Inspection on 13/04/09 for Amersham Park House

This inspection was carried out on 13th April 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.

Other inspections for this house

Amersham Park House 17/04/07

Amersham Park House 22/02/06

Amersham Park House 19/10/04

Amersham Park House 05/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Amersham Park House 111 Amersham Road Harold Hill Romford Essex RM3 9JA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Harbinder Ghir     Date: 2 7 0 4 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Amersham Park House 111 Amersham Road Harold Hill Romford Essex RM3 9JA 01708704963 01708704963 bobjfinlayson@hotmail.com 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) : Mrs Lynne Griffin,Mr Darren Griffin,Mr Robert Finlayson care home 3 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 3 The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home Amersham Park is a home registered to provide care and support for three people with learning disabilities with overlying mental health problems. The house is situated in a residential area of Harold Hill close to local shops and transport routes. Accommodation is spread over three floors with two bedrooms and one communal bathroom on the first floor and with one bedroom, the staff office and a second communal shower room being situated on the top floor. The building is well maintained and residents are encouraged to become involved in the day to day running of the house. Both the manager and deputy are also registered proprietors in respect of the Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home home and work at the establishment on a daily basis as part of the staff team. 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: The quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. This was an unannounced inspection undertaken by Regulation Inspector Harbinder Ghir over two days, on the 13th April 2009 and the 27th April 2009. One of the registered proprietors of the home was available throughout the second of the inspection and feedback was provided to him at the end of the inspection. During the inspection the inspector was able to talk to one resident. Their comments have been included in the report. Staff on duty during the day were also spoken to and were also observed carrying out their duties. The community psychiatric nurse who Care Homes for Adults (18-65 years) Page 6 of 32 was visiting the home was also spoken to as part of the inspection and their comments are also included in the report. The Commission for Social Care Inspection received a completed Annual Quality Assurance Assessment prior to the inspection. The inspector would like to thank everyone involved in the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 2, 3, 4. Prospective residents cannot be assured that their needs will be comprehensively assessed by the home prior to admission. Prospective residents are given the opportunity to visit and test drive the home before making a decision on whether they would like to move into the home. Evidence: Amersham Park has had one new admission since the last inspection. A new resident was admitted to the home on the 21/02/09. This residents care plan file was closely examined. It was identified that the home had obtained the appropriate health care and care management assessments prior to the admission but did not complete their own pre-admission assessment. Although the service consulted the assessment information they had received to see if they could meet the prospective residents Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: needs before making the decision to accept the application for admission and offering the place. They did not follow their own policies and procedures. The services Annual Quality Assurance Assessment sent to the Care Quality Commission states Service user needs are fully assessed prior to meeting to ensure that the home can meet their needs. Following the above evidence it is evident that this statement has not been applied. Since the admission the resident has presented challenging behaviour and the home has had to provide one to one care to meet the residents needs. This need for one to one care was not identified on the assessments sent to the home and therefore the home was not aware that they would be providing this level of support. If the home had completed their own comprehensive pre-admission assessment, the levels of support the resident required could have been identified. The service is currently unable to provide this level of support to the resident and are therefore unable to meet the residents needs, and the proprietors have informed us that the placement is to be terminated. The staff team also did not receive training in managing challenging behaviour, even though the assessment information received by the home highlighted the resident presenting challenging behavior. This has been discussed in more detail under staffing. It is evident that the admission was agreed without consideration to the specialist care the resident required or to the skills, ability or knowledge of the staff that would be caring for the resident. It will be stated as a requirement that prospective residents needs are fully assessed prior to admission by the home, to ensure they can meet individuals needs and aspirations. Trial visits are offered to all prospective residents and are given the opportunity to spend time at the home. The newly admitted resident visited the home five times and had two overnight stays. The resident was spoken to as part of the inspection and spoke very positively about the care provided at the home. He said I have no complaints about the care staff but this home is not for me. I see myself somewhere else. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 6, 7, 8, and 9. There is a satisfactory care planning system in place, which provides staff with the information needed, to meet the needs of residents. The right for residents to exercise choice and control is promoted by the service and they are actively consulted on, and participate in, all aspects of life in the home. Risk assessments are not reviewed and updated according to the changing needs of residents, which can place residents at risk. Evidence: The service involves residents in the planning of their care which affects their lifestyle and quality of life. Residents are supported to take control of their own lives and they are encouraged to make their own decisions. The two residents currently residing at Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: the home are able to communicate their needs clearly to the staff team. One resident is able to go out to the local shops independently and visits local cafes on his own. The other resident who has recently been admitted to the home requires the support of staff when going out . Staff have also supported the resident to visit friends and local areas which have been of importance to