Inspection on 18/05/09 for 374-376 Winchester Road

This inspection was carried out on 18th May 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

374-376 Winchester Road 16/07/08

374-376 Winchester Road 27/11/07

374-376 Winchester Road 18/05/07

374-376 Winchester Road 24/10/06

374-376 Winchester Road 15/02/06

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Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

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

Key inspection report CARE HOME ADULTS 18-65 374-376 Winchester Road Southampton Hampshire SO16 6TW Lead Inspector Annie Kentfield Key Unannounced Inspection 18th May 2009 09:30 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 2 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 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 374-376 Winchester Road Address Southampton Hampshire SO16 6TW Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 023 8078 9786 Integra Care Management Ltd Manager post vacant Care Home 8 Category(ies) of Learning disability (0) registration, with number of places 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning Disabilities (LD). The maximum number of service users to be accommodated is 8. Date of last inspection 16th July 2008 Brief Description of the Service: 374/376 Winchester Road is a small home providing personal care and support for up to eight residents with a learning disability who may have challenging behaviour and complex care needs. The home has been converted from two detached houses with the addition of a single storey extension that links the two buildings together. The residents have a bedroom of their own and access to a range of communal rooms and a large enclosed garden. The building is accessible on the ground floor but does not have a passenger lift or stair lift. Information about fees and any additional charges are available from the home. 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We made an unannounced visit to the home on 18 May 2009. The visit was with two inspectors who were in the home from 9.30 am to 5 pm. One of the inspectors spent some time in the morning and afternoon with some of the residents and staff in the lounge and dining room and looked at care records. The other inspector spent time speaking to the manager and two of the staff and also looked at other records in the home including staff rotas, activities records, staff training and recruitment records, and records of residents’ finances. We looked at what the service has done to improve the home environment since we last visited. We also looked at the improvement plan that was sent to us by the service following the last inspection visit in July 2008. Information was sought from Southampton Social Services about the outcome of a recent safeguarding investigation concerning allegations about poor practice in the home. The allegations resulted in the service being recommended to take appropriate action to ensure that residents in the home are protected from harm. Since the last inspection the service has had three changes to the management of the home. This means that the service has not been consistently managed by a person who is registered with the commission. The service has not sustained improvements in all areas of practice in the home and this has affected outcomes for residents in the home. For example, health action plans have not been monitored to ensure that residents have access to dental care and other health services when they need them. What the service does well: What has improved since the last inspection? A manager has been appointed and will be applying to be registered with the commission. Improvement has been made to the kitchen – this has been completely refurbished. The sitting/dining room has been decorated and there is new flooring. 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 6 The opportunities for residents to take part in social and leisure activities have improved and the service has appointed a member of staff as activities coordinator. The home is developing innovative communication tools to support residents and staff and improve communication of choices and preferences. What they could do better: The responsible individual must ensure that residents have access to dental care and that residents’ health care needs are recorded and regularly reviewed to ensure that health care needs are met at all times. The responsible individual must ensure that residents’ individual choices and independence are promoted and that practice in the home meets the different communication needs of the residents, at all times. The responsible individual must ensure that all staff working in the home follow agreed policies and procedures for reporting any events that affect the safety and well being of the residents, to Social Services, as safeguarding concerns. We found that one event affecting a resident had not been reported and this means that residents may not be protected from the risk of harm, at all times. The responsible individual must ensure that people working in the home receive training appropriate to the work they do (including structured induction training) and to meet the specific needs of the residents. A training plan must identify how staff training needs will be met with timescales for action. The responsible individual must ensure that pre-employment checks on new staff are satisfactory and meet regulatory requirements to ensure that residents are protected and demonstrate that new staff are suitable to work in the home. The responsible individual must ensure that quality monitoring systems are robust and consistent to ensure that the service is providing good outcomes for the residents as part of the ongoing development and improvement of the service. The responsible individual must ensure that there are suitable arrangements for residents to access their monies with appropriate advocacy support where required. 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 7 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. 