Inspection on 07/05/09 for Addington Close (12)

This inspection was carried out on 7th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Addington Close (12) 10/05/07

Addington Close (12) 11/05/06

Addington Close (12) 05/12/05

Addington Close (12) 11/07/05

Addington Close (12) 22/11/04

Addington Close (12) 21/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

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Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Addington Close (12) 12 Addington Close Devizes Wiltshire SN10 5BE one star adequate service The quality rating for this care home is: 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: Malcolm Kippax Date: 0 7 0 5 2 0 0 9 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. They reflect the things that people have said are important to them: 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. 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. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: Addington Close (12) 12 Addington Close Devizes Wiltshire SN10 5BE 01380720001 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) : Ordinary Life Project Association care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: No more than 3 service users with learning disabilities at any one time. Date of last inspection A bit about the care home 12 Addington Close is one of a number of care homes in Wiltshire that are run by the Ordinary Life Project Association (OLPA). The property is a detached bungalow in a residential area of Devizes. Each person has their own room. The home has a lounge and a dining room for communal use. There is a domestic style kitchen. The people who live at the home receive support from a manager and a permanent staff team. There is at least one person working in the home throughout the day. The fees range from 860.62 986.35 pounds per week. Information about the service is available in a Statement of Purpose. Copies of inspection reports are available from the OLPA head office at Beckford House, Gipsy Lane, Warminster, Wiltshire, BA12 9LR. They can also be seen at the Commissions website at www.cqc.org.uk 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 & Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct and Management of the Home Poor Adequate Good Excellent How we did our inspection: This is what the inspector did when they were at the care home Before visiting 12 Addington Close, we asked the home to complete an Annual Quality Assurance Assessment known as the AQAA. This was their own assessment of how they were performing. It gave us information about what has happened during the last year, and about their plans for the future. We sent surveys to the home so that these could be given out to the people who use the service, to staff members, and to health professionals. We had surveys back from two people who live at the home, and from three staff members. Two health professionals also completed surveys. We looked at all the information that we have received about the home since the last inspection. This helped us to decide what we should focus on during an unannounced visit to the home, which took place on 7th May 2009. During the visit we met with the three people who live at the home, and with two staff members. We looked at some of the homes records and went around the accommodation. We also went to the OLPA office so that we could look at the recruitment records for a new staff member. The home was without a manager at the time of our visit. The previous registered manager left in August 2008. The judgements contained in the report have been made from all the evidence gathered during the inspection, including the visit. The previous key inspection of 12 Addington Close was on 10th May 2007. What the care home does well People who use the service are asked about their personal goals and the things that are important to them. Decisions are then made about the support that people will need in the future. This helps to ensure that the service can focus on peoples individual needs and wishes. Details of peoples needs and goals are well recorded in individual plans. This means that staff have the information they need about what people want to achieve, and the support that they will require. Peoples individual plans reflect a range of needs relating to their health and personal care. Two people in particular have had significant health care needs in recent years. Staff have supported these people well, and ensured that the appropriate health professionals have been involved. Meetings are being arranged in the home, so that people can talk about the things that concern or interest them. This helps to ensure that people can express their views, and any problems can be sorted out at an early stage. People are well supported with keeping in touch with relatives. Within the home, people are encouraged to take part in the household tasks. We saw people helping out with cleaning, laundry and preparing meals. One person in particular likes to go food shopping with the staff, and they can choose the things that they want to eat. Overall, the staff team have got to know the people at the home well. Staff are familiar with peoples likes and dislikes. This provides stability for the people at the home, and helps to ensure that their needs are met. What has got better from the last inspection The accommodation has been improved in a number of ways. The kitchen has been completely refurbished. It has been given a more modern and stylish look, which people at the home said they liked. Further building and refurbishment work is being planned. Meetings have been held in the home, which have given people the opportunity to talk about this and say what they would like. We were given information in the AQAA about other developments that have taken place, or have been planned. A new house vehicle has been bought. A computer has been obtained to help with the record keeping, and there are plans for the home to have internet access. We were told that one person had asked to go on holiday to the Isle of Wight, and this had been booked. We met with this person and they were looking forward to their holiday very much. Staff training has been developed to include dementia, and refresher training in abuse awareness. This helps to ensure that staff members have the knowledge that they need to do their jobs well. What the care home could do better We found at the last inspection that there was a lack of flexibility in what people were able to do and when they were able to go out. We looked at the