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Inspection on 03/11/08 for 46 Severn Avenue

Also see our care home review for 46 Severn Avenue for more information

This inspection was carried out on 3rd November 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 46 Severn Avenue 46 Severn Avenue Weston Super Mare North Somerset BS23 4DQ     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: Jacqueline Sullivan     Date: 0 3 1 1 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 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: 46 Severn Avenue 46 Severn Avenue Weston Super Mare North Somerset BS23 4DQ 01934626731 01179699000 david.rogers@brandontrust.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Brandon Trust care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The maximum number of service users who can be accommodated is 6 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Severn Avenue is operated by The Brandon Trust and is situated in a pleasant suburban area of Weston-super-Mare. The home provides support for up to 6 service users with varying degrees of learning disability. Fees are negotiated with the placing authority. Care Homes for Adults (18-65 years) Page 4 of 34 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 quality rating for this service is one star this means the people who use this service experience adequate quality outcomes. This was an unannounced visit to the home as part of a Key Inspection of this service. The inspection was completed with the assistance of a pharmacy Inspector. The review of evidence and pre-inspection planning involved reviewing the report of the last Key Inspection and the service history, which details all contact with the home including notifications of significant events which they have reported to us. We (the CSCI) provided the home with their Annual Quality Assurance Assessment Care Homes for Adults (18-65 years) Page 5 of 34 (known as an AQAA).The AQAA was completed and returned. We gathered additional information during my visit through informal discussions with service users and Support Workers. Interaction and communication between staff and residents was also observed during our visit. Care plans and associated records were examined together with accident and incident reports, Risk Assessments, complaints procedures and health and safety records. We were also provided with a tour of all communal areas of the home and some of the residents own rooms. 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 Care Homes for Adults (18-65 years) Page 7 of 34 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 34 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 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes admission procedure ensures that a placement is only offered to those whose needs can be met. The residents will be more informed once the details of the manager is included in the statement of purpose. The residents are not fully protected as each does not have has an individual contract with all the necessary information. Evidence: The home has both a Statement of Purpose and a Service Users Guide. We examined the copies which were available in the office on the day of our visit. Since the last inspection both documents have been updated by the manager.The statement of purpose has all the necessary information except for the managers name. Care Homes for Adults (18-65 years) Page 10 of 34 Evidence: The residents plans contained a copy of the Brandon Trusts contract.These are written in plain English and have pictures to support the text, to help residents understand them. They have spaces for each residents name, picture, room number and the fees they are expected to pay in relation to accommodation and transport costs. The manager reviewed these documents in February 2008. We looked at four of these documents in detail and the letter from the Trust which is the contract with the resident. These were signed by the manager ,the resident or their representative or advocate to show that they have has been discussed and agreed with the people who live in the home. At the last inspection it was noted that the documents seen did not include the fees and contributions. At this inspection it was noted that this information has now been included. The contracts did not contain sufficient information about the actual rooms the residents occupied, full details of charges of use of the homes vehicle. There have been one new admission to the home, an assessment from the placing authority was seen to contain the appropriate information in order for the staff team to meet their needs. Care Homes for Adults (18-65 years) Page 11 of 34 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. Not all the residents can not be assured that their changing needs are reflected in their care plans. The residents are encouraged to make decisions about their lives . There is some evidence that the residents are supported to take risks but this could be further developed. Evidence: Each resident has a care plan and we examined three of these during our visit. At the last inspection it was noted that none of the plans examined were easy to follow and the information in them varied greatly. At this inspection it was noted that the care files had been reviewed to include person centred planning. Some staff members have had training in this area and there was evidence in the files that staff have worked hard to improve the quality of the plans. We noted that the plans now include Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: information about how the residents want to be addressed. However, as noted at the last inspection, the information is difficult to find and the quality variable. An example of the variable quality was the care plan for the most recent resident where we could only find the 2007 care plan. There was a note on file asking for the 2008 plan to be written up by particular member of staff. However,this had not been completed.Other care plans seen were more up-together. The manager said that he is working towards all the care files being of the same standard and would be addressing