him. The deputy manager informed that they supported the resident to visit Croydon and went on a three hour train journey as the resident wanted to show them where he had previously lived. Both residents are supported to make their own decisions about what they would like to do each day. The care plans for both residents were closely examined. Care plans were written in plan language and were easy to understand and looked at all areas of residents life. The documents covered the physical, social, emotional and health care needs of residents. Care plans are reviewed and updated on a three monthly basis. The risk assessments for both residents were closely examined. It was identified that for the newly admitted resident the home had not implemented all of their own risk assessments and were still using some of the risk assessments given to the them by the individuals previous care establishment. The risk assessments for this individual also had not been updated following the incidents that had taken place at the home, where the resident had self harmed and had presented challenging behaviour towards staff and the other resident residing at the home. The risk assessment for the other resident also had not been updated to highlight them being at risk from the newly admitted resident. These practices have placed both residents and the staff team at risk. It will be stated as a requirement that risks assessments are updated promptly with the changing needs of residents to ensure the safety of people using the service. 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. At this inspection we looked at standards 11, 12, 13, 14, 15, 16 and 17. Residents are provided with support to maintain their independence and in areas of personal development according to their needs and wishes. Residents are engaged in community life, promoting their opportunities to be part of the local community. Residents are offered meals that promote their choices and respect their individual preferences. Residents are supported to maintain family links and relationships inside and outside the home. Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: Both residents independently decide what activities they would like to participate in each day. Residents go out to local shops and cafes of their own choice. Both residents currently residing at the home refuse to attend clubs and participate in leisure activities. Daily case recording notes evidenced the flexible routines within the home with residents going to bed and getting up at their preferred times. On the day of the inspection one resident was observed to be having a lie in. Residents at the home have a choice of watching television, listening to music and watching DVD films of their choice. Family and personal relationships are actively promoted by the home. Residents can use the homes telephone to contact their family. Both residents are supported to visit and stay with family on the weekends. One resident has his girlfriend visiting and other friends visiting him at the home. Mealtimes are flexible and residents choose what they would like to eat each day. There was plenty of fresh fruit and vegetables at the home. Food was stored in air tight containers and food was correctly labelled with the date of opening in the fridge. Fridge and freezer temperatures had been taken consistently and were recorded for each day. One resident spoken to informed that The meals are nice and staff prepare the meals for them. He further stated I have no complaints about the care provided here. 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. At this inspection we looked at standards 18, 19, 20 and 21. Residents receive personal support and care in the way they prefer and require. Medication practices do not always ensure the safety of people who use the service. The ageing, illness and death of residents are handled with respect and as the individual would wish. Evidence: Each resident has a devised health plan which identifies the health care needs of residents including specialist health, nursing and dietary requirements, which are clearly recorded and act as an indicator of change in health requirements. The plan also identified residents daily routines including the type of support they need in relation to personal hygiene and according to their level of care needs. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: All residents have a designated key worker to promote their privacy and dignity, and all personal care is provided in private. Attention is paid to personal preferences in relation to the provision of personal care, for example whether one prefers a shower or a bath. Personal support takes account of individual preferences and residents choice of dress and appearance is respected. Residents were well dressed and groomed. Residents are supported by staff to attend appointments with health care professionals and their health is closely monitored and prompt referrals are made. There was evidence of the involvement of multi-disciplinary health care professionals and referrals where required were made to dentists, chiropodists, general practitioners and community psychiatric nurses. During the inspection the community psychiatric nurse who was visiting the home was spoken to as part of the inspection. They informed us that They have always found it a satisfactory home and have had no major issues with the home. They further informed that The home manages clients well, even though they can be difficult. The home provides good care and they try their best. Steps have been taken to find out the wishes of residents in the event of their death, including contacting relatives or representatives where the resident is unable to express their views. There are policies and procedures for staff to follow in the event of a death; to ensure the death of a resident is handled with respect and as the individual would wish. All medication at the home is stored in a locked cupboard in the staff office and is organised into blister packs. The home also has a separate controlled drugs cupboard which is fixed to the wall in the kitchen. The controlled drugs register was examined which was signed by one member of staff as the home does not always have two members of staff available at all times at the home. The pharmacy inspector was spoken to about this as the controlled drugs register requires two signatures as witness to the administration of controlled drugs. It has been the advise of the pharmacy inspector that under these circumstances the home can only enter the words no witness available in the section for the second signature. This will be stated as a recommendation. The medication administration records (MAR) were closely examined. It was identified that hand written entries were made on the MAR charts which were not signed and dated by the person making the entry. It was also identified that staff had used the code O which stands for other on the 17/03/09 but no