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Inspection on 03/09/09 for 7 Eworth Close

Also see our care home review for 7 Eworth Close for more information

This inspection was carried out on 3rd September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

Generally the home was found clean, warm, well lit and free from unpleasant odours. The atmosphere of the home was noted to be relaxed. Residents looked well cared for in their homely environment. Staff were seen interacting with the resaidents in an informal, respectful, personalised and dignified manner. The home told us in the AQAA that no new admission to the home would take place until the staff had met the prospective new resident and completed an assessment of that individual`s needs, skills and abilities to ensure that their needs would be met. All residents are encouraged to be actively involved in planning their care as it impacts on the quality of their lives. Residents are encouraged and supported to be involved in menu planning, preparing and cooking meals. Residents are encouraged to personalise their rooms and bring with them any items from home.

What has improved since the last inspection?

The AQAA states that the home has restructured the paperwork and made it more user friendly for residents and staff. It also states that staff training has improved.

What the care home could do better:

Whilst some of the standards we reviewed at this visit had positive outcomes for the individuals living in the home, there were areas of concern and these were discussed with the Senior Management team led by Paul Stephen. We agreed that in order to minimise hazards and to prevent falls generic risk assessments must be undertaken to include the kitchen, stairs, dining area and other areas that the residents have access to. It would be better if the kitchen is refurbished to provide the residents with a more confortable and dignified environment. To ensure that residents are adequately protected it would be better if the 5 yearly Periodic Inspection of Electrical Insallations Safety certificate is obtained and same forwarded to the Care Quality Commission for verification. Medication errors will be avoided if the information written in the Medication Administration Record Sheet in regards to dosage is the same as details supplied by the pharmacy. It would be better if staff receive regular supervision for support and guidance in the work they do. Residents needs would be met if adequate numbers of staff are on duty at all times. We recommend that a coded safe is installed at the home to enhance safety of residents` monies and valuables.

Key inspection report Care homes for adults (18-65 years) Name: Address: 7 Eworth Close Bank House 2-4 Wood Street Old Town Swindon Wiltshire SN1 4AB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Grace Agu     Date: 0 3 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: 7 Eworth Close Bank House 2-4 Wood Street Old Town Swindon Wiltshire SN1 4AB 01793878169 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: mariaarthur18@yahoo.co.uk Ian Charles care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: No more than six service users with a learning disability may be accommodated at any one time. Date of last inspection Brief description of the care home 7 Eworth Close is run by a partnership, which operates under the name of Ian Charles. The home is located in Grange Park, which is a residential area on the outskirts of Swindon. It is a two storey detached property with a large garden. Each service user has their own bedroom. Two bedrooms are on the ground floor and they are therefore suitable for people who cannot manage the stairs. One of the bedrooms on the first floor has an en-suite toilet. There are two bathrooms on the first floor and a `wet? room with a shower on the ground floor. The communal rooms consist of a large lounge and a kitchen with a dining area. There is an office on the first floor, which is also used as a staff sleeping-in room. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 6 Brief description of the care home Service users receive support from the acting home manager and a team of support workers. The range of fees is £500 - £700 per week. There are additional charges made for hairdressing, toiletries, activities, papers and magazines, day centre activities and transport. Information about the home and Ian Charles is available in a Statement of Purpose. Copies of inspection reports can be obtained from Ian Charles and are also available through the Commissions website at: www.cqc.org.uk 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 was an unannounced visit which was undertaken as a part of key inspection over eight and half hours to review the requirements made at the last inspection and also to review the care practice to ensure that it is in line with the legislation and that best practice is followed at the home. The inspection was also undertaken in response to the information we received regarding allegation of theft of a residents money at the home. We met with, the Senior Management Team of Ian Charles Homes. Whilst touring the building, we spoke with a number of residents and staff and a number of records were viewed. Care Homes for Adults (18-65 years) Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Whilst some of the standards we reviewed at this visit had positive outcomes for the individuals living in the home, there were areas of concern and these were discussed with the Senior Management team led by Paul Stephen. We agreed that in order to minimise hazards and to prevent falls generic risk assessments must be undertaken to include the kitchen, stairs, dining area and other