Inspection on 02/06/08 for Apple Tree House Residential Care Home Ltd

This inspection was carried out on 2nd June 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Apple Tree House Residential... 22/08/07

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

CARE HOME ADULTS 18-65 Apple Tree House Residential Care Home Ltd 31 Norwood Beverley East Yorkshire HU17 9HN Lead Inspector Carol Haj-Najafi Key Unannounced Inspection 2nd June 2008 09:00 Apple Tree House Residential Care Home Ltd DS0000069449.V365065.R01.S.doc Version 5.2 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Apple Tree House Residential Care Home Ltd DS0000069449.V365065.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Apple Tree House Residential Care Home Ltd DS0000069449.V365065.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Apple Tree House Residential Care Home Ltd Address 31 Norwood Beverley East Yorkshire HU17 9HN 01482 873615 01482 872322 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Apple Tree House Residential Care Home Limited Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Apple Tree House Residential Care Home Ltd DS0000069449.V365065.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 category: Learning Disability - Code LD The maximum number of service users who can be accommodated is: 7 22nd August 2007 2. Date of last inspection Brief Description of the Service: Apple Tree House opened in March 2007, and is a Victorian terraced property in a residential area, close to the centre of the market town of Beverley. It is situated adjacent to a main road offering easy access to public transport, and within walking distance of the local shops and markets. On the ground floor there is a conservatory/dining area, lounge, kitchen and one bedroom. Further bedrooms and bathrooms are on the on the first floor. There are two self-contained flats in the courtyard area and they have their own bathroom, kitchenette and lounge. The courtyard offers a small garden area to people. The home does not have a stair lift so accommodation on the first floor is not suitable for people with mobility problems. One bedroom is part of the main building of the home, but is only accessible by a rear staircase. At the visit in June 2008 the registered provider confirmed that the weekly fees range between £508 and £1207. In addition people pay for toiletries and hair care. More information about the home and the current fees can be obtained directly from the home. Apple Tree House Residential Care Home Ltd DS0000069449.V365065.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The Commission for Social Care (CSCI) inspects care homes to make sure the home is operating for the benefit and well being of the people who live there. More information about the inspection process can be found on our website www.csci.org.uk The last key inspection was carried out on 22 August 2007. Before this unannounced visit on 2 June 2008 we reviewed the information we had about the home. The manager completed an annual quality assurance assessment (AQAA) and we used this to help us decide what we should do during our inspection. Surveys were sent out to people who live at the home, their relatives, staff and health care professionals. Ten surveys were returned. Comments from the surveys have been included in the report. One inspector was at the home for one day from 9am to 6pm. During the visit we looked around the home and talked to people who live at the home, people who work there, a visiting professional and the owner of the home. We observed staff caring for people in the communal rooms and looked at care plans, risk assessments, daily records and staff records. Feedback was given to the manager and the owner of the home at the end of the visit. What the service does well: People who live at the home said they are happy with the care they receive. One person said, ‘It’s really brilliant’. Another person said, ‘ It’s fantastic living here’. People also said they have a good lifestyle. One person said, “It’s great, there’s plenty to do and plenty of people to talk to”. Another person said, “We go out to the cinema, bowling and bingo”. People are also happy with the staff. They said staff always treat us well and carers always listen and act on what we say. One person said, “staff always help me.” Another person said, “all staff are great.” Staff also told us the home provides good care. One person said, ‘We provide very individual care’. Another staff member said, ‘We sit as a family, we have fun and laughter’. Staff have good knowledge about the people who live at the home. Apple Tree House Residential Care Home Ltd DS0000069449.V365065.R01.S.doc Version 5.2 Page 6 Good systems are in place to make sure people’s general healthcare needs are met. A healthcare professional said, “the home was good at contacting professionals if they have any concerns about the people living there and will follow advice given.” People are very comfortable living in a safe, pleasant and homely environment. What has improved since the last inspection? What they could do better: The home should make sure people have detailed individual plans that describe the support they need and people who live at the home must be involved in deciding the type of support they want. This will make sure the care they receive is the right care and it is person centred. Risk assessments should be completed with each person to make sure potential risks of harm are recognised and minimised. People who live at the home should be encouraged and have more opportunities and time with staff to engage in jobs around the house. This will help people develop independence. Medication must be stored more carefully and people who live at the home should have more opportunities to control their own medicines. This will make sure choice and independence is promoted and medication is administered safely. Other agencies should be told when important events happen to people who live at the home. This will make sure the home is properly monitored and people get the right support. Staff should be better trained to make sure they can understand and meet people’s specific needs, and make sure people are safe. Apple Tree House Residential Care Home Ltd DS0000069449.V365065.R01.S.doc Version 5.2 Page 7 Staff should have a better induction when they start working at the home so they know how to meet people’s needs. The recruitment process should be more robust to make sure people who live at the home are protected. The home should have a registered manager that has the skills, experience and knowledge. This will make sure the home is managed the home properly and improvements are made within reasonable timescales. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Apple Tree House Residential Care Home Ltd DS0000069449.V365065.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Apple Tree House Residential Care Home Ltd DS0000069449.V365065.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. People have their needs properly assessed before they move into the home. This makes sure their needs are identified and everyone understands how they should be met. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: In the AQAA the manager said, “The home provides the opportunity for every person to come and visit the home in order to assist them in the decision on whether or not they would like to come and live here at Apple Tree.” They told us they have a transition plan for people who want to move into the home. People at the home said they received enough information about the home before they moved in so they could decide if it was the right place. Only one person has moved into the home since the last inspection and this was done on an emergency basis. The person at the home said they had settled in reasonably well. We looked at the information that was gathered as part of the admission process. The placing authority had completed an in-depth assessment before Apple Tree House Residential Care Home Ltd DS0000069449.V365065.R01.S.doc Version 5.2 Page 10 the person moved into the home. This gave the home very good information about how the person’s needs should be met. The home did not complete it’s own assessment but the manager said it was because the placement was an emergency admission. A review of the placement was due soon after the inspection. Apple Tree House Residential Care Home Ltd DS0000069449.V365065.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People who use the service experience adequate quality outcomes in this area. People who live at the home are treated as individuals and are encouraged to make decisions. People have limited involvement in the care planning process so the service they receive may not be person centred. Care plans did not contain enough individual information about people’s needs, which could result in their needs being overlooked. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: We talked to people who live at the home. They said they are happy with the care they receive. One person said, ‘It’s really brilliant’. Another person said, ‘ It’s fantastic living here’. Apple Tree House Residential Care Home Ltd DS0000069449.V365065.R01.S.doc Version 5.2 Page 12 We asked the staff what the home does well and they all said provide good care. One person said, ‘We provide very individual care’. Another staff member said, ‘We sit as a family, we have fun and laughter’. Staff have good knowledge about the people who live at the home. They were able to talk about people’s family members, where they had lived and what they had done before they moved into the home. Staff described how they looked after people individually and how they provided different care to different people. Staff said they knew how to support people because they knew them well. We looked at three people’s care plans and assessments. There was some good information in the care plans that clearly identified how individual needs should be met. One plan described very well how the person managed their money and the support they needed to make sure their money was safe. Another plan provided good information about how to support the person with personal care. There were some gaps in the care plans because some important information was not recorded. For example, one person had very specialised needs associated with their disability but there was nothing recorded in their care plan. Another plan made reference to supporting the person with their laundry but there was no other information about other daily living tasks. We looked at an assessment that had been completed by a social worker and we looked at the care plan that had been completed by the home. They contained some very different information. One document said the person doesn’t have a good relationship with their family; the other document said they have a close relationship. The assessment said the person finds social situations difficult; the care plan did not refer to this. We talked to people who live at the home about their care plans. They were aware of the plans and had signed them but people had really not been involved in developing the plans. Management and staff had written the plans and then people had been asked to sign them. Care plans should be developed with the person to make sure they are person centred. The manager and registered provider said they had drawn up the plans in a relatively short period of time because the existing care plans did not meet the needs of the people at the home. We looked at people’s risk assessments. Most of these were general and many of the outcomes were the same for everyone. For example, each person had a plan for ‘weight gain’ with a risk of ‘poor mobility/health problems’. One person was very slim and not likely to gain weight but the assessment did not reflect this. People also had an assessment for ‘exploitation’. The assessment Apple Tree House Residential Care Home Ltd DS0000069449.V365065.R01.S.doc Version 5.2 Page 13 said, ‘(name of person) is open to exploitation- staff to be aware of other clients’. Again this has not been assessed on an individual basis and it also does not demonstrate fairness or respect to other people living at the home. We talked to one person about the risk