staffing arrangements during this inspection. Staff members spend a lot of time working by themselves. This continues to have an impact on the support that people can receive and what they are able to do. One person we met liked to go out and this was reflected in their individual plan. They had a number of goals relating to going out regularly for activities, such as swimming and walking. These activities would also help the person to keep fit. Staff told us that often worked alone and it was difficult to support the person with these activities, as planned. More staff need to be deployed, so that people can receive the support that they require with their planned activities and goals. The person who wanted to go out was not able to do this without staff support. Staff were concerned enough about the person leaving the home on their own to have a procedure to prevent it happening. The front door was kept double locked, and it was also alarmed to alert staff if the door was opened. A risk assessment about this had been undertaken. However, we thought that the arrangements should be reviewed, in relation to the persons rights and the need for a different approach. The absence of a manager has had an impact on the running of the home and the support that people receive. The registration of a new manager is a priority, so that people can be confident about how the service is being managed, and how it will develop in the future. We were told that an appointment had been made and a new manager was due to start in June 2009. A staff training plan has been produced, which focuses on OLPAs mandatory subjects. As recommended at the previous inspection, the training plan could include more specialist and skills related areas of training. This will help ensure that people who use the service benefit from staff who are developing their knowledge and skills. We were told in the AQAA about the homes own plans for improvement in the coming year. OLPA recognises the importance of having a new manager in post. We were told about other developments that are being planned. These included supporting people to have health action plans, and providing information in formats which will meet their needs better. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Malcolm Kippax 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 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 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 . There is sufficient information about the home for people to decide whether it will be suitable for them. However, the information is not always in a suitable format for the people who use the service. The home has procedures in place so that it can obtain enough information about the needs of a prospective user of the service. Evidence: A Statement of Purpose for 12 Addington Close was kept in the home. Interested parties could also get a copy from the OLPA office. There was a Service Users guide, which contained information for the people who use the service. The guides had been personalised for the people who live at the home. We were told in the AQAA that one of the things that the home could do better would be to produce information in Various formats to meet differing needs of service users. It was reported in the AQAA that something else the home needed to do better was to review the Statement of Purpose and Service Users guide more regularly. We were told that a new manager for the home had been appointed, and would be starting in June 2009. The Statement of Purpose can be reviewed at that time, and updated to include details of the new management arrangements. We were told in the AQAA that the home had not had recent experience of somebody moving in, as the last admission had taken place six years ago. However, we were given information about the homes policies and procedures for admissions, and told Evidence: that these had been thoroughly reviewed in June 2008. It was reported in the AQAA that the admission process would include full liaison with the persons care manager, ensuring that the home received a community care assessment. Information from other parties, for example family, would also be sought. All the information would then be used by the homes manager and the OLPA service co-ordinator to assess whether the persons needs could be met. 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 . Peoples needs and aspirations are well reflected in their individual plans. However people do not always receive the support that they need to achieve their goals. People can make decisions in different areas of their lives although there are restrictions which limit what they are able to do. Evidence: People had discussed their needs and goals at annual review meetings. Information had then been recorded in a Person Centred Plan. These plans helped to ensure that all staff knew what had been agreed, and the individual support that people needed. We asked staff members in their surveys whether they were given information (for example in the care plans) about the needs of the people they supported. The staff members responded Always to this question. One staff member commented The care plans are always updated accordingly. Two peoples plans had been written in March 2009. One person had needs in relation to their health. Their plan reflected this, and the decisions that the person needed to make about their treatment. This person also had goals for things they wanted to do, such as going to a football match, and going to Wimbledon for the tennis. Another person had goals which would help them to be more independent. These included support with saving money and attending a cookery course. A third person had a number of needs and goals which had been agreed in 2008. This Evidence: included having a holiday on the Isle of Wright. The person told us that they were looking forward to this and arrangements had been made for a holiday in the summer. Their plan included attending other activities outside the home on a regular basis. These were activities such as pitch and putt golf, swimming, and skittles, which would help the person to keep fit. However, we heard from staff that resources were not always available to support this person with these activities (see Staffing section of this report). People met together each month and were asked about items for the meeting agendas. We looked at the minutes of recent meetings. These showed that people had ideas about what they wanted to do and made decisions about things that affected them. People had talked about some refurbishment