areas that the residents have access to. It would be better if the kitchen is refurbished to provide the residents with a more confortable and dignified environment. To ensure that residents are adequately protected it would be better if the 5 yearly Periodic Inspection of Electrical Insallations Safety certificate is obtained and same forwarded to the Care Quality Commission for verification. Medication errors will be avoided if the information written in the Medication Administration Record Sheet in regards to dosage is the same as details supplied by the pharmacy. It would be better if staff receive regular supervision for support and guidance in the work they do. Residents needs would be met if adequate numbers of staff are on duty at all times. We recommend that a coded safe is installed at the home to enhance safety of Care Homes for Adults (18-65 years) Page 7 of 32 residents monies and valuables. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 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 9 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. Residents receive information about the home and are assessed before admission with terms and conditions of stay agreed. Evidence: The home has a Statement of Purpose and a Service Users Guide that has been developed in accordance with the Regulation and was recently reviewed on 11/06/09 There has been one new admission to the home since the last inspection. The manager was unavailable on the day of the visit however discussion with the provider demonstrated a good understanding of the procedures for admitting residents to the home including providing opportunities to meet with staff and other residents living at the home prior to moving in. This is also to enable staff to understand how the introduction of a new person would impact on the lives of those already using the service. We spoke to the person during the visit and the individual appeared to be settled and to be enjoying the company of other residents. Staff members we spoke with told us Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: that the person had made friends and that they will continue to support them to ensure that their needs are met. The home stated in the Annual Quality Assurance Assessment (AQAA) that a new admission to the home would not take place until the staff had met the prospective new resident and completed an assessment of that individuals needs, skills and abilities. This was confirmed in the review of the care file of a recently admitted individual. We noted that the person has an individual file in the home, which contained assessment records and other pre-admission documentation. There was a community care assessment from the Care Management Team of the placing council. Records were previously completed about the individuals likes and dislikes and their personal and domestic skills along with other information and had been obtained directly from the persons previous residence, including a personal profile and reports from health professionals. The provider told us that the Person Centred plan will be completed to reflect the individuals needs while living at 7 Eworth close. The provider told us that the trial period is 6 months during which the council could terminate the contract with one weeks notice. In regards to contract, the provider told us that the company has its own contract however this is not being used because there is a contract between the Council and Provider which specifies the arrangements on behalf of the resident including how much money is paid and the contribution to be made by the resident. The provider stated that a copy of the contract is kept in the care file however we were unable to find this in the two care files reviewed. Care Homes for Adults (18-65 years) Page 11 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. Residents care plans reflect their needs and demonstrate how they are supported to make decisions about their lives. The home is supporting residents to take responsible risks. Evidence: We looked at two care files at this visit and each care file contained an individual plan of care on how the needs of the person were being met. We noted that care plans focus on the aspirations and goals of the resident and ways to maximise their independence. Records seen and discussion with the provider indicate that the residents had been involved in their care plan meeting. Information noted on one of the care files includes how to support the person with personal care. We noted that a document termed My Plan in the care file which provided detailed information about the residents likes and dislikes, important things in his/her life and things people need to know about supporting the person have not been completed. The provider told us that these documents have always been there and had gone Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: missing following the departure of the previous manager. The present acting manager has commenced developing the Plan again with the residents and the key workers, however the one we looked at had not been completed. The AQAA stated that all residents have individual care plans that are written with them, and reviewed every six months, making changes as identified. The individuals are also encouraged to be part of the Risk Assessment process. Discussions with staff showed an understanding of the needs of the resident and improvements in enabling residents to make their own decisions about their lives. This practice is also noted in the care plan where residents rights and decisions to choose, if they wish, to take part in activities are recorded. Discussion with the residents confirmed they are able to choose the time for