this with the staff team. At the last inspection it was noted that each individual had been supported to set their own goals and aspirations, although the systems to monitor progress towards them remains unclear. At this inspection it was noted that work was in place to identify the residents goals but the monitoring system was not consistent in the files seen. A recommendation has been made about this issue. Care plans examined contained details of the last annual review attended by the resident , a representative from their Funding Authority and staff from both the home and Day Services, if this is appropriate. The Funding Authority had provided each person with a copy of their review notes. At the last inspection, the review processes used within the home was inadequate and inconsistent. At this inspection we noted that the plans are more consistently reviewed not in sufficient detail. We noted that the staff team frequently write no change in the plans without any further information. In the last inspection report, the involvement of the people who live in the home in making decisions about their lives and planning for the future was seen to be inadequate. At this inspection it was noted that the frequency of residents meetings has improved and there was some evidence that their wishes were recorded in their care plans. Each individual has a person centred risk assessments in place which is designed to support them to take risks as part of their lifestyle. In one persons file, we read that they had fallen from their bed and then bean bags were used to protect the resident. Full risk assessments and alternative strategies to protect this person were not in place. Requirements were made at the last inspection about care plans and risk assessments.At this inspection these requirements have been repeated.However, there was some evidence that work has taken place to improve these areas so enforcement Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: action will not be taken. However significant improvements must be made by the next inspection. This will therefore be a focus of the next inspection. Care Homes for Adults (18-65 years) Page 14 of 34 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. Residents are generally supported to develop engage in appropriate leisure activities and access community facilities but the recording completed by the staff team could be further developed. The residents enjoy a balanced diet. However the staff team need to record the food that is eaten by the residents. Evidence: Residents have the opportunity to attend sessions at local day centres and colleges. Facilities available in the wider community are also used including going out for drives and walks, trips to local pubs and cafes, shopping and horse riding. On the day we visited some residents were at home and one was attending a day Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: centre.We spoke with these residents and one said I like living here At the last inspection it was noted there was lack of clarity in the support for individuals to develop or work towards their goals and how they are involved in determining their own lifestyle.As previously noted there are improvements in this area but these could be further developed. One resident told us that they go on trips to town go to a daycentre and the theatre. This resident said they liked the daycentre. Staff members said they took the residents out. Some evidence in the files confirmed this but the recording was inconsistent. A recommendation has been made about this. As noted at the last inspection residents are supported to maintain regular contact with their family and friends and visitors to the home are welcomed. Staff have worked hard to ensure each service user is supported to choose, organise and attend a holiday. This remains the case. Discussions with the staff team and observations made at inspection confirmed that staff shows that each person who lives in the home is treated with respect and dignity. The kitchen was seen to be clean and tidy. The staff team record the temperatures of the fridge and freezer. Both were see to be appropriately stocked with a variety of foods. The menus mostly described what the residents ate and the choices that they made but this inconsistent. A recommendation has been made about this The kitchen was clean and tidy and the temperatures of the fridge and freezer were seen to meet the standard. The menus showed that the residents eat healthy meals. However the registered manager should ensure that the choices that the residents make about the food they eat is recorded in the menus. . Care Homes for Adults (18-65 years) Page 16 of 34 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 residents can not be confident that their health needs will always be met by the stff team. Evidence: Systems are in place to ensure that medicines are handled safely in the home however some improvements in practice are needed to make sure that residents health is better protected. The pharmacist inspector looked at handling of medicines in the home during the inspection and spoke to two members of staff by phone the following day. People living in this service are registered with a local doctors practice. Staff request prescriptions from the doctors and these are sent straight to the pharmacy for dispensing. The pharmacy supply medicines using a monthly blister pack system. A pharmacist has recently paid an advisory visit to the home. Some of the advice given has been acted upon. Advice to have the homely remedy policy (for treatment of minor ailments) agreed with the doctors still needs to be acted upon. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: Staff told us that no-one using this service is able to look after their own medicines but they are looking at how they could help one person to be more independent with their medicines. One person is prescribed a special toothpaste, which is kept in their bedroom. There is no information about this in the persons care records and no record is made on the medicines administration record of whether it is used. This means that it may not be used appropriately. Secure storage is available for medicines. A medicine fridge is not needed at the moment. Systems are in place to allow staff to audit medicines and check that they have been given correctly. Staff told us that they check the medicines every week. We checked a small sample of medicines and found that records for one medicine, used occasionally, was not correct. This needs to be checked and updated, the disposal of any unwanted tablets must be recorded. We saw an excess supply of some prescribed inhalers, with those supplied in July and August still in the cupboard. This increases the risk of mistakes being made if the prescription is changed at a later date. We saw some medicines which had been prescribed to be given as directed, this increases the risk that the wrong dose of medicine is given. Action should be taken to ensure that all medicines supplied have the full dosage instructions. Photos are kept of each person living in the home to help make sure that medicines are given to the right person. Staff told us that two members of staff are always involved in giving the medicines and both sign the medicines administration record. This helps to reduce the risk of mistakes being made. The pharmacy provides printed medicines administration record sheets for staff to complete. These had been completed fully. One of the printed record sheets was confusing and could result in the person being given a medicine twice by mistake. This needs to be discussed with the pharmacy. We also saw that staff had recorded that they had given one medicine but were actually giving a different one, that had been supplied for this person earlier in the year. This must be checked with the prescribing doctor to make sure that the correct medicine is given. We looked at the staff training records for medication administration. The registered manager told us that he does an annual assessment with each member of staff to check that they are able to safely give medicines. The manager told us that he has had no formal medication training himself. We looked at three training records and saw only one record of assessment of competence carried out in 2008. However, staff we Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: spoke to confirmed that they did have an annual assessment. Records showed that all had done the training for the monitored dosage system of medicines, provided by the pharmacy. This provides a basic training and in some cases had been done several years ago. One person is doing the medication part of the National vocational training (NVQ) 3 training. All staff involved in medication administration should receive medication training from a suitably qualified source and have documented annual assessments. This is to make sure that they can carryout this task safely and protect the health of the people using the service. Care Homes for Adults (18-65 years) Page 19 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents views are listened to and acted upon. They are protected from abuse,neglect and self-harm. Evidence: As noted at the last inspection the home has a formal Complaints Policy an Adult Protection Policy and a Whistle Blowing Policy, which staff can use in confidence to raise any issue or concern they have regarding the service. Discussion with staff members the manager and the residents confirmed that residents know who to speak to if they were unhappy. Each individual spoken with at inspection confirmed that they felt safe living at the home. There is a rolling programme of staff training in relation to the Protection of Vulnerable Adults and they are subject to Criminal Record Bureau enhanced disclosures before they start work in the home. There is very little challenging behaviour displayed by people who live in the home and support plans contain guidelines which explain how to support individuals if they become distressed or present behaviours which may be perceived as challenging the service provided. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: We looked at the complaints folder and noted that the recording of the complaints needs to be revised so that it evidences that the complaints areresolved within the required timescales. A resident told us that they would complain to the staff if they had a problem. The home maintains records of accidents and incidents. It also notifies us of any significant event which occurs within the home. Care Homes for Adults (18-65 years) Page 21 of 34 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 residents enjoy a homely enviroment. Evidence: Severn Avenue is a detached property situated in a pleasant suburban area of Westonsuper-Mare. The garden area at the front and side of the house is paved, including a parking area for the homes vehicle. There is a reasonably large rear garden which residents are free to use. There are six single bedrooms, some on the ground floor and others on the first floor. There are sufficient communal bathrooms, showers and toilets which the residents share. There is a communal lounge on the ground floor, a dining room kitchen, entrance hall and lobby and one bathroom, which also contains a walk in shower. On the first floor there is the laundry, one bathroom, a small office and the sleeping-in room which staff use. A camera has been installed at the front door so that staff members and residents can see who is at the door. A resident said that this made them feel safe. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: We saw some of the residents own rooms. These are all decorated and furnished differently to reflect the taste and choices of each individual. They contained many personal items, pictures and photographs which helped to make them personal to each individual. The procedures in place for infection control are in need of development. We saw a urine bottle containing urine on a radiator in the bedroom of a resident and another was seen on top of the toilet in the bathroom. Although this was noticed in the middle of inspection the bottle in the bathroom was still there at the end of the inspection until it was removed by the manager. We were told that the bathroom downstairs is due for refurbishment and that the shower will be altered so that a resident who has restricted mobility can use it. A requirement has been made about this. Care Homes for Adults (18-65 years) Page 23 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are protected by an experienced and qualified staff team. Evidence: At the time of the last inspection there have been some significant issues relating to the staffing of the home. The Registered Manager who had been on long-term sick leave has now returned to their post. We discussed with the manager the impact this had on the staff team. Evidence in the supervision records and discussions with the manager confirmed that there had been some staffing issues but these had now been resolved. Each member of staff acts as a Key worker to one service user. Staff spoken with were able to evidence that they understood their own roles and accountability. Some staff members told us they feel their views are listened to and they were happy with the management in place at the home.The staff team meets once a month. The records of these meetings show they are usually well attended, with a wide variety of topics discussed. Residents we spoke with said they liked the staff team and were well supported by Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: them. The staff team are provided with a variety of training opportunities. The home maintains a training matrix. This shows that staff have attended training in person centred planning person centred thinking, first Aid, manual handling,food hygiene, fire safety,the protection of vulnerable adults,person-centred planning and person- centred training. At the last inspection it was noted that several members of staff required refresher training in First Aid ,Food Safety training and Manual Handling.It was noted at this inspection that there is a rolling programme in place to ensure that this training is completed. Each member of staff has formal supervision sessions with their line manager. Examination of their supervision records showed that supervision is held approximately every six to eight weeks. At the last inspection it was recommended that he frequency of staff supervisions should be improved to support them in providing a good quality service to each person who lives in the home. At this inspection it was noted that the frequency has improved. Staff are supported to gain a National Vocational Qualification, known as an NVQ. The home has made good progress in this area and the majority hold this award. Care Homes for Adults (18-65 years) Page 25 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents benefit from a well run home where improvements are being made. There is a system in place to ensure that residents views are listened to by the staff team. The residents can mostly be assured that their health and safety needs are met by the staff team. Evidence: The Registered Manager is now available at the home following a period of sick leave. At the last inspection it was noted that the home was being managed by two Senior Support Workers supported by a Registered Manager from another Brandon Trust service. The absence of the Manager and the permanent Senior Support Worker had had a substantial effect on the planning and actioning of improvements which was acknowledged at the last inspection. At this inspection it was noted that the manager Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: has worked hard to meet the requirements of the last report s,ince he has been in post but there is still some work to do. The manager was able to demonstrate effective leadership. At the last inspection it was clear that many changes have been made including working to improve care planning general record keeping roles and responsibilities of staff and their working hours. However many of these improvements were still required completion. At this inspection it was noted that many of the recommendations of the last report have been met but the manager needs to ensure that care planning and meeting the health needs of the residents are prioritised. The staff we spoke with were positive about the manager. They described the manager as relaxed and helpful. The home is nearly fully staffed with one full time vacancy and twenty staff hours frozen. At the last inspection it was noted that how the views of service users are gained and their level of input into the running of the home remains unclear. At this inspection it was noted that there frequency has improved as they were seen to be held every two months. Residents views about aspects of their lives, like their diet and activities were sought at these meetings. Consideration should be given to including an action plan for these meetings. We asked one resident if they found the meetings helpful and they said that they were happy with the way things are in the house. The Brandon Trust have comprehensive policies and procedures to support the home, which are designed to ensure it complies with the law and remains aware of good practice guidelines. Full details of each policy were provided by the Manager as part of the AQAA he completed for us as part of this Key Inspection process. A requirement has been made elsewhere in this report about the manager ensuring that the environment is safe for the residents. The Registered Providers representative makes regular auditing visits to the home and produces a short report of their findings. These reports continue to be sent to us on a monthly basis. The organisational monitoring and support remains an essential element in the development and improvements required within this service to ensure residents are provided with a safe effective and accountable service. The Brandon Trust has a quality assurance system, which is designed to monitor and Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: review the service provided to each person who lives in the home on an annual basis. The last review was carried out in November 2008. It was held on the homes computer. At the last inspection recommendations were made about the fire systems. At this inspection the systems had improved and were