and building work that was being planned as part of the homes development. They had suggested things, such as another toilet, that they would like to be included in the plans. Information had been recorded in peoples personal files which showed how they had been supported with decision making and exercising their rights. One person had a job coach who was helping them to find employment. We saw that another person had received a letter from the local authority confirming that they were registered for a postal vote at the next election. People had keys to their own rooms. They had individual savings accounts and received support from staff with the safekeeping of their personal money. A system of accounting was in place, which included staff obtaining receipts when they had supported people with their purchases. We met with one person when they returned home from being out during the day. This person went out by themselves and did a lot of things independently. A risk assessment had been undertaken in connection with this. We saw that risk assessment forms had been completed in relation to other activities and tasks that people were involved in. Most of the assessment records were dated as having been reviewed on 27th October 2008. Two other people needed support when going out from the home. A risk assessment had been undertaken in respect of one person Walking out of front door unaccompanied. This assessment had been reviewed on 26th February 2009, and the form signed by the persons care manager and the OLPA service co-ordinator. There was a procedure in place to prevent this person from leaving the home on their own. The front door was kept double locked, and it was also alarmed to alert staff if the door was opened. The risk assessment had been undertaken, although we thought that the arrangements should be considered further, in relation to the persons rights and the need for a different approach. 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 . People have daily routines that generally reflect their needs and abilities. However there is a lack of flexibility and support at particular times, which is likely to affect peoples quality of life. People receive support, so that they can keep in touch with their families. People can help to choose their meals and staff support people with their dietary needs. Evidence: 12 Addington Close is in a well established residential area of Devizes. One person went out independently and was able to walk to many of their regular activities in the town. This included going to a resource centre, which they were attending on the day of our visit. They returned home later in the day and said that they would be going to a Gateway Club after tea, with somebody else who lives at the home. The other two people had fewer regular activities in the community, and they spent more time at home. We heard that one person was being encouraged to do more things outside the home. Another person told us that they liked to go out, and they helped staff with food shopping at a local supermarket. They had been on some occasional day trips in the area, including a visit to Longleat. This person also wanted to take part in other recreational and sports related activities on a regular basis. Information about this was recorded in their Person Centred Plan. As reported under the section Individual Needs and Choices, they were not able to Evidence: leave the house without support, and staff were not always available to accompany them. There was information in peoples individual files about their families and personal relationships. People told us about the visits that they had made to their parents and other family members. There were birthday lists and other information on the files, which would help people to keep in touch. Two people were having homebased days when we visited. One person spent time during the morning cleaning their room and doing their laundry. Staff told us that they encouraged people to take responsibility for the domestic tasks, but supported them with the jobs that they found difficult. Staff asked people what they would like to have for lunch, and helped them to prepare it. One person had cheese sandwiches and a fruit smoothie. Somebody else chose to have beans on toast, followed by a yoghurt. This person said that they sometimes went food shopping with staff and could choose things that they liked to eat. Fresh fruit was available in the home. People had their main meal during the week in the evenings, and there was a six week cycle of menus. Staff had written this to include a varied range of meals that were known to be popular with people. One person who used the service told us that people took it in turns to choose what they had for Sunday lunch. 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 . Peoples health needs are met, although they may benefit from more individual support with their personal care. People are protected by the way in which the home manages their medication. Evidence: Each person had a care plan which covered a range of topics, such as personal care, general health, bathing, dressing and communication. The plans included a statement about the objectives for providing support, and comments about how staff should go about their work. This helped to ensure that staff supported people in a consistent way. When we asked in the surveys what the service does well, two staff members mentioned a high standard of care. However they also commented about the staffing arrangements and the impact this had on peoples personal care and on making appointments (see Staffing section). One of the health professionals also commented positively about the delivery of care. Both health professionals told us in their surveys that the service met peoples individual health care needs. One commented that the staff team appeared to be committed and caring, and carried out specific aspects of care as requested. The health professionals also thought that the service respected peoples privacy and dignity. One commented This has been witnessed. People looked well supported with their personal appearance. We were told in the AQAA that one person has started having regular hair and manicure appointments at the salon of their choice. Evidence: People had their own rooms where any personal care could take place in private. The bedrooms did not have en-suite facilities but were close to a bathroom and toilet. The home had a policy on cross-gender care. Peoples personal files contained health records, with details of their contact with GPs and other