getting up and going to bed and this practice was noted in residents daily notes. Two residents we spoke with stated they were happy at the home, and that they are encouraged and involved to make decisions on the daily running of the home. For example, we noted on arrival that one resident was cleaning the windows and later told us at a discussion that it was part of her routine on Tuesdays and Thursdays. The two care files had risk assessments in place to include shopping and going out with friends. For example, we noted that there was a risk assessment in relation to one individual who is very independent, however at risk of being exploited by others. The risk assessment was aimed at supporting the person to take responsible risks in their relationships. We noted that staff were interacting with residents in a sensitive and dignified manner and demonstrating understanding of the various needs of individual residents. Staff were also aware of the importance of keeping residents information confidential. Care Homes for Adults (18-65 years) Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to maintain contact with families, friends and community. Their individual rights are respected and they are provided healthy diets at chosen times. More opportunities need to be provided for more regular holidays. Evidence: Evidence from discussions, reviews of the care files and the information seen in the visitors book in the house confirmed that the home supports the residents to keep in touch with families, friends and representatives. The home enables and supports residents to participate in activities based on individual assessment and capabilities. Evidence from the activities programme noted at the home showed that three residents attend regular day centre activities on different Fridays at One Step Ahead and Open Door. Another resident attends White Cross Club every fortnight. The rest of the week there are individual activities at the Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: home based on individual capabilities and concentration. One resident told us that they attend the Pilgrims Centre restaurant on Tuesdays and Fridays for non paid voluntary work. I like going to work, I also go out shopping on my own. The home stated in the Annual Quality Assurance Assessment (AQAA) that residents also have access to activities in the local community such as swimming, ice skating and tea dancing. They have also had the opportunity to attend television show recordings in London. One staff member told us that the last time the residents went on holiday collectively or individually was two years ago. The provider stated that this was due to residents choice. We believe that more support and encouragement should be given to the residents to take holidays more often. The residents menu was reviewed and was found to be satisfactory. Residents interviewed stated that they are supported to use the kitchen and participate in planning the menu. The AQAA also told us that residents have an understanding of healthy living and through the menu planning they are able to make personal choices and try new foods. The AQAA also indicated that staff have good knowledge and demonstrate good practice when supporting those who have problems eating, ensuring that the individuals dignity is respected. Some residents were noted accessing the kitchens with the support of staff members. Some of the comments made by residents include. I help out with the washing up, and I do my own laundry. The kitchen was found clean however the cupboards were looking tired and need urgent renovation. The provider stated that the kitchen will be included in the improvement plan next year. The laundry area was found to be clean and satisfactory. . Care Homes for Adults (18-65 years) Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive preferred support as required, their emotional and physical health needs are met, and also respect is given to their wishes in the event of death. Medication practices at the Home fail to provide adequate protection from potential harm to the residents. Evidence: The two care files that we looked had care plans which described in detail the level of support each individual receive at the Home in relation to their personal care. This relates to any specific health issues, name and times of medication and what health care services are used by that individual. One resident spoken with stated, Staff help me when I want them to. I can make my own bed, staff are kind to me, and they let me do things for myself. I can do many things for myself. One staff member told us that one individual had recently returned from hospital admission and that the care plan had been updated to meet the individuals needs. The person was noted mobilising at the time of inspection and confirmed that they were happy at the home and are well supported by staff to live as much independent life as possible. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: There was evidence that residents have their General Practitioners (GPs) and are supported to access this service. It was also noted through the care files that residents have access to other health professionals to include Speech and Language Therapist. There were regular medications reviews. We noted that care file we reviewed had a record of the persons monthly weight, and the AQAA confirmed other records such as all health appointments, menstrual cycle, epilepsy recording, food and fluid intake and sleep monitoring form are also recorded to enable staff to monitor the individuals health and to initiate necessary intervention when the health deteriorates. Medication administration was reviewed and some of discrepancies were noted.. We noted that there were errors in the handwritten medication on Medication Administration Record Sheet (MARS) relating to two residents. For example the dosages on the boxes dispensed by the pharmacy were different from what was written on the MARS. We believe that this error potentially puts the individuals at risk of drug error. We discussed this problem with the Coordinator of Ian Charles Homes who contacted the pharmacy and requested for printed MARS in future in order to prevent further errors. We were also concerned that staff were crushing of individuals medication ( Ferrous Sulphate 200mg tablets) without any evidence of consultation with the person ,General Practitioner, pharmacy and or family members. We recommended that this practice be reviewed and we received information from the provider that the medicine had been changed to a liquid alternative. The home had death and dying policy and details of residents choices and wishes in the event of their death were noted in the care files reviewed. Care Homes for Adults (18-65 years) Page 17 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. Residents are encouraged and supported to complain. The home failed to protect a former resident from financial abuse. Evidence: The Home had a complaint procedure displayed at the entrance of the house and a copy in the Service Users Guide. The home told us in the AQAA that it had introduced the complaints procedure in a picture format however we are unable to confirm that this is the case. The home stated in AQAA that the organisation encourage the residents to express any concerns or complaints that they may have about the service provided, the staff or any other aspect of the home. The complaints procedure is also discussed with staff at their staff meetings and staff are also encouraged to promote a culture where the residents feel that they can safely discuss concerns. The complaint book showed no recorded complaints. However the Care Quality Commission received information from Swindon Borough Council Safeguarding of Vulnerable Adults Department regarding allegation of theft in relation to a former residents money when the previous manager was in post. The matter had been referred to the Police and two safeguarding adult meeting had been held. The issue Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: had not been resolved as police investigation is still ongoing. The next meeting is scheduled to take place in October 2009. Following this allegation we looked at all the monies held on behalf of the residents at the home. We noted that three residents monies are managed by the Swindon Borough Council as Appointees, one individual is supported to manage their money, the home manages one individuals money for them and the relatives of the new resident will be managing their finances. We noted that all the monies were recorded correctly and the amount stored tallied with the amount stored. We recommend that the home install a coded safe at the home to enhace the safety of residents monies and other valuables held at the home. Following this incident the provider stated that the operations manager had commenced monthly checks of all residents monies and that when a new resident is admitted to the home the operations manager will be involved from day one with double checking of the finances. We noted that the homes Statement Of Purpose has information regarding advocacy for residents who are unable to manage their financial affairs however at a discussion with the Provider, this information was not provided to the residents who have no relatives or friends. We noted that the address and telephone number of the advocacy service was in the Statement of Purpose it was unclear whether residents were supported to take advantage of this service. The provider told us that the organisation will ensure that this information is made available to those residents who may require this service to ensure that they are adequately protected especially in terms of managing their finances. Staff have attended abuse training and are aware of their responsibilities in regards to bad practices. One staff member we spoke with stated that they would report any known incidents of abuse to the manager or contact Social Service and the Care Quality Commission if not satisfied with the action taken by the organisation. The home has policies and procedures in relation to protection of vulnerable adults. Guidance on reporting abuse from Swindon Borough Council was noted at the home. The Homes recruitment procedure is satisfactory as evidenced in the two care files Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: reviewed. Care Homes for Adults (18-65 years) Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, tidy and odour free but attention needs to be given the kitchen to ensure that residents have a dignified and comfortable area to prepare and enjoy their meals. Evidence: 7 Eworth Close is run by a partnership, which operates under the name of Ian Charles. The home is located in Grange Park, which is a residential area on the outskirts of Swindon. It is a two storey detached property with a large garden. Each service user has their own bedroom. Two bedrooms are on the ground floor and they are therefore suitable for people who cannot manage the stairs. One of the bedrooms on the first floor has an en-suite toilet. There are two bathrooms on the first floor and a wet room with a shower on the ground floor. The communal rooms consist of a large lounge and a kitchen with a dining area. There is an office on the first floor, which is also used as a staff sleeping-in room. The home was found in clean and tidy. The communal areas bathrooms and bedrooms met the standards. The bedrooms were homely in a good decorative order, clean and free from unpleasant odours. Residents were noted accessing different areas of the Home without restrictions. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: We looked at the hot water supply to the hand basins in the rooms following the requirement made at the last inspection in 2007. It was good to note that that requirement had been met though the taps had to be left to run for a few minutes before accessing hot water. While touring the building we noted that the major part of the laundry had been moved to the garage and only one washing machine was noted in the kitchen dining area. The staff member we spoke with stated that all soiled linen and clothes are washed in the washing machine in the Garage to prevent cross contamination in the kitchen area. We discussed the lack of maintenance of the kitchen with the provider. This situation we believe had resulted in the all cupboards looking very tired and undignified for the residents. The provider Mr Paul Stephen stated that they were aware and that the refurbishment of the kitchen will be included in the improvement plan for next year. We have issued a requirement to ensure that his happens. There was evidence that the fridge and freezer temperatures were taken regularly. Care Homes for Adults (18-65 years) Page 22 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. The residents enjoy good, warm relationships with staff. The homes recruitment procedure offers protection to the residents however the home failed to provide staff with regular supervision and adequate numbers of staff on one occasion. Evidence: On the day of inspection, the home had adequate numbers of staff to meet the needs of residents at the Home. Staff on duty demonstrated knowledge of the needs of the residents and were interacting with them in a friendly and informal way. While we are aware that the numbers of staff on duty on the day was adequate we were concerned that only one member of staff was on duty from 2pm on 31/08/09 to 10 am on 1/09/09. We believe that this practice puts the lives of the individuals living in the home and staff member at risk due the vulnerability and challenging needs of some of the residents. At a discussion about the shortage of staff above the operations manager showed lack of knowledge of the needs of the individuals at the home and felt that one staff covering the home for that length of time was appropriate. However, One staff member we spoke with told us that having one staff member during the afternoon was not adequate because needs of two individuals could be unpredictable due to their challenging behaviour. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: The provider stated that the senior management had taken over the rota from the acting manager following the departure of the previous manager tomonitor the staffing level to ensure that the needs are met but was unable to cover the shift on the 31/08/09 afternoon due sickness and unavailability of staff from the agency. There was evidence of this arrangement on the rota shown to us. The provider also told us that they would always ensure that the numbers of staff on duty meet the needs of the residents. The Coordinator stated that four staff members had left the home in the last 3 months. She had introduced exit interview to enable the organisation to improve on their recruitment and retention and reduce staff turnover. There was evidence of staff training, which include, Health and Safety, Protection of Vulnerable Adults from Abuse, Challenging Behaviour, Mental Capacity Act, Record Keeping, Communication Skills, Infection Control Manual Handling Managing Epilepsy.The acting manager and one staff member have commenced a 20 week Distance Learning Course on Safe Handling of Medicines on 25/08/09 Training proposals for 2009 include Approaches to Epilepsy in September and November, Health and Safety and Manual Handling in October, First Aid in October and December. One staff member currently has National Vocational Qualification (NVQ) at 2 We have made a requirement for staff to receive supervision to support and provide them with guidance in the work that they do and to enable them to perform their duties effectively as there is no evidence to suggest that this is taking place. Appropriate and satisfactory procedures are in place for recruitment of a new staff member in the staff file we reviewed however we were unable to confirm effectiveness of the induction process at the home which may be a factor in the large turn over of staff as noted earlier in the report. There was evidence of good team building at the home as staff were noted interacting with each other in a professional manner to ensure that residents receive appropriate care. There was evidence that staff attend various staff meetings to discuss different needs and other issues that affect the residents. At these meetings staff are encouraged and supported to familiarise themselves with the residents and their need including behaviours which challenges. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: At the staff meeting on the 20/08/09 seven staff members attended and issues discussed include, Dairy entries, training needs, staff job sheets, staff memo book, incident and accident file, recording of information, monthly activities training schedules and control checks. 