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New residents do not move into the home until their care and support needs have been assessed and the home is confident they can meet care needs. EVIDENCE: The home has eight residents and no-one has moved into the home since we last visited in 2008. Therefore, we were not able to look at the way that the home has organised the assessment and introduction to the home for any new residents. However, we are aware that the service has previously demonstrated an organised and inclusive assessment process for new residents. This has usually involved the prospective resident and their representatives, and other health and social care professionals involved in the care of the person, with lots of opportunities to visit the home beforehand. 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each resident has an individual plan of care and these are person centred, however, residents are not fully involved in their individual care and support plan promoting choice and independence. Residents with more complex communication needs do not have their choices listened to at all times. Some residents do not have access to their own monies and this affects their daily living and choices. EVIDENCE: Since the last inspection the service has worked with an independent consultant to develop person centred care planning. This is still a development process to ensure that the new care plans are relevant and personal to each resident and easily useable for care staff. When we looked at some of the care and support plans and talked to staff it was evident that the format of the care 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 11 plans involves a lot of duplication in recording and there are four different files for each resident. Each person has a person centred plan, a health action plan, a daily records folder and a care plan folder. Generally the presence of four folders is confusing and there were instances when information between the files was inconsistent and some information recorded in one file was not transferred/recorded in others. Care staff confirmed that the four files were also a bit confusing and they generally only looked at the daily records. This means that people using the service may not be fully involved in the development and review of their care plan and some essential information may be overlooked. For example, although the care plan for one resident contained a communication plan, in practice, this was not being followed. Over a period of two hours, staff made no communication at all with one resident in the home and the resident was not offered a drink, although other residents were requesting and receiving drinks during this period. This means that people whose communication styles are more easily understood by staff may be more involved in the day to day living and social activities in the home. The care plans that we looked at contained risk assessments and a plan of how risks are to be managed, some of the information had not been recently updated and some of the risk assessments were signed and dated for June 2008. This means that the records may not give an accurate picture of the care and support that people are receiving. Since the last inspection the service has started to develop more innovative methods of communication and have developed yes/no cards for residents, picture menus, and greater use of pictorial images. The responsible individual has not resolved an outstanding issue about the management of the personal finances for three residents. Other residents have advocacy support for their financial and legal affairs from either family or the local authority. However, we saw records of correspondence from the previous manager to health and social care professionals that demonstrate that the issue has been highlighted as an urgent issue of concern. The responsible individual has told us that the service has now realised that it would not be good practice for anyone employed by the home to act as appointee for a resident, or manage any financial accounts for residents in a company account. The responsible individual told us that the issue is still being followed up. However, because of the length of time involved since this issue was highlighted and because it affects residents who are not able to access their own money, we have referred this as a safeguarding issue to Southampton City Council Social Services Department. 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 and 17 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although people using the service are being offered a greater variety of social and leisure activities, the approach is not consistent and residents with more complex communication needs may be overlooked. EVIDENCE: Since the last inspection the home has appointed a senior member of staff as activities co-ordinator. In addition, the home has developed person centred care plans that focus more on meeting residents’ social, emotional and communication needs. It is evident from the weekly activity schedule that some of the residents are being offered opportunities to try new activities such as horse riding, different therapies and more opportunities to go out for shopping, meals etc. However, the information in the individual activities programmes does not always match up with what happens in practice. For 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 13 example, one support plan states that a resident likes to go swimming but the daily records for the month prior to our visit indicate that the resident did not go swimming at all, the records do not comment on why this did not happen. Another care plan states that a resident likes to take part in sensory activities but on the day that we visited, the sensory activity took place for 5 minutes. It was not clear if this was the choice of the resident or if staff were not clear or confident about doing activities. This means that the care plans may not accurately reflect up to date information about what residents like to do, or, the care