. It incorporated fresh fruit and vegetables. None of the residents have any special dietary needs although as 2 residents do not have any teeth some food items are cut into smaller pieces or mashed. When asked about choice the manager said that the menu is checked with the residents on the day to see is any changes are necessary. There are 2 areas where residents can eat and towards the end of the inspection, when residents were having a snack, we saw that both tables were being utilised. Care Homes for Adults (18-65 years) Page 15 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive assistance with or prompting with personal care in a manner, which respects their dignity and privacy. Residents health care needs are met through access to health care services in the community. Residents general health and wellbeing is compromised when members of staff that assist the resident to take medication have either not received any training or their training has not been refreshed in accordance with good practice guidelines. Evidence: If residents require assistance with personal care tasks this can be provided by a carer of the same gender. The rota is arranged so that there is a female member of staff on duty in the evening and in the morning to assist the female resident with dressing and bathing. Where assistance is provided in the form of prompting this is done in a way that respects the dignity of the resident. When looking at case files we looked at records relating to access to health care facilities in the community. We noted that there was evidence of regular appointments with the dentist and optician. Residents had regular appointments with the psychiatrist and there was mention in a letter of the home providing an escort when the resident Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: attended out patient appointments. We looked at the medication records. The current MAR sheets for residents that were on holiday at the start of the inspection had gone with the residents so we looked at the previous records for the period ending the 16th September. One resident had not gone to Hastings and their current record sheet was available. The records that we saw were up to date and complete. We also noted that the home kept a medication disposal record book. The storage of medication was satisfactory. We asked the manager which members of staff were responsible for administering medication to residents. There was no evidence on the staff files that each of the persons responsible has received medication training or if they have done in the past there was no evidence that they have received any refresher training. A statutory requirement was identified during the previous key inspection that members of staff administering medication must receive refresher training. This requirement remains outstanding and enforcement action is being considered. Care Homes for Adults (18-65 years) Page 17 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A complaints policy is in place to protect the rights of residents. An adult protection policy is in place but the lack of any or of up to date protection of vulnerable adults training for staff compromises the safety of residents. Staff records fail to demonstrate that the safety and welfare of residents is protected through a robust recruitment procedure. Residents records fail to demonstrate that the financial interests of residents is protected. Evidence: There is a complaints policy and procedure in place in the home. It is user friendly but the contact details for the CQC are out of date. The manager said that no complaints have been recorded since the last key inspection. The survey forms completed by members of staff working in the home confirmed that they knew what to do if someone has concerns about the home. When social or health care professionals were asked on a survey form whether the care service responded appropriately if they or a person using the service or another person raised any concerns 1 person ticked always, 2 people ticked usually and 1 person ticked sometimes. We looked at the financial records for the 3 residents whose case files we had selected. Each of these residents has the registered manager as their appointee and bank/savings accounts are in the joint names of the manager and the individual resident. We informed the manager during the inspection that the records were unclear and that recovering the residents contributions towards their fees, 1 or 2 Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: months in arrears made difficulties with accounting for withdrawals and in pursuing an audit trail. We were told that for 1 resident some of the residents money is passed to the parent, as the resident stays with the parent on a regular basis. A withdrawal had been made from the bank of £300 on the 10/7/09 but there was no record, signed by the parent, to acknowledge receipt of all or part of this money. It appeared that a small sum of money had been credited to the residents petty cash amount and the balance of the £300 matched the amount of the clients contribution to their fees. However, this amount had not been credited to the residents account and the manager said that the dates in the records for the residents contributions that were outstanding were incorrect and that there had been a typing error. Had this error not been identified during the inspection the resident would have paid twice for their monthly contribution towards their fees. Enforcement action is being considered. We saw in the file of another resident that they had an investment bond that matured in January 2009 and that it had been re-invested after maturity for a further 6 months. We noted that the re-investment sum was £10,000 more than the maturity sum. During the inspection the manager said that he had