assessments in their file. They said they had never seen the risk assessments before. The manager confirmed that the risk assessments had not been discussed with the person. We spent time observing the care being given to people. This included how staff interact with people at the home. Everything was done at a relaxed pace. Staff treated people with warmth and respect and they were kind and courteous. In the AQAA the manager said, “Apple Tree House continues to promote and encourage choice, empowerment and supports people to be as independent as possible. The home believes it is the right of each service user to live the lives the way they choose.” People at the home told us they can do what they want during the day, on an evening and at the weekend. Two people said they always make decisions about what they do each day; three people said this usually happens. They said they choose when to go to bed and when to get up. One person said he gets up and goes to bed at set times during the week but this is to make sure he has time to do organised activities. Residents’ meetings are held and these provide people with opportunities to talk about what happens at the home. People who live at the home are responsible for chairing the meetings. One person said they talk about what they like doing and check people are happy. Apple Tree House Residential Care Home Ltd DS0000069449.V365065.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16 & 17 People who use the service experience good quality outcomes in this area. People enjoy living at the home and feel well cared for, and have a varied and fulfilling lifestyle. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: We talked to five people who live at the home. They all said they liked living there. People talked about going out independently or with staff and spending time with staff when they are at home. One person said, “It’s great, there’s plenty to do and plenty of people to talk to”. Another person said, “We go out to the cinema, bowling and bingo”. We received a survey from a relative. They were happy with the service and said, ‘the care home looks after (name of person) very well and provides an Apple Tree House Residential Care Home Ltd DS0000069449.V365065.R01.S.doc Version 5.2 Page 15 excellent service. It provides a safe environment which helps (name of person) to develop her potential.’ We sat with everyone at lunch. It was well organised and people received good support, there was a relaxed and pleasant atmosphere. Staff talked to people throughout the meal and offered help when assistance was needed. People enjoyed the food. One person said, ‘staff are good at cooking, we have nice meals’. Several people had just returned from a five day holiday with staff, which they had obviously enjoyed. One person said, “I want to go back again”. People go to various organised activities during the week. Some go to college; others do voluntary work; one person goes to a day placement. On the evening of the visit some people were going out swimming. Management said they actively encourage people to lead fulfilling lifestyles and talked about college courses they are exploring for next year. People talked about doing jobs around the house. Each person has an allocated day when they clean their bedroom and do their laundry. They also make some snacks and drinks. Staff generally cook the main meals and clean communal areas. One person who lives at the home said, “Staff do the cooking, cleaning and dusting”. Another person said, “We sometimes help staff out”. Staff agreed that ‘daily living skills’ is an area that could be developed which would help promote peoples’ independence. However, it was acknowledged that this could be time consuming and difficult to introduce because the home does not have any domestic or catering staff so care staff are responsible for everything. The registered provider said they had talked about this and identified that people would benefit from developing their levels of independence. She agreed to look at freeing up some staff time to make sure people have more opportunities for personal development. Apple Tree House Residential Care Home Ltd DS0000069449.V365065.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People who use the service experience good quality outcomes in this area. People’s general healthcare needs are well met. Improvements are needed to some aspects of the medication systems and practices. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: We received comments from two professionals who are involved with the service. They told us the care service provides support to individuals to live the life they choose wherever possible and the care service responds to the different needs of individual people. We talked to a healthcare professional who was visiting the home. They said the home was good at contacting professionals if they have any concerns about the people living there and will follow advice given. They also said the home ‘has a nice feel, it doesn’t have a clinical feel’ and the last year ‘had been a steep learning curve’. Apple Tree House Residential Care Home Ltd DS0000069449.V365065.R01.S.doc Version 5.2 Page 17 We looked at information that showed us people’s health and welfare is properly monitored. Weight is monitored and healthcare appointments are clearly recorded. On the day of the site visit one person was supported to go to the dentist; another person was supported to the GP surgery. We looked at medication systems. Staff had correctly signed medication administration records. The supplying pharmacist had recorded against one medicine ‘none supplied this cycle’ but the medicine was supplied. This had not been picked up be staff who had checked the medication when it was delivered or by staff administering the medication. The medication cabinet had been replaced but there was no shelving. Medication was stacked on top of each other, which made it difficult to access. People had an assessment for medication administration. The assessments were the same for each person and said, ‘possible overdose- staff to administer all medication’. Care plans did not have details about administration of medicines or consent for staff to administer the medication. It is important that assessments are carried out individually to make sure independence and dignity are respected and medication is administered safely. Apple Tree House Residential Care Home Ltd DS0000069449.V365065.