plans have not been regularly reviewed with the resident and their key worker, to ensure social needs are being met, or changed to reflect what residents like or don’t like to do. Three of the residents go out to community day centre resources on five days each week and the home told us that they have asked for another resident to be assessed for day centre activities as it is felt that the resident would benefit from this. Other residents are involved in activities in the home or are taken out individually or in small groups for walks or other outings. Picture menu cards have been developed, and are being used, to support residents in making informed choices about what they would like to eat. Residents take their meals in the two dining areas in the home. One resident had a burger and bun for lunch, although the care plan recorded that the resident did not eat wheat products. Staff were unclear about this. This means that the care records may not accurately reflect residents’ food likes, dislikes or special dietary needs. 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the 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 health and personal care needs of the residents are recorded in a health action plan. However, there are some gaps in the information and health care needs are not consistently monitored with sufficient attention given to changing health care needs. Residents are not being supported to access dental care when needed. Residents receive their medication safely and as prescribed. EVIDENCE: Since the last inspection the home has developed and put into practice, person centred plans for each resident. The person centred plan includes a health action plan to provide staff with guidance on how residents’ health care needs are to be met. We looked at the health care records for three residents and there were some gaps in the information. For example, there was no record in the health action plan for how residents access dental care. Contact and visits to health services such as GP or chiropodist were not up to date. For one resident, important information about health care treatment had not been 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 15 communicated to the manager and staff from the registered provider. This means that the resident is at risk of receiving health interventions that would not be in their best interests. Some of the daily records of care have not consistently recorded weight checks. This means that residents’ changing care needs may not be reviewed and addressed. We identified in the previous section that staff have not found the new care plans easy to use and there is some duplication of recording. This means that health action plans may not have been regularly reviewed to ensure that gaps in the recording of residents’ health care needs are monitored on a regular basis by the key workers. Staff may not have clear guidance on what they must do to ensure that residents’ health care needs are met. This means that residents may be at risk of their health care needs being overlooked or met inconsistently. The procedures for safely administering residents’ medication have improved and the registered person has complied with a previous legal requirement about storing controlled drugs. The home carries out monthly audits of medication practice and these records were up to date. Updates of training have been arranged for staff in the safe administration of medication. The home has developed an internal training plan for assessing and monitoring the competence of staff that dispense medicines to residents. The care plans for medication that are prescribed to be given as and when required state that consultation must take place with the registered manager. The home told us that this guidance would be amended to reflect that the home does not have a registered manager at the moment so that staff have clear and up to date guidance. 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the 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 are protected from the risk of harm or abuse with policies and procedures for staff to follow including links with external agencies. However, agreed policies and procedures are not consistently followed and some staff may not be familiar with the guidance or be able to access them easily. EVIDENCE: Allegations of abuse and concerns about the safety of the residents in the home have recently been investigated by Social Services under their safeguarding adults procedures. The home worked closely with Social Services during the investigation and took appropriate steps to protect residents in the home. Some recommendations to improve practice in the home were made. However, previous recommendations following safeguarding concerns have not been met in a timely manner – staff have not yet updated their good practice training and awareness of restraint issues. This means that practice in the home may be inconsistent or staff may not put a priority on rights and choices for the residents. Incidents or events that affect the safety and well being of the residents have been reported to us (this is a legal requirement) and the home has made appropriate referrals to Social Services under agreed safeguarding procedures. However, one event in the home was not referred to Social Services as a safeguarding concern, by the registered person (responsible individual). This 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 17 means that staff may not be familiar with the agreed procedures: that all events affecting the safety or well being of the residents must be referred to Social Services and notified to the commission. The individual care and support plans for residents have identified any risks to residents with a plan in place for how risks are to be minimised or events managed. However, some of the risk assessments and action plans have not been reviewed. This means that residents’ needs may have changed but staff may not have clear guidance about how changing care needs and choices are to be met to ensure residents are safe and their choices respected. 