not noticed the difference in figures and gave no explanation of why there had been a significant increase in the sum invested. Although the manager said that he had asked the building society to reinvest the money July 2009 there was no evidence on file to confirm this and he had not contacted the Building Society prior to the inspection to chase up any missing paperwork. A statutory requirement was identified during the previous key inspection that records of money paid into a bank must be kept. This requirement remains outstanding. Since the inspection he has emailed the Commission to say that the balance had increased by £10,000 from his (the residents) carried forward balance from the previous year. He has supplied information from a building society passbook to show that this sum was transferred. We are concerned that information was not available during the inspection and that the person acting on behalf of the resident in financial matters was not readily familiar with the support given nor have they contacted the building society when paperwork to confirm that the request made had been actioned, failed to materialise. We have since asked the manager whether the residents financial accounts are audited by an accountant and have been told no. Due to the lack of accurate, detailed records enforcement action is being considered. There is a protection of vulnerable adults policy in place in the home. The manager has previously said that the home also has a copy of the local authoritys inter agency guidelines in the event of abuse. He said that no allegations or incidents of abuse have been recorded since the last inspection. When we looked at staff files we noted that 2 members of staff had attended safe Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: guarding adults training over 2 years ago and 1 member of staff had not attended any training. It is of concern that when we first looked at staff files they did not contain all the necessary references and checks that are part of a recruitment policy that safe guards the residents. Comments regarding the documents held on staff files are included in Standard 34. Care Homes for Adults (18-65 years) Page 20 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy a comfortable and homely environment with comfortable communal and private facilities in which to relax. Residents live in a home that is clean and tidy. However, the lack of infection control training for members of staff fails to assure residents that the risk of cross infection is minimised. Evidence: During the inspection we carried out a site visit. We noted that the general upkeep of the home was good and that communal areas (an open plan kitchen, dining and lounge area) and bedrooms were spacious. Each of the 4 residents has their own single bedroom and 2 of the bedrooms have en suite facilities. There are bedrooms on both the ground and first floors and toilet and bathing facilities on each level. There is a pleasant garden at the rear of the property. The premises were bright and airy. When we visited all parts of the home we noted that the home was clean and tidy and that the rooms were free of any offensive odours. Laundry facilities are in a room that is off the ground floor bathroom and the laundry facilities consist of a domestic washing machine and tumble drier. The home has an infection control policy. Only 3 of the members of staff have evidence of undertaking infection control training. One certificate was dated 2000. Care Homes for Adults (18-65 years) Page 21 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. NVQ training enhances the general knowledge of carers. Although the rota demonstrated that there were sufficient staff on duty to support the residents the inclusion of a person called a carer/cleaner that had not received any training for their role as carer fails to assure residents that all members of staff have the skills necessary to meet their needs. Recruitment practices, which did not consistently include carrying out checks and taking up references, fail to protect the welfare and safety of residents. The lack of training, particularly in safe working practice topics, compromises the quality of care that residents receive. Evidence: We looked at the progress that the home was making towards the target of a minimum of 50 of members of staff achieving an NVQ qualification. There were 9 names on the staff rota, excluding the manager, and 1 person has an NVQ level 4, 2 people have an NVQ level 3 and 2 people have an NVQ level 2 qualification. Another member of staff is currently studying for their NVQ level 2 qualification. The home has therefore achieved the target. We looked at a copy of the rota for week commencing the 21st September. Although 3 of the 4 residents were enjoying a short break holiday in Hastings, and returning on the 24th, the fourth resident had returned from a short stay with their relatives and Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: was present in the home when the inspection began. The member of staff that had covered the sleeping in duties was due to leave at 8am but stayed longer to assist with the inspection. When she left she said that the next carer was starting at 9am and the resident was supported by a person that had previously been introduced as the cleaner. When the manager arrived we asked what post the person held in the home and he said that the person was a carer/cleaner. These handover arrangements were in place on a daily basis. We saw that generally there were 2 or 3 people on duty during the day (including the manager) and that at night 1 member of staff carried out sleeping in duties. When we requested to see staff files at the start of the inspection we were told that they were not kept in the home and when the manager arrived he brought them with