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use the service experience adequate quality outcomes in this area. People are confident that they will be listened to and any concerns will be dealt with appropriately. People who live at the home are being placed at risk because the home is failing to share information with the right agencies. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: In the AQAA the manager said, “Apple Tree House treats each complaint/concern seriously and deals with the complaint promptly in hope to provide a satisfactory outcome.” People at the home told us they know who to speak to if they are unhappy and they know how to make a complaint. Staff said they know what to do if people who live at the home have any concerns. The AQAA said the home has received five complaints since the last inspection. We looked at the complaints record. The complaints were recorded and there was good detailed information to demonstrate that they had been investigated. In the AQAA the manager told us they have improved the service in the last twelve months because all staff have completed safeguarding adults training. Staff and management have attended training in the protection of vulnerable adults. They were able to say what action they would take if they suspected Apple Tree House Residential Care Home Ltd DS0000069449.V365065.R01.S.doc Version 5.2 Page 19 abuse or if someone made an allegation of abuse. They were also able to describe the different types of abuse. Since the last key inspection visit there has been one safeguarding matter. When this first arose it was referred to the appropriate agency and initially dealt with properly. However, the registered provider and manager received more safeguarding information for at least one week but had chosen not to share it. At the visit they were asked to pass on this information to the local authority because they are responsible for looking into safeguarding matters. We checked four days after the visit and the home had not passed on this information. It is important to involve other agencies in all aspects of safeguarding to make sure people who live at the home are protected. We looked at the accident records and we found that there had been two recent accidents that had resulted in a person sustaining an injury and needing medical assistance. For example one person had burnt their stomach and had been regularly visiting a healthcare professional to get it dressed. We had not been told about the accidents. The home should tell us about important events so we can monitor what happens at the home and make sure people are safe. The manager said only one person who lives at the home has money that is held on their behalf. We looked at these personal allowance records. All financial transactions were recorded and receipts were obtained. Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People who use the service experience good quality outcomes in this area. People are very comfortable and live in a pleasant, safe and homely environment. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: In the AQAA the manager said, “Apple Tree House provides a homely atmosphere which is safe, warm and welcoming.” We looked around the home and agree that people live in a homely, welcoming and safe environment. The home is furnished to a high standard and has many small touches to create a homely and domestic style home. For example, there are pictures on the walls and ornaments throughout the home. People who live at the home were very comfortable relaxing in the lounge. Everyone has keys to their rooms and clearly see these as ‘their space’. Some people invited us to look at their accommodation, which again was well furnished. People had personalised their rooms. One person had their own landline phone, another person had turntables, and other people had computers. The registered provider said there is not a fixed programme of decoration but areas are decorated when they start to show signs of wear and tear. This system appeared to work satisfactorily. Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 People who use the service experience poor quality outcomes in this area. People who live in the home are supported by a caring staff team. Staff may not understand people’s specialist needs because they have not received the right training which could result in people’s needs not being properly met. People who live at the home are being put at risk because recruitment practices are not safe. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Surveys and discussions with people who live at the home were positive and it was clear they were happy with the staff. We received the following comments: • • Staff are really great Staff always help me • • • • • All staff are great There are plenty of staff Linda (registered provider) is fantastic. I wouldn’t be without her. Staff always treat us well Carers always listen and act on what we say. In the AQAA the manager told us they have improved the service in the last twelve months by providing regular supervision to staff. Staff told us they received training which is relevant to their role and helps them understand and meet the individual needs of the people who live at the home. They said their manager meets with them to give them support on a regular basis. Staff said they usually have enough staff. One person added, “some residents need a lot of attention and 1 to 1 thus occupying staff time”. Another staff member said, “we are supposed to be getting more staff soon to cover the busy periods.” As stated under the ‘lifestyle’ section of this report, the registered provider has agreed to look at staffing levels and staffing roles to make sure staff have enough time to work with people who live at the home and help them develop their