Inspection on 06/12/08 for 4 Ashley Drive

This inspection was carried out on 6th December 2008.

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

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

Other inspections for this house

4 Ashley Drive 26/06/08

4 Ashley Drive 21/08/07

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 4 Ashley Drive Tylers Green Buckinghamshire HP10 8BQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Chris Schwarz     Date: 0 6 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: 4 Ashley Drive Tylers Green Buckinghamshire HP10 8BQ 01494814569 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Turnstone Support Name of registered manager (if applicable) Miss Patrice Hosier Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the follwing gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disabilities (LD) Date of last inspection Brief description of the care home The service is located in Tylers Green and is a domestic dwelling that has been adapted into accommodation for six people. There are three bedrooms with en-suite facilities on the ground floor and a further three bedrooms on the first floor. The upstairs rooms are accessible by a staircase and not suitable for people with mobility issues. Communal accommodation is comfortable and includes a sizeable kitchen and dining area. There is a pleasant rear garden which is accessible to people with physical difficulties. The home is approximately seven miles from the town centre and there are local facilities within walking distance. The home has its own vehicle and people using the service are able to access public transport. Care Homes for Adults (18-65 years) Page 4 of 32 care home 6 Over 65 0 6 Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted by Chris Schwarz over the course of a day and covered all of the key National Minimum Standards for younger adults. The last key inspection of the service took place on 26th June 2008. Prior to the inspection, a detailed self-assessment questionnaire was sent to the manager for completion and surveys were sent to a selection of people living at the home, staff and visiting professionals. Any replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with the manager and other staff, opportunities to meet with people using the service and relatives, examination of some of the homes Care Homes for Adults (18-65 years) Page 6 of 32 required records, observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. The manager, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. What the care home does well: What has improved since the last inspection? What they could do better: Management of controlled drugs needs to be improved through securing the controlled drugs cabinet to a wall or other permanent fixture to ensure safe storage and for staff witnessing or administering controlled drugs to sign the register to ensure proper records are kept. Complaints procedures need to contain the current contact details of the Commission for Social Care Inspection to make sure that people have the right information to hand. Care Homes for Adults (18-65 years) Page 8 of 32 The environment needs to be improved through making the communal areas more homely and ensuring they are kept warm. Lino flooring in the dining area needs replacing with carpet to improve appearance and make the area more comfortable. The practice of leaving all the doors leading off the dining and lounge area open needs to be reviewed. Soap and hand towels need to be maintained at all times in the laundry and bathrooms/toilets to ensure that proper infection control measures are in place. Recruitment needs to be improved by ensuring that detailed information is sent to the service before any agency worker starts and provides confirmation of required checks and mandatory training. For permanent staff, either copies of all required checks need to be on the premises or improved verification processes employed. The provider and managers need to keep the Commission informed promptly of important events at the service, such as planned hospital admissions and changes of manager. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 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. People using the service are thoroughly assessed prior to admission and have access to a good range of information to help them decide whether they want to move in. Evidence: There had not been any new admissions to the service since the last key inspection in June this year. At that time the service was judged to be undertaking thorough assessments of prospective users needs and offering placements to people whose needs it could meet. Information about the service in the statement of purpose and service users guide was also looked at on that occasion and found to be good resources for prospective users and their representatives. These documents were still in place. From returned surveys, some service users said they had been asked if they wanted to move into the home and had received enough information to help make a decision about this. For others, decisions had been made by family members. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: Details of the current range of fees may be obtained by contacting the provider direct. Care Homes for Adults (18-65 years) Page 12 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is good regard for the diverse needs of the people living at the service and their requirements related to their disabilities, lifestyle choices and personal preferences are sought, recorded and met by the staff team, respecting their rights, choices and individuality. Evidence: Care plans were in place for each person and the files kept in their bedrooms. Two of the files were read in detail. Information had been collated relating to a wide range of support needs and had been dated and signed. Each file started with a sheet containing essential information about the person, such as their preferred name, previous address, next of kin, emergency contact, doctor details, nationality, religion, height and weight and a photograph. A note was also made of any distinguishing marks and colour of hair and eyes - this would be particularly useful in the event of anyone going missing. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: Information had been noted to show people using the service had chosen their keyworkers although in one case the carer no longer worked at Ashley Drive and this will need updating. Peoples likes and dislikes had been noted. A document called things you need to know about me outlined details of supporting one person to eat healthily, how to support him in getting up in the mornings and supporting at night. The first two sections had been due for review in June this year but there was no evidence that this had been done. The manager was made aware of this. Information was also noted in sections such as how I like to be supported when things are going wrong. Support plans contained detailed information that staff need to carry out specific tasks and described them well, such as how staff and the service user needed to be positioned when cleaning teeth. The level of detail in support plans was such that it should be possible for any new member of staff to support people in a way that ensures continuity of care. Where a service user had epilepsy, a care plan was in place to address this called about my seizures. It provide details of any known triggers, a description of a typical seizure, how the person is likely to behave after the seizure and what to do in emergency situations. This too was well written. The need to produce communication dictionaries for each person had been identified during a monitoring visit by the provider in August this year. These had not been started. At the previous key inspection a requirement was made around use of restraint at the service and having a support plan in place to justify this, agreed with outside agencies. An example was seen where one person may need a harness when travelling. Records showed that the local authority had agreed to write a risk assessment for this although it had not been received at the service yet. The manager advised that the harness may not be necessary, provided an escort was in the vehicle. She was advised to contact the local authority to check which method they agree to and to ask for the risk assessment to be forwarded. Risk assessments were in place for a range of areas such as managing medication (no one self medicates), managing epilepsy where relevant, in the event of fire, specific individual health needs, travelling, use of bed bumpers, keeping healthy, moving and handling and personal care. All had been dated and signed and were current. There was evidence of peoples needs being reviewed through a things that have happened this month document. These were divided into sections on what had made the person happy or sad, things they had enjoyed doing, any changes during the month, health problems, medication changes, changes to their personal monies, new Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: risk assessments or support plans that had been introduced and things they wanted to try or do differently. The manager advised that three service users had recently been reviewed by their placing authorities; the reports were awaited. Two peoples money was checked to see how it is managed at the service. Lockable cash tins and records were kept safe in peoples rooms. Individual records were maintained with receipts kept to verify expenditure. Both tins tallied with recorded balances. From returned surveys, most service users said they can make decisions about what they do. Throughout the day, staff were observed involving people using the service such as when answering the door, making drinks and going into town to buy Christmas decorations. Staff asked a service user who had been unwell in the night and still felt poorly whether he wanted to go out to a group he is part of and let him make the decision without rushing or influencing the decision. Some records in care plan files contained a service users signature; coloured ink stamps were seen in one persons file which the manager had recently introduced where people cannot sign for themselves. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. A varied diet is provided to meet peoples nutritional needs. Evidence: Records of activities are kept for each person. Everyone attends day services for part or all of the week and records showed that when people are not at day services they make use of the local library, go to the post office and local shops, have lunch out, go for walks, are involved in shopping, go into town, go to the cinema, have haircuts and attend Causeway group. Service users are also encouraged to take part in meal preparation and one person likes to update the staff on duty notice board each day. On the day of this visit, a Saturday, several service users went out with their relatives, one went out with staff for a walk and another went into town with staff to buy Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: Christmas decorations and have lunch out. The person who was feeling unwell would otherwise have been at Causeway group. People who completed surveys said they can do as they wish during the day, in the evenings and at weekends. The manager was aware that a greater range of activities and more flexible options were needed for people using the service. She was able to produce proposed activity plans for each person which took into account their interests and things they would like to try, like nightclubs. She was aiming to involve people more in evening activities and had taken steps to overcome potential barriers, such as a 6 pm PEG feed that one person requires, through acquiring a portable back pack feed system. With Christmas events and some service users staying with families over the bank holidays, the activity plans were due to be introduced in the new year. An advocate from Talkback visits the service every two weeks to meet with service users. Consultation meetings, to which relatives are invited, take place periodically. Improvements have been made to how meals are offered to service users. Detailed records are now being kept of what people have eaten and there is evidence of how they make decisions about what to eat, such as through pointing to pictures or touching a food item. A four week rotating