healthcare professionals. One person was able to visit their GP independently, and other people received support from staff. One persons file included evidence of preventative well-man checks having been undertaken. In another file we read about advice that had been obtained from an occupational therapist. This was to help ensure that one person who used the service could get in and out of the homes vehicle safely. A risk assessment had also been undertaken. It was reported in the AQAA that the home would be Exploring the Valuing People idea of Health Action Plans for service users with input from CTPLD / GPs. This is a priority, as the Governments Valuing People White Paper recommended that each person with a learning disability should have a health action plan in place by June 2005. We looked at the minutes of staff meetings and saw that peoples health and needs were being discussed. This helped to ensure that any changes in peoples wellbeing were identified and responded to appropriately. People told us that they were happy with the support that they received from staff. We were told at the last inspection about two peoples health conditions, which meant that they had been having regular appointments with health specialists. We were given more up to date information in the AQAA. Both people were reported to have made good progress, but one person has continued to see specialists and have tests on a regular basis. They had an individual plan for their health and personal care. This was dated April 2008 and it had been reviewed in October 2008. The plan was due to have an annual review in April 2009, but this had not yet taken place. Their risk assessments for poor nutritional intake and for skin deterioration were due to be reviewed in May 2009. It was stated in the persons care plan that their weight would be measured on a weekly basis. We saw from the records that this was being done monthly. People at the home received support from staff with the safekeeping and administration of their medication. People had signed consent forms confirming their agreement to this. The patient information drug leaflets were available. There was a medication file which contained photographs and information about each persons prescribed medication. This helped to ensure that people received the right medication at the right time. No controlled medication was being prescribed at the time of our visit, and facilities for this were not available in the home. P.R.N. (as required) medication was limited to some prescribed painkillers. Evidence: The records of administration and stock were up to date. We were told in the AQAA that the home was shortly to change to a monitored dosage system for the administration of medication. 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 . People who use the service are listened to by staff and their views are acted on. There are procedures in place which help to ensure that people are protected from harm and abuse. Evidence: OLPA has produced a complaints procedure and copies of this had been given to people to keep in their rooms. We were told in the AQAA that one improvement during the last year had been the production of the procedure in a pictorial format. This was designed to be used by people who cannot read. People had been given information at meetings about how to make a complaint. The meeting minutes showed that peoples views were being listened to, with staff taking responsibility for following up any concerns that had been raised. We asked people in their surveys whether they knew who to speak to if not happy with something. They confirmed that they did. One person commented I talk to the staff. People also confirmed that they knew how to make a complaint. We were told in the AQAA that the home had not received any complaints in the last 12 months. OLPA have had experience of making referrals under the local authoritys procedures for safeguarding vulnerable adults. The OLPA service co-ordinator had usually taken the lead on this, on behalf of the organisations residential services. There was written guidance in the home for staff members to follow if they had a concern about possible abuse and how this should be reported. Staff members were provided with a copy of the No Secrets booklet, which gives guidance about abuse and what to do if abuse is suspected. They confirmed in their surveys that they knew what to do if somebody had concerns about the home. Evidence: Abuse awareness was included as a subject in OLPAs staff training programme. We have recommended at previous inspections that staff have the opportunity to receive abuse awareness training more than once during their employment. This was so they would be familiar with any changes that are made in the policies and procedures for safeguarding adults. We were told in the AQAA that refresher training for staff was now being arranged. 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 accommodation is generally homely and well maintained. The environment is being improved over time and people will benefit from the further developments that are planned. People are well supported with keeping the home clean and tidy. Evidence: 12 Addington Close is situated in a quiet cul de sac, within walking distance of Devizes town centre. The home is an ordinary domestic property and its style is in keeping with the local area. There was a good-sized rear garden, with a patio area and barbeque. The accommodation was decorated in a homely and domestic manner. There was a spacious sitting room and a separate dining area. People had their own rooms, which were close to a bathroom and toilet. The rooms varied in size. The smallest bedroom had been well personalised, but was very limited in terms of space for socialising. The facilities for staff were not ideal, as they had to sleep in the lounge after people had gone to bed. There was a cover on a couch type bed which helped with the overall appearance of the room. The dining area was also being used as an office. Efforts were being been made to minimise the impact of the staffing facilities on the home environment. The accommodation has been improved in a number of ways since we last inspected the home. The kitchen has been completely refurbished. It has been given a more modern and stylish look, which people at the home said they liked. We were told in the AQAA about the further building and refurbishment work that is planned to be carried out in the next 12 months. This included the addition of a conservatory / garden room. The garage is to be converted for use as an office and staff sleeping-in room. This will free up more communal space for the people who use Evidence: the service. The home looked clean and tidy. Externally, the window frames were in need of attention because the paint was peeling off, exposing the bare wood. 