independence. Apple Tree House provides care to people with specialised and complex needs. Three days before the visit one person’s health had suddenly deteriorated. A health professional who was familiar with the person said this had happened before, and staff and management had dealt with the deterioration appropriately. However, people who work at the home were surprised at the sudden change. They were visibly upset and said they had not expected to see such a change. Staff have not received specialised training that will help them understand and meet people’s specific needs, which includes autism and mental health. Staff and management said they would benefit from some additional training. People’s care plans did not contain enough information about their specialist needs. For example, one person requires specialist support because they have autism but their care plan did not identify the support and it made no reference to autism. In the AQAA the manager said 3 staff were working towards NVQ level 2 or above. At the inspection the manager and registered provider confirmed only two people were working towards the award. The manager said she is planning to complete ‘tutor training’ with a local college that will qualify her to train staff at the home. This will include equality and diversity training. We looked at the records that were used to recruit the last three staff members. One of the staff was the manager; this recruitment process was very poor and it raised several concerns. We have recorded the detail in the management section of this report. The recruitment process for one staff member was satisfactory and all the relevant information was available. For the third member of staff, two references and a satisfactory CRB had been obtained but there were no dates for employment. If dates of employment are not provided it is not possible to track employment history which is an important part of a safe recruitment process. We identified at the last key inspection that the home’s recruitment procedures were not thorough and therefore people who live at the home were not protected. People who live at the home have been involved in recent recruitment interviews. The manager said people had written and asked questions. They said it was a successful process and they are going to continue involving people who live at the home in future recruitment. In the AQAA the manager said they provide staff induction training that meets the National Minimum Standards. At the site visit we identified this was not the case. There were no records of staff inductions. The manager had written a checklist which she said would be used for future inductions but it did not contain any detail about what each area should cover. She agreed to develop the checklist to make sure new staff receive enough information when they start working at the home. We identified at the key inspection in August 2007 that staff do not receive a satisfactory induction when they start working at the home. We looked at staff training records and there were some gaps because staff had not received specific training or the recommended timescales for up dating training had lapsed. More information is recorded in the management and administration section of this report because the shortfalls relate to health and safety. The home should have a staff training plan to make sure staff receive enough training to equip them with the knowledge and skills to carry out their jobs properly. We identified at the last key inspection they must produce a training plan because staff had not completed enough training and this put people who live and work at the home at risk of harm. Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42 People who use the service experience adequate quality outcomes in this area. The home needs to be managed in a better way that ensures care is delivered using good and up to date practices. This would be helped if the manager developed her own knowledge and skills to manage the service more effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post since January 2008. She has started the NVQ level 4 award in Health and Social Care, which she hopes to finish in the next twelve months. The manager said she is waiting for her criminal record’s check to be returned and then she will submit her registered manager’s application. The manager said she has worked with people with learning disabilities for eighteen years and has over 2½ years experience of managing a care home. Staff said the manager and the registered provider are approachable and are always available. Staff also said they spend time with the people who live at the home and they make sure they receive a good service. One staff said, “the new manager has made a big difference, it is better, more relaxed.” The registered provider said she thought that since the last inspection, they had a more confident management team. Before we visited the home, we received some information that told us there were concerns about how the manager was recruited because proper references had not been obtained. At the visit we looked at the manager’s recruitment records and this confirmed that the recruitment process was not done properly. The manager’s application form did not contain enough information and was not dated or signed. It did not have details of any posts the manager had held during any previous employment so it was not possible to establish what jobs she had previously done. The form did not have dates of employment and there were no reference details. We looked at three references. Two of the references were character references and provided positive information about the manager. One reference, which was supposedly from a previous employer, did not have any name on it, and was not signed or dated. Again it contained positive comments but the authenticity of the reference is dubious. The registered provider had asked for a (CRB) criminal records check to be carried out on the manager but it was dated for the beginning of August 2007 and was for the position of care assistant. The registered provider said this was because the manager had