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have benefited from improvements to the decoration and furnishing of the home. The home is clean and hygienic and almost all of the staff have completed training in safe working practice for the control of infection. EVIDENCE: At the last inspection we made a regulatory requirement that the home must be kept in a good state of repair internally and externally to provide a good quality of life for the residents. We also made an immediate requirement for two light fittings to be repaired and for toilets, used by residents, to have toilet seats fitted. During the visit we found a number of improvements to the home: the kitchen has been refurbished, the sitting room has been decorated and has new flooring, toilets were fitted with toilet seats, and light fittings had been 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 19 repaired. This has improved the home environment for the residents. The outside/garden area is private and provides residents with a paved seating area and a grassed area with a trampoline. There were some items of old furniture and mattresses in the garden and we were told that these were waiting to be taken away. We were told that staff are looking for soft furnishings such as curtains, to make the home look more attractive and homely, and to provide window coverings that are suitable, attractive, and safe for the residents. There were plans to make another bedroom in the home, converted from the first floor office. However, these plans have changed and the office has moved downstairs and the first floor room is currently being used as a staff room/storage room. We received permission from some of the residents who were at home to look at some of the bedrooms. These were decorated and personalised according to individual choice and interests. The home has an additional kitchen that some of the residents are able to use to make themselves snacks and drinks. At the last inspection we also made a regulatory requirement for the home to make suitable arrangements for maintaining satisfactory standards of hygiene and control of infection. The home employs a cleaner and since new flooring was fitted in the sitting room and kitchen – this has improved hygiene. During the visit we noted that cleaning materials had been left out in a hallway and this could put residents at risk, this was discussed with the manager who took immediate action. Since the last inspection, all of the staff, except one, have completed training in infection control procedures. The home has a policy and procedure for staff to follow to ensure safe practice in good hygiene. 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not have a training plan to ensure that staff have the skills, qualifications and competencies to meet the specific needs of the residents. The procedures for staff recruitment are not robust and this has the potential to place residents at risk of harm or abuse. EVIDENCE: Since the last inspection the permanent staff team has increased. The home still uses some agency staff to cover shortfalls in the staff rota but this has reduced. For the week beginning 18 May, three shifts were being covered by agency staff. Temporary staff may not know the residents well and this may affect how well the home is able to provide person centred care or provide activities for the residents. Since the last inspection the records show that training has been arranged in first aid, infection control, food hygiene, report writing, and manual handling. 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 21 We saw records of distance learning that has been arranged for staff later in the year, for safe administration of medication, and healthy eating. The training records show that staff are now receiving opportunities for training, (and updates to training), in all mandatory areas of safe working practice. In addition, fifty per cent of the staff have achieved an NVQ (national vocational qualification) in care at level 2 or 3 and other staff are working towards this. We were told by the manager that the home has not yet arranged specific training for staff in learning disability awareness, autism awareness, specialist communication skills or other areas specific to the needs of the people using the service. This means that the service does not have a training plan to ensure that the needs of the residents are met by appropriately trained staff at all times. Last year, a safeguarding investigation by the Local Authority Social Services department recommended that staff should update their training in awareness and use of safe restraint techniques. Although training has been arranged for the manager and another senior staff member in this area for later in 2009, with the intention of cascading this training to all staff: the recommendation has not been met in a timely manner. This means that people using the service may be at risk if staff have not been assessed as competent and skilled in managing challenging behaviour. At the last inspection we noted that improvements had been made to the recruitment procedures for new staff. At this visit we looked at the records for the recruitment of three members of staff. Improvements have not been sustained and records show that the service does not consistently operate thorough and robust recruitment practice, for example, in two records, the service had not obtained two satisfactory written references before employment, and had accepted general references for one person. We were not able to see evidence of satisfactory criminal record bureau checks, although the service told us that checks have been received - but subsequently destroyed. Failure to maintain robust and thorough recruitment procedures that meet regulatory requirements means that the service cannot demonstrate that people using the service are safeguarded, and that staff are suitable to work in the home. We previously made a good practice recommendation for the service to provide a comprehensive induction for new staff using the nationally agreed induction standards. The home has not put this into practice. 