menu was in place offering various choices. The freezer and fridge were quite well stocked and staff had added the date of opening to items in the fridge. There was lots of fruit, particularly bananas which one person enjoys. A selection of breakfast cereals was available. Care Homes for Adults (18-65 years) Page 17 of 32 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. The health and personal care needs of people living at the service are being met, promoting health and well-being. Improvement is needed to the management of controlled medicines to ensure they are handled safely. Evidence: Peoples care plans provided clear details of how they are to be supported with their health and personal care. A record of appointments with health care professionals was being kept and showed that people have access to routine and specialist services. In terms of equipment to assist with daily living, one person required a hoist, which was in place, and ceiling tracking was on order for another service user. Three bedrooms are located downstairs to accommodate people with mobility issues, and each of these bedrooms has an ensuite bathroom to meet their needs. Records within the home showed that there had been a couple of hospital admissions since the last inspection. One visitor said that there had been times recently when their relative looked unkempt and had food stains on his clothes when collected to go out and no belt had been put on his trousers which were now loose due to weight loss. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: Medication was being managed using a monitored dose system. Three cabinets were located in the office. Improvement had been made to storage of the keys through use of a number coded box on the wall to keep the keys in. Cabinets were locked when not is use. There was a lot of stock of some items which the manager had already identified as needing to be addressed. Staff had written the date of opening on packets of eye drops and creams so that these were not used beyond their expiry times. Concern was expressed by the inspector that a new, purpose designed controlled drugs cabinet which was in use, had not been affixed to a permanent structure. A requirement is made to address this. The manager was also advised that it was not necessary to place items in a lockable cash tin within the controlled drugs cabinet, as was found, as there is no need for this and also that spillage from the two bottles that were in there could happen if they were not kept upright. Medication administration records were looked at. These were well maintained and had a photograph of the service user for reference. There were accompanying individual protocols for any as required medications and preparations that people needed. A policy document on medication was contained within the policy folder in the office. A copy of the British National Formulary dated September 2003 was also in the office; the manager was advised to obtain an up to date version. In the controlled drugs register one member of staff was not signing her name, just printing her first name, which is not acceptable. A signature is required for any person administering or witnessing administration of controlled drugs and a requirement is made to address this. Observation of staff administering morning medication showed that correct procedure was followed, dealing with one persons medicines at a time, offering them a drink with their tablets and only signing the records after ensuring that the persons medicines had been taken. Positive feedback was received from a surgery which considered that the service seeks advice when needed, always meets peoples health care needs, always respects peoples privacy and dignity, and always responds appropriately if any concerns have been raised about care. Care Homes for Adults (18-65 years) Page 19 of 32 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. Safeguarding procedures are in place to protect people from the risk of harm and staff undertake training to recognise and be able to respond to abusive practices. Updating is needed to complaints procedures to make sure people have correct information to hand. Evidence: The manager was not aware of any complaints or safeguarding incidents occurring since the last key inspection in June this year. Three compliments had been noted. The Commission has not been made aware of any issues about the service. The complaints procedure was looked at. There was a detailed complaints procedure which gave incorrect details of the Commission for Social Care Inspection and needs to be updated. A simplified version suitable for service users who can read was also seen which gave another out of date address for the Commission. A requirement is made to update these in order that people have correct information to hand. A safeguarding policy was in place which contained detailed information on protecting people using the service and outlined the responsibility of managers to notify the Commission and Social Services when there are allegations or suspicions of abuse. The service had a copy of the local authority multi agency guidelines in place. Staff training records showed that they receive training in this area of practice. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: Feedback was received from a relative who felt that a safeguarding matter involving a former staff member and an agency worker earlier in the year had not been handled well. There was concern in the first instance that abusive care practice had taken place and not been picked up and then that the final outcome of the investigation had not been communicated to the family who were worried that the member of the staff would return to work. Since the inspection, the provider has advised that the outcome of the investigation could not be communicated until the full process had been completed, which includes the right of the employee to appeal any disciplinary decisions. The provider said regular telephone calls to the family were attempted, with messages left for them. As part of regular meetings with families, the provider included disciplinary processes on the agenda of a meeting last summer although the family with the concerns were not able to attend this. It was possible to see that since the manager has been at the service, staff are being instructed to record any marks or bruises on service users as they carry out personal care and incidents and accident records and body maps were seen to be in use which are counter signed by the manager. Most service users said they knew who to speak with if they were unhappy and that carers listened and acted on what they say. Staff said in surveys that they knew what to do if anyone raised a concern or complaint about the service. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises would benefit from touches to make them more homely for people using the service and need to be kept warm to ensure that people are comfortable. Evidence: The building is a detached property located in a residential street in Tylers Green. It is close to a parade of shops and nearby there is a branch library. A bus route runs from around the corner to take people into High Wycombe. There is a large front garden and a smaller enclosed garden at the rear. Parking is located at the side of building. Inside, there are three downstairs ensuite bedrooms and the communal rooms. The lounge/dining area is a large open space with the kitchen leading off it. There are doors either end which lead to the staircases. On arrival at the home, the inspector sat in the lounge and spoke with people using the service. A draught from the window could be felt whilst sitting on the sofa by the lounge window and it was not particularly warm. The sofa was placed right against the radiator which may have been obstructing heat. Two relatives that were spoken with said they felt the building was not generally warm enough and that downstairs did not look homely. An absence of pictures or decorative items in the lounge and dining area, a lino floor in the dining area and doors leading off the communal areas left open detracted from a pleasant ambiance. The manager advised that agreement has been given to redecorate downstairs. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: Recommendations are made to improve the environment to make it look and feel more homely. The kitchen was large with plenty of storage space and contained a locked cupboard for cleaning products. It had been kept clean although the inspector drew the managers attention to food splashes inside the microwave and these were then cleaned away by staff during the inspection. The laundry is located in the garage and is accessed from a door leading off the kitchen. The laundry had sufficient equipment for a home of this size and a sink for hand washing. However, there was no soap or paper towels for staff to wash their hands before returning to the building via the kitchen. A requirement is made to address this to ensure that proper infection control measures are in place. Upstairs, there were further bedrooms and two bathrooms with toilets. Neither bathroom had soap in - this was rectified when pointed out. Bedrooms that were viewed had been personalised and looked comfortable. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are patient and gentle in their interactions with people using the service and receive training to make sure their skills and competencies are up to date. Recruitment needs to be improved to make sure that people are not placed at risk of harm. Evidence: People using the service said in surveys that staff treated them well. Staff commented that they are usually given up to date information about people using the service and receive training relevant to their roles, which keeps them up to date with new ways of working and helps them to understand and meet peoples individual care needs. They said the ways in which information is shared usually worked well and that there were always/sometimes enough staff to meet needs. One person said that training, including service users, care support and valuing people were areas of practice that the service does well. Staff indicated that they had been recruited thoroughly and have opportunities to meet with management for support. Three staff were on duty during the day, a typical level of cover according to the rotas. At night there is one waking night staff plus a person sleeping in. One of the carers on duty was from an agency. There were two full time and two part time vacancies at the service. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: Observation of staff practice showed that they were gentle and respectful in their interactions with people using the service. They gave them eye contact and offered choices and waited for them to answer. People who needed assistance to eat or drink were helped in a dignified manner. A notice board in the lounge/dining area was up to date with which staff were on duty and the day and date. Photographs of staff had been added for reference. Recruitment records of three permanent staff and one agency worker were looked at. Photographs had been added to files to comply with a requirement made at the last inspection. One permanent worker had just joined the service and her main recruitment file was said to still be at head quarters. For the other two permanent staff, some of the required checks could be seen such as proof of identification and references. A sheet at the front of their files gave the disclosure number and level of Criminal Records Bureau check but the sheet which also contained details of other checks had not been signed by a person in authority to verify the checks had been undertaken and were satisfactory, and confirming that the original documents are located at head quarters. For the agency member of staff the information was on a sheet of paper written by the agency which included details of a second person as well, and said the person had minimum of six months experience and Criminal Records Bureau checked. The nature of their previous work was not indicated and a generalised statement confirmed that checks had been carried out and mandatory training was up to date. However, the Commission would expect to see individualised proformas for agency staff which relate only to them and provide more detail for the service and for inspection purposes. A requirement is made to improve