him. We asked why the records were not kept in the care home and the manager said that there were problems with storing files securely and during the inspection we discussed how this might be achieved. We looked at each of the staff files for the members of staff whose names appeared on the rota. We noted that on some files 1 or both references were absent, proof of identity (passport details) was absent and the enhanced CRB disclosure had been obtained by a previous employer. During the inspection and since the inspection the manager has produced the documents that were absent from the files and we have now seen proof of identity for a further 4 members of staff and references, which were dated after the inspection have been produced . We are concerned that staff files did not have copies of the necessary documents on them at the start of the inspection and that the references made available demonstrate that members of staff have been working in the care home without 2 satisfactory references being received prior to their start. Enforcement action is being considered. After being told that the member of staff on their own in the care home with a resident was a carer/cleaner we looked at their staff file to see what training they had attended. There were no attendance certificates on file. The application form and references on file were for the post of cleaner. The manager has since provided a new application form and new references, dated after the inspection, for the post of carer/cleaner. We looked at staff files and discussed training with the manager. Since the inspection he has provided a list of planned training courses with the number of staff attending from within the company. (The company operates 2 care homes and the members of staff that would be attending were not identified). Staff files lacked a training profile and contained only copies of attendance certificates. We noted that there were gaps in terms of members of staff that had undertaken safe guarding, medication and Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: infection control training. There was no evidence that all members of staff had undertaken manual handling training, first aid, food hygiene or fire safety training. Enforcement action is being considered. Care Homes for Adults (18-65 years) Page 24 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Continuing to undertake further training enables the manager to develop his knowledge, skills and understanding. Service satisfaction questionnaires, meetings and individual discussions with residents help to monitor the quality of the service provided to residents. However, the lack of management audits in key areas in the home compromise the development of the service. A lack of training in safe working practice topics compromises the health, safety and welfare of the residents. Regular servicing and checking of equipment used in the home ensures that items are in working order and safe to use and this needs to include the electrical items in use. Evidence: We discussed the managers experience and qualifications. He told us that he has worked for approximately 9 years in a care setting in a management role. He has an RMNS, NVQ level 4 and an RMA qualification. He is also a certified accountant. Since the last key inspection he has attended short training course on the Mental Capacity Act and has attended training seminars organised by the local authority. We looked at quality assurance systems that are in place in the home. As verbal Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: communication from residents is limited 1:1 meetings with residents to gauge satisfaction with the service received use Makaton to assist understanding. Questionnaires are given to relatives prior to care plan reviews to enable them to give feedback. Members of staff have opportunities to give feedback during staff meetings, which there was evidence that they took place on a regular basis, appraisals and supervision sessions. We are concerned about the statutory requirements that were identified during the last key inspection and that remain outstanding. We are concerned about the way in which residents finances have been handled and about the way in which members of staff have been employed to work in the home before all the necessary references and checks have been carried out. These are areas that the manager has been responsible for. Throughout the inspection we looked at records although these were not immediately available to us and residents records are not immediately available to all members of staff. Financial records were not up to date and accurate in respect of residents contributions to their care. Records of transactions could not always be followed through in an audit trail and supporting documents to verify where money had been transferred to were not always available. Staffing records did not initially contain all the documents specified in the Care Homes Regulations 2001. We saw evidence that systems and equipment in the home were maintained and serviced although there was no certificate for the testing of the portable electrical appliances. Fire drills and fire alarm/smoke detector testing are carried out. Not all members of staff have received training in safe working practice topics. Care Homes for Adults (18-65 years) Page 26 of 35 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 20 18 Staff who administer medication must attend a refresher training. This will ensure that the staff have up-to-date skills to administer medication. 