description was given on the MAR chart to why the code was used. It was only when the inspector spoke to the deputy manager that they informed that a medication error had occurred on that day and thats why the code was used. A member of staff had administered the evening Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: medication in the morning as well as the morning dose to the resident. The incident was recorded in the residents daily notes and staff had taken the right actions to ensure the safety of the resident. A senior member of staff was contacted as well as the residents general practitioner. The incident was also recorded in the member of staffs file who had made the error. However, staff must clearly record the reasons why a medication code is used to ensure others are aware of any incidents taking place and must clearly sign and date in the medication details box when making a handwritten entry, to ensure accountability of those making the entries. This will be stated as a requirement. Care Homes for Adults (18-65 years) Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 22 and 23. The service has a complaints procedure but must be updated to ensure that it clearly communicates to people using the service, that they can contact the Care Quality Commission at any stage of a complaint being made. The service has safeguarding policies and procedures in place and all staff have received training in safeguarding adults ensuring the safety of residents. Evidence: The service has a complaints procedure in place which is also devised in picture format. The procedure was displayed around the home and was also seen displayed in a residents bedroom, which was in picture format. However, the complaints procedure did not clearly communicate that the Care Quality Commission can be contacted at any time of a complaint being made. It is recommended that the procedure is updated to include this information. Timescales within which a complaint would be investigated were stated on the complaints procedure. The complaints file was viewed. Complaints received by the home, were responded to within the specified timescales. The service has obtained the safeguarding procedures devised by the London Borough of Havering and the London Borough of Tower Hamlets who currently fund the Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: residents residing at the home. The service has its own safeguarding policy and procedures, which were comprehensive and clearly stated the details of the appropriate bodies to contact in the event of making an alert. All staff have attended training safeguarding adults and the area is also covered comprehensively in the homes induction programme. 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. At this inspection we looked at standards 24, 25, 26, 27, 28, 29, 30 Residents live in a comfortable environment and decor is of a good standard and provides a homely and pleasant living environment enhancing residents comfort. But further maintenance would improve the environment of the home. Evidence: Amersham Park House is a three bedroom semi- detached property located in the area of Harold Hill. The home provides a main lounge, kitchen and a conservatory, which is the only smoking area in the house. There are two bedrooms and a communal bathroom on the first floor and there is a third bedroom, a further communal bathroom and staff office located on the third floor. The home currently has one vacant room. The overall decor of the house is homely and furnishings are satisfactory. The communal bathrooms are in need of decoration as the overall appearance of both bathrooms looks tired. Both residents hold a key to their bedrooms and one resident chooses to keep his bedroom door locked. All rooms were lockable and could be overridden in an emergency. Care Homes for Adults (18-65 years) Page 21 of 32 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. At this inspection we looked at standards 32, 33, 34, 35 and 36. People who use the service are generally supported by a competent staff team. Recruitments practices are not robust and do not ensure the safety of residents. Staff must be provided with specialist training in order to meet the changing needs of residents. Staffing levels do not always ensure the safety of people who use the service. Evidence: Two staff files were closely examined at this inspection, which included a file of recently recruited member of staff. The first file included all the relevant checks. There was a completed application form and a copy of the interview questions on file, and a completed Criminal Bureau check. There were also good identification checks in place. However, when examining the references, it was noted that two references had been obtained but they had not been verbally verified as they did not have company logos on them. The second file was of a member of staff who started employment with the Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: service in February 2009. The application form had not been completed in full as there was no leaving date recorded for one past employer and no start date recorded for another employer. The application form also did not allow the applicant to declare any previous convictions or offenses on the form. The member of staffs criminal bureau check was also in the process of being completed and the service had obtained a POVA first. It was identified by looking at the staff rotas, that this this new member of staff was working alone at the home and was also administering medication to residents on her own, which is in breach of Regulation 19 of the Care Homes Regulations 2001. A member of staff where a criminal bureau check has been applied for must only commence employment on the basis that a appropriately qualified and experienced member of staff is able to supervise the new worker; so far as possible ensure that the staff member is on duty at the same time as the new worker; and ensure the new worker does not escort people who use the service away from the care home premises unless accompanied by the supervising staff member. On the first day of the inspection this new member of staff was on duty alone. This was discussed with one of the proprietors of the home who also works as a deputy manager at the home. They informed that they were not aware of this Regulation. The Registered persons must ensure that they update themselves on the Care Homes Regulations 2001 to ensure that robust recruitment practices are in place and followed to ensure the safety of people who use the service. All new members of staff complete an induction programme at the start of their employment with the registered manager. There is a training programme in place and all staff had attended training in health and safety, first aid, safeguarding adults, manual handling, medication administration and the mental capacity act. However, both residents currently at the home can present challenging behaviour and it was