applied for a position as a care assistant in August 2007 but had not been employed and then applied for the manager’s post in January 2008. At the inspection we told the manager and the registered provider that we had serious concerns about the poor standard of the application and the recruitment process. They both accepted the recruitment was not satisfactory. In the AQAA the manager told us they listen to people who live at the home and their relatives. They said the home “provides questionnaires on living in the home.” They also told us they “hold a residents meeting every month, the service users do the agenda, chair the meeting and type the minutes.” The registered provider and manager were not aware that we use Key Lines of Regulatory Assessment (KLORA) to assess our evidence and make our judgements. This is an essential tool that assists everyone to understand what a service should be providing. The management team must update their knowledge to make sure they are familiar with current practices. We identified at the key inspection in August 2007 that the home had breached a number of regulations. We identified that there were the some of the same breaches at this inspection. A good management team would have made sure these shortfalls were addressed. We looked at the records that tell us what people who live in the home have been doing. Staff complete a daily summary at the end of each plan of care. People have a number of plans of care so staff have to make several entries for each person. It was difficult and time consuming to get an overall picture of what the person has been doing. Staff have attended a number of training courses that help make sure people who live and work at the home are safe. Staff have recently attended safeguarding, infection control, medication and basic first aid, although some training was not up to date. Basic food hygiene certificates were out of date, and some staff had not completed fire training. This poses a risk because staff do not have up to date health and safety knowledge. The manager said fire training was booked for two weeks after the site visit and all staff would be attending. No concerns around safe working practices were seen on the day of the inspection. In the AQAA the manager told us equipment has been serviced or tested as recommended by the manufacturer or regulatory body. SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 1 X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 1 X 3 X 2 1 X Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 12 (1) 15 (1) Requirement People who live at the home must have an individual plan that identifies how their needs are met. This should include any specialist needs and daily living skills. This will make sure people’s health and welfare needs are identified properly and met. Timescale of 30/09/07 not met People who live at the home must be involved in developing their individual plan. This will make sure the care is person centred. Potential risks to people who live at the home must be assessed and risk management strategies agreed. This will make sure the risk of harm is minimised. Timescale of 30/09/07 not met Medicines must be stored appropriately and this must include proper shelving. This will make sure medication is safe and does not get damaged. Timescale of 30/09/07 not met Timescale for action 30/09/08 2. YA6 15 (1) 30/09/08 3. YA9 13 (4) (c) 30/09/08 4. YA20 13(2) 31/08/08 5. YA20 13(2) 6. YA20 13(2) 7. YA23 12 13 37 (1) (e) 18 (1) (a) 18 (1) (c) 8. YA32 9. YA34 19 (1) (b) 10. YA35 18 (1) (a) 18 (1) (c) 11. YA37 9 Records of medicines entering the home are up to date and accurate. This will assist to ensure that the risk of errors is reduced. Timescale of 30/09/07 not met People who live at the home must have the opportunity to control their own medicines. A risk assessment and care plan must identify where this is or is not appropriate. This will make sure choice and independence is promoted and medication is administered safely. Important information must be passed on to relevant agencies. This will make sure people are safe and events in the home can be properly monitored. Staff must receive training that equips them with the skills and knowledge to meet the specialised needs of the people living at the home. This will make sure individual needs are met. The registered person carry out a through recruitment process before they employ any person to work at the home. This will help make sure the correct people are employed so people who live at the home are protected. Timescale of 30/09/07 not met People who work at the home must receive a satisfactory induction that gives them the knowledge to meet the needs of the people who live at the home. Timescale of 30/10/07 not met The home must have a registered manager that has the skills, qualifications and 31/08/08 31/08/08 31/08/08 30/09/08 31/08/08 30/09/08 30/09/08 12. YA37 13. YA42 knowledge to manage the home. This will make sure people’s needs are met. CSA The manager must make Section 11 application to be registered. This will make sure the manager who is responsible for the day to day running of the home is accountable to the Commission. 13 (4) (c) Staff must receive appropriate 18(1)(c)(i) health and safety training, 23 (4) (d) including refresher training, to make sure they have the right skills and knowledge to protect people who live and work at the home. 30/09/08 30/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA11 YA32 YA35 Good Practice Recommendations People who live at the home should have more opportunities and be encouraged to develop independence and daily living skills. The registered person should ensure that 50 of the staff team are qualified to National Vocational Qualification (NVQ) level 2 or equivalent in care. The registered person should have a staff training and development plan. This will make sure staff receive the right training to meet the needs of the people living at the home. Daily records should be in good order so the health and welfare of people living at the home can be properly monitored. 4. YA41 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!