20/03/2009 2 23 20 Any money belonging to a resident must not be paid to or taken from the bank unless it is in the residents name. Records of all transactions must be kept. This ensures that the residents finances are protected and used by the residents only. 30/01/2009 Care Homes for Adults (18-65 years) Page 27 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 14 The manager must contact the local authority responsible for convening a meeting to review the placement when this becomes overdue and must contact them 4 weeks after the meeting has taken place to request a copy of the minutes of the meeting, if they have not been received. This will assure residents of the ongoing suitability of the placement to meet their individual needs. 21/12/2009 2 6 12 All members of staff working 21/12/2009 in the home must have access to residents files containing care plans, risk assessments and guidelines for supporting residents. This will assure residents that the support given is in accordance with the agreed Care Homes for Adults (18-65 years) Page 28 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action intervention contained in the care plan that is necessary to meet the goals identified, carried out in a manner that is in accordance with safe working practices and meets the residents preferences and wishes for the way in which they want to be supported. 3 9 13 The case file of a resident 21/12/2009 with epilepsy must contain a risk assessment. This will assure the resident that strategies are in place to support them and that in the event of a seizure taking place members of staff are aware of how to respond appropriately. 4 9 13 The registered person shall 21/12/2009 ensure that all unnecessary risks to the health or safety of the service user are identified and so far as possible eliminated and kept under regular review. Enforcement action is being considered. This will assure residents that their safety in the home and their enjoyment of communal areas is promoted. Care Homes for Adults (18-65 years) Page 29 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 5 9 13 When drawing up a risk assessment the circumstances or situations that might trigger an action or response must be included. This will assure residents that the risk assessment is detailed and allows members of staff to be aware of any factors that can addressed to avoid an incident occurring. 21/12/2009 6 20 18 The registered person shall 21/12/2009 ensure all carers responsible for administering medication have received appropriate training. Enforcement Action is being considered. This will assure residents that the persons assisting them with their medication is competent to do so. 7 22 22 The complaints procedure must include the up to date contact details for the CQC. This will enable a complainant to contact the CQC, if they wish. 21/12/2009 Care Homes for Adults (18-65 years) Page 30 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 8 23 13 Members of staff must 21/02/2010 receive training in safe guarding adults and the training must be refreshed on an annual basis. This will ensure that the safety and welfare is promoted and protected by all people working in the home. 9 23 25 Residents financial records 01/04/2010 must be audited by a firm of accountants on an annual basis. This will ensure that financial record keeping is open to scrutiny and in accordance with good practice guidelines. 10 23 12 There must be an internal audit of financial records on a regular basis. This will ensure that any errors in accounting are identified quickly and can then be rectified. 21/12/2009 11 23 17 The registered person shall ensure an accurate, detailed record of service users finances is held in the home and made available for inspection. Enforcement Action is being considered. 21/12/2009 Care Homes for Adults (18-65 years) Page 31 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will enable the home to demonstrate that the financial interests of the resident are being protected. 12 23 17 The registered person shall ensure a record of the care home charges to service users including any extra amounts payable for additional services not covered by those charges are held in the home and made available for inspection. Enforcement Action is being considered. This will enable the home to demonstrate that the financial interests of the resident are being protected. 13 30 13 All members of staff must attend training in respect of infection control procedures either as a new topic of training or as refresher training. This will assure residents that standards of hygiene in the home are maintained and that the risk of cross infection is minimised. 14 34 19 The registered person shall ensure that all staff are recruited in line with the 21/12/2009 01/02/2010 21/12/2009 Care Homes for Adults (18-65 years) Page 32 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Regulation 19. Enforcement Action is being considered. This will assure residents that people who are unsuitable to work with vulnerable adults have been excluded from working in the home by a thorough and searching recruitment procedure. 15 34 19 The registered person shall ensure a record of all documents identified in Schedule 2 are held and made available for inspection. Enforcement action is being considered. This will assure residents that recruitment practices promote and protect their safety and welfare. 16 35 18 The registered person shall ensure that all staff are appropriately trained and skilled in the area of their work they undertake. Enforcement Action is being considered. This will assure residents that the members of staff supporting them are skilled and knowledgeable. 21/12/2009 21/12/2009 Care Homes for Adults (18-65 years) Page 33 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 17 42 23 Testing the portable 21/12/2009 electrical appliances must be carried out. This will reassure residents, member of staff and visitors to the home that the appliances are safe to use. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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