identified that staff had not received training in managing challenging behaviour. A new resident that had recently been admitted to the home who had complex needs was at high risk of presenting challenging behaviour as indicated by their assessments completed by their previous placement. There had also been numerous incidents at the home where the resident had become challenging and no staff training had been provided in managing the residents challenging behaviour. When spoken to one of the proprietors about the incidents and how the staff team were coping, he described them as stressed. The staff team must be provided with specialist training appropriate to meeting the changing needs of residents. This will be stated as a requirement. The staff rota includes at least one member of staff on duty during the day who is supported by a second member of staff when required to support residents to go out into the community. At night there is one waking member of staff on duty. The service had not completed lone working risk assessments with staff to ensure people working at the home and residents were safeguarded, having regard to residents being at risk Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: of presenting challenging behaviour and the incidents that have taken place at the home. The registered persons must review their staffing levels and complete lone working risk assessments with with all members of staff working at the home. This will be stated as requirement. Staff supervision records evidenced that staff were supervised at least six times a year. Members of staff spoken to also commented that they were supervised regularly. Staff meetings are organised on a monthly basis and staff spoken to confirmed that they always take place, allowing them an opportunity to discuss issues or any concerns they have. 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. At this inspection we looked at standards 37, 39, 42. The management of the home need to ensure they update themselves with the Care Homes Regulations 2001 to ensure they are in compliance with them and to ensure they can improve care practices at the home. The systems for service user consultation are in place and views are acted on, to ensure the home is run in the best interests of residents. The health and safety of staff and residents is promoted by the homes policies and procedures, to ensure the safety of people who use the service. Evidence: The service has policies and procedures in place but there is evidence that these have not been followed. Serious shortfalls in completing robust recruitment checks and not reporting incidents under Regulation 37 have not ensured the safety of people who use Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: the service. A medication error that occurred at the home on the 17/03/09 was not reported to the Care Quality Commission. The deputy manager was not aware they they had to report the incident under Regulation 37 of the Care Homes Regulations 2001. The service has also failed to follow its own pre-admission processes and update and complete risk assessments for residents to ensure their safety and do not have robust recruitment practices when recruiting new members of staff in place. This in turn has led the rating of the service to drop to Adequate in consultation with the Key Lines of Regulatory Assessment. Services users records of finances were viewed and the inspector tracked the amounts of money the service held for three service users. All amounts were accounted correctly and were in order. Quality assurance systems are in place and surveys for people who use the service, relatives, care managers and other professionals were seen which were completed in January 2009. Residents also have their own meetings on a regular basis to discuss any issues they have regarding the running of the home. A completed Annual Quality Assurance Assessment was received before the inspection and was supported by a wide range of evidence. It informed of the changes the service has made and where they still need to make improvements. Health and Safety records were inspected. The gas and safety certificate, gas safety inspection, fire system and emergency lights checks were all in good order and appropriately completed. The service had obtained insurance cover with the certificate from the company displayed in the main office of the home. The deputy manger informed that the water temperature at the home is controlled centrally by the boiler and this is checked every two weeks, but the checks are not recorded. It is recommended that these checks are recorded to ensure the safety of residents. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 The Registered Person must ensure that they complete pre-admission assessments before any prospective resident is admitted to the home, to ensure the home can meet their needs. . 31/05/2009 2 9 15 The Registered Persons must ensure that risks assessments are updated promptly with the changing needs of residents to ensure the safety of people using the service. . 31/05/2009 3 20 13 The Registered Persons 30/06/2009 must ensure that staff clearly record the reasons why a medication code is used to ensure others are aware of any incidents taking place and must clearly sign and date in the medication details box when making a handwritten entry, Page 29 of 32 Care Homes for Adults (18-65 years) to ensure accountability of those making the entries. . 4 32 18 The Registered Persons 30/06/2009 must ensure that the staff team are provided with specialist training appriopraite to meeting the changing needs of residents. . 5 33 18 The registered persons must 30/06/2009 review their staffing levels and complete lone working risk assessments with all members of staff working at the home. . 6 34 19 The Registered persons 30/06/2009 must ensure that they update themselves on the Care Homes Regulations 2001 to ensure that robust recruitment practices are in place and followed to ensure the safety of people who use the service. They must also ensure that applicants complete their applications in full and are able to declare any past convictions or offenses on the form. References must also be verbally verified where there are no company stamps included. . Recommendations Care Homes for Adults (18-65 years) Page 30 of 32 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 20 It is recommended that staff enter the words no witness available in the section for the second signature, when administering controlled drugs, when there is only one member of staff available to administer the drug. It is recommended that the complaints procedure clearly communicate that the Care Quality Commission can be contacted at any time of a complaint being made. It is recommended that water temperature checks are recorded to ensure the safety of people who use the service. 2 22 3 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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