recruitment practice at the service. Training records of three staff showed that they were up to date with mandatory courses. The manager was advised to make use of free training run by the local authority and to access the community team for people with learning disabilities as a useful resource. Care Homes for Adults (18-65 years) Page 25 of 32 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. Health and safety is generally managed well to keep people safe from risk of harm. The service is monitored by the provider to assess quality of care and some improvements are evident. The provider and managers have not kept the Commission informed of important events at the service which causes us concern. Evidence: There have been changes to management at the service. The current manager advised that the previous manager had been on long term sick leave since the last inspection and then resigned. She joined the service at the end of September this year. No notifications were received by the Commission about changes to management or cover during the sick leave. A brief note was added to the improvement plan submitted in September 2008 which was not substantial enough or timely enough. A requirement is made to ensure all such changes are reported without delay. The manager was approachable and came in voluntarily from a day off to assist with the inspection. She is experienced in working with people with learning disabilities and Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: demonstrated awareness of good practice during discussions. She is undertaking National Vocational Qualification level 4 and the Registered Managers Award. There has been regular monitoring of the service by the provider with reports available of findings. These were detailed. Two of these reports showed that two hospital admissions had taken place, one in June and one in November this year. The Commission had not been notified of one of these occasions, which was for a planned admission to hospital. It is advisable for managers to notify of planned as well as emergency admissions and a recommendation is made to this effect. Returned quality assurance questionnaires for 2007 were looked at. The findings had not been collated into a report and shared by people who took part in it. They may not have been informed of any actions that took place as a result. It is recommended that a report is produced of any future questionnaires in order that people are informed of the outcomes. Policies and procedures were in place in the office for staff to refer to. These covered a wide range of areas such as missing persons, supporting people who challenge, fire safety, clinical waste and infection control, health and safety and an emergency plan. Health and safety was managed well overall. An environmental health inspection of the kitchen, laundry and lounge/dining area took place in November this year which resulted in satisfactory findings, although the lack of a ramp to the laundry was highlighted. There was a current gas safety certificate in place and verification of satisfactory electrical installation. Portable electrical appliances had been checked this year and the fire alarm was serviced last month. Extinguishers had been serviced at the start of the year. Quarterly health and safety checks were being undertaken of the premises and were up to date. Fridge and freezer and hot water temperatures were being monitored. A fire based risk assessment was in place and individual risk assessments were in place in peoples care plan files. Accident and incident reports were being completed effectively. Cleaning products were kept safely locked away. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 32 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 20 13 Staff witnessing or administering controlled drugs are to sign the controlled drugs register to ensure proper records are kept. The controlled drugs cabinet is to be secured to a wall or other permanent fixture to ensure safe storage of controlled medicines. 01/01/2009 2 20 13 01/01/2009 3 22 22 Complaints procedures are 01/02/2009 to contain the current contact details of the Commission for Social Care Inspection to make sure that people have the right information to hand. Soap and hand towels are to 01/01/2009 be maintained at all times in the laundry and bathrooms/toilets to ensure that proper infection control measures are in place. 4 30 13 Care Homes for Adults (18-65 years) Page 29 of 32 5 34 19 Where original documents of 01/02/2009 recruitment checks are kept away from the service, such as at head quarters, copies of documents are to be kept at the home or a verification sheet which confirms satisfactory checks. This will need to be signed by a person in authority who has seen the documents and can confirm that they are satisfactory. This is to protect people from risk of harm. 6 34 19 Where agency staff are used 01/01/2009 to cover the rota, the manager is to ensure that detailed information is sent to the service before the worker starts at the service and provides confirmation of required checks and mandatory training. This is to protect people from risk of harm. 7 37 8 Changes to management of 07/01/2009 the service are to be reported to the Commission without delay to comply with regulations. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 24 The practice of leaving all the doors leading off the dining and lounge area open is to be reviewed to keep this part of Page 30 of 32 Care Homes for Adults (18-65 years) the home warm and comfortable. 2 24 The lino flooring in the dining area is to be replaced with carpet to improve the environment and make it more homely. Communal areas of the home are to be made more homely through purchase of things such as pictures and ornaments. Heating levels are to be monitored and maintained at a level suitable to the needs of people using the service. Notification is to be made of planned hospital admissions as well as emergency situations. The results of any quality assurance exercises are to be collated into a report and shared with interested parties. 3 24 4 5 6 24 37 39 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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