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. The home has no registered manager policies and procedures are in place to protect the residents, some aspects of health and safety need attention. Evidence: The acting manager Adele King was recently appointed following the resignation of the previous manager in March 2009. Adele was on holiday on the day of this visit however the senior management team we met assisted with the inspection process. The provider told us that Adele has National Vocational Qualification in Care Management at Level 4 and had attended the statutory trainings to include health and Safety and Manual Handling trainings. The provider stated that the organisation is actively looking to recruit a home manager as soon as possible. On the day of inspection, there was evidence of a friendly and interactive atmosphere in the home. Residents looked well cared for and staff were noted interacting with the residents in an informal, dignified and respectful manner. The systems for reviewing the quality of the service were discussed with the provider. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: In addition to feedback from residents survey returned to us, social services reviews, care plans and house meetings the home uses the organisations documentation for measuring the quality of its service. This document was sent to the Commission and seemed satisfactory and would help the home to identify areas of concern and develop action plan to meet the shortfalls. The provider stated that at the residents meetings specific questions are asked to help get residents views on the quality of the service. The most recent resident meeting was on 21/06/09. Issues discussed include activities outside the home and menu. There are regular staff meetings to enable staff to discuss ways that service can improve in order to meet the needs of the residents. The fire logbook is up to date and in order. The record shows that the inspection of fire fighting and fire alarms systems and fire drills and fire risk assessment had been carried out. Others records in terms of Health and safety include portable appliance (PAT) of all electrical appliances gas inspection and Liability insurance. The provider was able to provide the policies and procedures that we requested . The home also had a folder prepared by the organisation which contained a range of policies and procedures. There is a Health and Safety policy in the home however we are unsure if staff have attended training on Control of Substances Hazardous to Health (COSSH) to guide staff on action to be taken in the event of chemical emergency. The provider told us that the 5yearly Periodic Inspection of Electrical Installation Safety had never been undertaken since the home was registered so many years ago. We have issued a requirement for this inspection to be carried out to ensure that the residents are not at risk in regards to maintenance of the electrical installation at the home. We have also required that the certificate of the tests is forwarded to the Care Quality Commission for verification. The home had the records required by the regulations. We viewed the residents monies and financial records. The amounts held for the residents in the home in the cash books were correct the amount of cash held in the home was the same as the balance recorded into the cash books. Receipts could be identified from the cash book held for the residents. We had previously discussed this under Standard 22. However we are concerned that the organisation was unable to prevent the loss of a large amount of money from missing from a resident who was living at the home. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: While we recognise the action put in place following this incident we believe that the organisation could have have tighter control in place relation to management of the residents money at the home through their monitoring procedures and supervision of the managers activities. The organisation had been undertaking the Statutory Monthly visits but was unable to identify this problem. We believe that the system in place at present offers protection to the resident money hence there was no problem noted in relation to residents monies at this visit. Accident records were reviewed and were found satisfactory. There was evidence that a generic risk assessment of various aspects of the home including the radiators had taken place, it was agreed that the risk assessment should include the kitchen dinning area , the stairs any any other place that the residents had access to. Care Homes for Adults (18-65 years) Page 28 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 29 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 iEnsure correct information 21/10/2009 is written in the Medication Administration Record Sheet in regards to dosage is the same as supplied by the pharmacy. To prevent medication errors 2 28 23 Ensure that the kitchen is in good state of repair. To provide the residents with a comfortable environment 21/01/2010 3 33 18 Ensure adequate numbers of 30/09/2009 staff are on duty. To meet the needs of the residents. 4 36 18 Ensure that staff receive regular supervising. To receive support and guidance in the work they do. 21/11/2009 Care Homes for Adults (18-65 years) Page 30 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 5 42 13 Ensure generic risk assessment inludes the kitchen, dining, stairs and any other place the residents have access to. To minimise the risk of fall/accidents. 21/10/2009 6 42 13 Undertake 5 yearly Periodic 21/10/2009 Inspection of Electrical Installation at the home. Forward the certificate to the Care Quality Commission To protect the residents staff and visitors from potential harm. 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 23 We recommend that the home install a coded safe to provide enhanced safety of the residents monies and valuables Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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