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People using the 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 home is not consistent and this affects outcomes for the people living in the home. The home has not had a registered manager for twelve months. Quality monitoring systems are not consistent and robust. EVIDENCE: People using the service have experienced several changes in the management of the home since the last inspection. The manager who was appointed in August 2008 left in February 2009. This means that the home has not been consistently managed to ensure that improvements are sustained and embedded into the practice of the home, for example, the home has not maintained the improvements made to their recruitment procedures. 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 23 A new manager has been appointed and will be applying to become the registered manager for the home. The manager has relevant care and nursing qualifications and management experience and plans to achieve a management qualification at the earliest opportunity. The home has a fire safety risk assessment in place but the records for fire safety training and fire drills were not up to date. Records for the weekly testing of the fire alarm and emergency lighting have not been kept up to date. The responsible individual must ensure that specific requirements for fire safety are clarified and legislation complied with to ensure the safety of residents and staff. The manager confirmed that risk assessments for the use of cleaning products and other hazardous materials are in place and up to date. At the last inspection we made a requirement that the registered person must notify us of any event that affects the safety or well being of people living in the home. We have been notified of events in the home, however, we had to write to the registered provider recently because we had not been notified of a safeguarding concern. We also found records in the home of some events that have not been notified to us or reported to Social Services as safeguarding concerns. This means that residents may be at risk of harm or abuse if events are not reported to Social Services using the agreed safeguarding policy and procedures. Residents have individual care and support plans that are person centred. However, records of health and personal care show that residents have not been receiving access to regular dental and chiropody care and the responsible individual must ensure that this is included in residents’ health care plan and regularly reviewed. The responsible individual must also ensure that important health care information about residents is clearly recorded in care plans and communicated to staff to ensure that residents’ health care needs are met at all times. Since the last inspection the service has developed systems for measuring the quality of the service provided. We were shown the outcome of a satisfaction survey with the residents; this was carried out in April 2009. Staff used pictures, yes/no cards, observations of body language and their knowledge of the residents to seek feedback from residents. The outcomes were generally good although only 50 of the residents indicated that they were satisfied with privacy in the home. We were told that this is being followed up. The home has been carrying out audits of activities for residents, monthly audits of medication, and a consultant has been engaged to inspect the service on a monthly basis on behalf of the registered provider/responsible individual. We looked at the last inspection report for April 2009 and noted that some areas that need action are clearly highlighted with a timescale for completion. 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 24 The report is also linked to the national minimum care standards. However, the internal inspections of the service have not identified all of the areas of practice that require action to meet regulatory requirements and ensure the safety of the residents, for example, access to dental care and recording all medical appointments in the health action plans for residents. This means that internal quality monitoring practice is not robust and residents may at risk of their health and care needs being overlooked, or met inconsistently. 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 1 35 1 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 x 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 2 x 2 x x 2 x Version 5.2 Page 26 374-376 Winchester Road DS0000062649.V375984.R01.S.doc NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. YA19 Standard Regulation 13 Requirement The responsible individual must ensure that residents are able to access dental and chiropody care as required. The health care needs of residents must be regularly reviewed to demonstrate that health care needs are met all of the time. Timescale for action 31/08/09 2. YA35 18 The responsible individual must 31/08/09 ensure that people working in the home receive training appropriate to the work they do (including structured induction training) and to meet the specific needs of the residents. A training plan must identify how staff training needs will be met with timescales for action. The responsible individual must ensure that new staff have satisfactory pre-employment checks that meet regulatory requirements. The responsible individual must ensure that residents are 3. YA34 19 and Schedule 31/08/09 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 27 protected by thorough recruitment practice and demonstrate that new staff are suitable to work with the residents. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 374-376 Winchester Road DS0000062649.V375984.R01.S.doc Version 5.2 Page 28 Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4WH National Enquiry Line: Telephone: 03000 616161 Email: enquiriessoutheast@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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