seen to meet the standard. The home keeps records of hazardous products used within the home risk assessments relating to their use are in place. The Registered Manager is now available at the home following a period of sick leave. At the last inspection it was noted that the home was being managed by two Senior Support Workers supported by a Registered Manager from another Brandon Trust service. The absence of the Manager and the permanent Senior Support Worker had had a substantial effect on the planning and actioning of improvements which was acknowledged at the last inspection. At this inspection it was noted that the manager has worked hard to meet the requirements of the last report s,ince he has been in post but there is still some work to do. The manager was able to demonstrate effective leadership. At the last inspection it was clear that many changes have been made including working to improve care planning general record keeping roles and responsibilities of staff and their working hours. However many of these improvements were still required completion. At this inspection it was noted that many of the recommendations of the last report have been met but the manager needs to ensure that care planning and meeting the health needs of the residents are prioritised. The staff we spoke with were positive about the manager. They described the manager as relaxed and helpful. The home is nearly fully staffed with one full time vacancy and twenty staff hours frozen. At the last inspection it was noted that how the views of service users are gained and their level of input into the running of the home remains unclear. At this inspection it was noted that there frequency has improved as they were seen to be held every two months. Residents views about aspects of their lives, like their diet and activities were sought at these meetings. Consideration should be given to including an action plan for these meetings. We asked one resident if they found the meetings helpful and they said that they were happy with the way things are in the house. Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: The Brandon Trust have comprehensive policies and procedures to support the home, which are designed to ensure it complies with the law and remains aware of good practice guidelines. Full details of each policy were provided by the Manager as part of the AQAA he completed for us as part of this Key Inspection process. A requirement has been made elsewhere in this report about the manager ensuring that the environment is safe for the residents. The Registered Providers representative makes regular auditing visits to the home and produces a short report of their findings. These reports continue to be sent to us on a monthly basis. The organisational monitoring and support remains an essential element in the development and improvements required within this service to ensure residents are provided with a safe effective and accountable service. The Brandon Trust has a quality assurance system, which is designed to monitor and review the service provided to each person who lives in the home on an annual basis. The last review was carried out in November 2008. It was held on the homes computer. At the last inspection recommendations were made about the fire systems. At this inspection the systems had improved and were seen to meet the standard. The home keeps records of hazardous products used within the home risk assessments relating to their use are in place. Care Homes for Adults (18-65 years) Page 29 of 34 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 42 23(4) All fire safety equipment 20/11/2007 must be checked regularly to ensure service users would be warned of and adequately protected in the event of a fire. Care Homes for Adults (18-65 years) Page 30 of 34 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 1 4 The registered provider must ensure that the statement of Purpose and Service Users Guide are amended to contain all the required information. To ensure that the residents have full information about the service they can expect from the home. 03/04/2009 2 5 5 The registered provider must ensure that the residents contracts have all the required information To ensure that the residents are clear about the services available to them . 03/04/2009 3 6 14 The registered person must write a care plan for each service users, which demonstrates how their support needs will be met. The plan must indicate each individuals involvement in the process. 03/05/2009 Care Homes for Adults (18-65 years) Page 31 of 34 To ensure that the residents are well supported by the staff team. 4 9 13 The registered person must 03/05/2009 ensure that risk assessments are in place for all activities where there is potential risk to residents. To ensure that the residents can take risks safely. 5 18 13 The registered manager must ensure that medicines are administered safely by suitably trained staff. To ensure that the residents health needs are met. 6 24 23 The registered manager must ensure that a suitable shower is in place for residents with restricted mobility. To ensure that all residents can safely shower. 7 30 23 The registered person must 09/04/2009 ensure that procedures for infection control are followed by all the staff team. To ensure that residents are safe within the home. 19/04/2009 06/03/2009 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 7 the registered person should ensure that there is a system in place to evidence that there is work in place to ensure Page 32 of 34 Care Homes for Adults (18-65 years) that the aims and goals of the residents are met. 2 14 The registered person should ensure that the there is clear evidence recorded about the activities that the residents take part in. The registered person should ensure that the food that the residents actually eat is recorded. The registered manager should ensure that the record of complaints evidences that complaints are resolved within twenty eight days. 3 4 17 22 Care Homes for Adults (18-65 years) Page 33 of 34 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. 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