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 . People who use the service benefit from a staff team who know their needs well. However, the deployment of staff means that an individuals needs and wants are not fully met, and restricts what they can do. Staff training is developing but would be improved by the inclusion of a more varied range of subjects. People are protected by the way in which staff members have been recruited. Evidence: There was one staff member working when we arrived at the home on 7th May 2009. Their shift meant that they were working alone from 10.30 am on the previous day, until 10 am on 7th May, when another staff member came on duty. The other staff member would then work alone from 10.30 am until 10 am on the following day. There was a half hour handover period between shifts. Both staff members shifts included sleeping-in at the home overnight. We looked at staff rotas and talked to staff about how they were deployed. The usual pattern was for lone working, except for Fridays and Mondays when there was some double cover during the day. Staff said that these were times when shopping could be done, and appointments made for people. The staff we spoke to acknowledged that lone working meant that they were not able to support people with some of the activities and goals that had been agreed in their individual plans. In their surveys, we asked the people who use the service whether they could do what they wanted to during the week and at weekends. People confirmed that they could, but one person commented Only if we have two staff on duty. We asked staff members in their surveys whether there were enough staff to meet the individual needs of all the people who use the service. The three staff members Evidence: responded Sometimes to this question. One staff member commented about the staffing arrangements can make outings and sometimes appointments difficult. Mornings when giving personal care, would be nice if it could be on a one to one, as one staff is seeing to three people. Another staff member told us if we had more staff we could do more with the service users, i.e. going out, and with the personal care in the mornings. The third staff member commented Staffing can be an issue. When asked in their surveys what the service could do better, staff members commented More staffing would always be welcome, and More bank staff. We saw that the staffing arrangements had not improved since the last inspection. We had found then that the deployment of staff resulted in a lack of flexibility in what people were able to do and the level of support that they received, such as with being able to go out at the weekends. After the last inspection we were told that the staffing situation would be improved by the appointment of a new staff member. A new staff member has been was appointed since the last inspection . However there have been other changes in the management and staff team, which have had an impact on the support that is available to the people who use the service. Most members of the staff team had worked in the home for several years. The relationships we observed between staff and the people who use the service appeared to be friendly and respectful. Staff members showed that they were aware of peoples needs and the areas in which they required support. We looked at the recruitment record for the staff member who had been employed since the last inspection. An application form had been completed, to include details of employment history, and declarations in relation to criminal convictions and health. Two references, proof of identity, and a Criminal Record Bureau (CRB) disclosure had been obtained. The persons name had been checked against the POVA (Protection of Vulnerable Adults) list before they started working in the home. The new member of staff told us that they had undertaken a period of induction. This included working day shifts in the home alongside other members of the staff team. Early and late shifts were not included, although these would have given the new member of staff useful experience of the support that people needed at these times. The staff member told us that they had completed OLPAs mandatory training. They were due to start a National Vocational Qualification (NVQ) at level 3. We were told in the AQAA that 80 of the staff team have a NVQ at level 2 or above. We were given information in the AQAA about staff training. It was reported that staff received mandatory training which included Health and Safety, First Aid, Medication, Food Safety, Fire Training, Abuse Awareness, Manual Handling, Person Centred Planning and Infection Control. Evidence: We had recommended at the last inspection that staff members have the opportunity to receive abuse awareness training more than once during their employment. Refresher training in this subject was now being arranged. Each staff member had an individual training and development record. Some staff were still to do training in Person Centred Planning. We recommended at the last inspection that the homes plan for staff training is expanded to include more specialist and skills related areas of training. The homes training plan still focussed on mandatory and annual refresher training. However training about dementia had been arranged during the last year. We were told in the AQAA that the homes plan for improvement in the next 12 months included training for staff in the Mental Capacity Act, Deprivation of Liberties, and Equality and Diversity issues. 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 . Changes in the homes management have taken place, which we were not made aware of at the time. People benefit from a well established staff team, and the support of an OLPA service co-ordinator. However the absence of a full-time manager is having an impact on the running of the home and the service that people receive. Evidence: The home was without a manager at the time of this inspection. OLPA wrote to us in September 2008 to inform us that the registered manager had left during the previous month. We were told that the manager of another OLPA home would be managing 12 Addington Close, in addition to the home that they currently managed. Similar arrangements (in which one person manages two homes) were already in place at other OLPA homes. In March 2009 we rang to the home, in order to ask the new manager about their progress with applying for registration. We were told that the manager had left in February 2009. It was reported in the AQAA that the appointment of a part-time manager had not proved successful and that a full-time position had been advertised in February 2009. OLPA have since told us that an appointment has been made. An OLPA service co-ordinator has continued to visit the home in the absence of a manager, and provided supervision for staff. Staff members told us that they felt supported by this. They said that the service co-ordinator was also available at the end Evidence: of the phone and could be at the home within about half an hour if needed. When we asked staff in their surveys what the service could do better, one staff member commented On-call should be better, but they didnt elaborate on this. We saw copies of some reports of visits that had been made during the last year by representatives from OLPA. There was a report dated 02.04.09, although the previous report was dated 27.11.08. Under Regulation 26 of the Care Homes Regulations 2001, a representative from OLPA must visit the home and write a report of the visit each month. We discussed this with an OLPA service coordinator when we visited the OLPA office. They were confident that visits were being made each month and reported on, and they said that they would follow up the whereabouts of the reports. We were told in the AQAA that one barrier to improvement during the last 12 months had been that there were not enough management hours being put into the home since the registered manager left in August 2008. A staff member said that the managers hours in the home had not been replaced, and this had had an impact on the level of support that was available for people (see Staffing section). We reported at the last inspection in 2007 that the manager was developing a system of quality assurance that was relevant to the home. This was focussed on incorporating peoples views into house development plans. A house development plan 2006 - 2007 had been produced. We looked at quality assurance again during this inspection. There was no current house development plan. We were told that this had not been completed due to the manager post vacancy, and that a plan would be completed when a new manager was in post. Information about health and safety, including the maintenance and servicing of equipment, was provided in the AQAA. We looked at some records relating to health and safety during our visit. We saw records of risk assessments that had been undertaken. These covered a variety of areas, such as hot water, extension leads, wet slippery floors, and lone working. The assessments had all been reviewed on 27th October 2008. Data on the Control of Substances Hazardous to Health (C.O.S.H.H.) was kept on file and this information was readily available to staff. The homes fire log book was looked at. A fire risk assessment had been undertaken in January 2007, and reviewed in January 2008. It was due to be reviewed annually, but it had not been reviewed again in January 2009. We spoke to the OLPA service coordinator about this, so that it could receive attention. We also discussed the situation of the locked front door, and advised the service co-ordinator to obtain the views of the fire officer about this arrangement. The homes fire alarm system was being tested regularly. Fire drills had taken place in March and April 2009, with full details recorded about the outcome of these. Are there any outstanding requirements from the last inspection? Yes  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 33 18(1)(a) That staff are deployed in a 11/05/2007 way that will provide the greater flexibility that is needed at particular times of day. 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 Description 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 Description Timescale for action 1 19 12 30/06/2009 People must receive the support that they require as detailed in their individual plans. This includes the monitoring of a persons weight, when this is required because they are at risk of poor nutritional intake. This is to ensure that people are not put at risk because they are not being fully supported in accordance with their care plan. 2 33 18 That staff are deployed in a 30/06/2009 way that will provide the greater flexibility that is needed at particular times of day. This is to ensure that the people who use the service receive the support that they need with their planned activities outside the home. 3 39 26 The Ordinary Life Project 30/06/2009 Association must ensure that reports of all visits that are made to the home in accordance with Regulation 26 of the Care Homes Regulations 2001 are kept in the home and available for inspection. This is to ensure that there is a record of the visits and the findings, and that the people who use the service can be confident that the running of the home is being monitored appropriately by the provider. 4 42 13 The homes fire risk assessment must be reviewed and action taken, as indicated by the outcome of the review. 30/06/2009 This is to ensure that any changes in the homes fire precaution arrangements are identified, and people are protected because the appropriate safety measures are in place. 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 1 That information is produced in formats that meet the needs of the people who use the service. This is to ensure that people can understand the information that they are being given. That the arrangements in place for preventing a person from leaving the home on their own are reviewed. There should be evidence that the arrangements are appropriate 2 7 with regard to peoples individual rights and mental capacity. 3 4 19 20 That Health Action plans are completed with the people who use the service. A cupboard that meets the current storage regulations for controlled drugs, the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007 should be installed. This is so that any controlled drugs that are prescribed can be stored safely if they need to be kept in the home in the future. That the homes plan for staff training is expanded to include more specialist and skills related areas of training. This will help ensure that people who use the service benefit from staff members who have attended a wider range of training courses. 5 35 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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