Inspection on 27/04/09 for Blenheim Care Centre

This inspection was carried out on 27th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Blenheim Care Centre 18/04/07

Blenheim Care Centre 20/04/06

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Blenheim Care Centre Hemswell Cliff Gainsborough Lincs DN21 5TJ     The quality rating for this care home is:   zero star poor 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: Dawn Podmore     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: Blenheim Care Centre Hemswell Cliff Gainsborough Lincs DN21 5TJ 01427668175 01427668179 blenheimcentre@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southwark Park Nursing Home Limited care home 80 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Blenheim Care Centre comprises of three units: Blenheim House, Blenheim Lodge and semi independent flats within Blenheim House. Blenheim House and Blenheim Lodge are detached properties situated in a rural trading/industrial setting in the village of Hemswell Cliff, which offers a range of amenities, such as an Antiques Centre and business services. The village also has a post office and shop. The home provides personal, respite and nursing care for up to eighty people of both sexes whose ages range from 18 years upwards, some with physical disabilities or acquired brain injury. Residents aged over 65 years are mostly accommodated in The Lodge. The home provides transport to enable residents to take part in activities in the community and Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 80 80 0 80 Brief description of the care home for residents to visit the nearby town of Gainsborough or City of Lincoln. The units have large communal areas comprising lounge/dining-rooms and quiet areas on the ground floor. Bedrooms are located on ground and first floors. There are passenger lifts to first and second floors in both units. The gardens are separated by fencing from the surrounding buildings, having grassed and paved areas for the use of the residents. A car park is situated at the front of the main building. At the time of the inspection the home confirmed that the weekly fees ranged from three hundred and fifty one pounds to eight hundred and forty six pounds, depending on the residents assessed needs. Additional charges are made for things like toileteries, newspapers, chiropody and hairdressing. Information about these costs as well as the day-to-day operation of the home, including a copy of the last inspection report is available in the reception area. 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: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was unannounced and took any previous information held by us about the home into account. Throughout this report the terms we and us refers to the Care Quality Commission (CQC). Before the the visit the provider had returned an Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans for improvement over the next twelve months. We also sent out surveys to residents and staff, some of which were returned in time to be included in this report. The main method of inspection used was called case tracking. This involved selecting 6 residents and tracking the care they received through the checking of records, discussions with them and the staff who care for them, and observation of care Care Homes for Adults (18-65 years) Page 6 of 32 practises. A partial tour of the home was also conducted, which included looking at some bedrooms, communal areas and bathing and toilet facilities. We spoke with 8 residents, relatives, 6 members of staff and 3 visiting professionals. They shared their views about how the home operated on a day to day basis and the support and facilities provided. The manager was available throughout the day and the general outcome of the visit was discussed with her. On the day of the visit 62 people were living at the home. What the care home does well: What has improved since the last inspection? What they could do better: Care plans must outline peoples medical and personal care needs in detail and provide staff with comprehensive guidance about how to meet these needs. They should be more person centred so that they tell staff about peoples preferences, their involvement in decision making and their aspirations for the future. Once formulated the plans need to be regularly reviewed and updated so that they fully reflect each persons changing needs. Risk assessments must be completed more robustly, so that any potential risks are identified and management strategies documented. This will help to ensure that staff know what actions they need to take to minimise identified risks. Once formulated they must be regularly reviewed and amended to reflect changes in peoples conditions. Each resident must be consulted about his or her social interests, this information can then be used in the care planning process so that staff know how to support them to have the lifestyle they wish. A programme of activities that meets these needs must then be formulated so that residents know what stimulation is available. Complaints and concerns need to be robustly recorded so that there is a record of each issue raised and the outcome. The company need to formally assess the environment of the home so that they can develop a redecoration and refurbishment plan to address any areas needing attention. Peoples dependency levels and the layout of the home must be used to assess if there are sufficient staff are on duty on each shift to meet the needs of the people who live at the home. Staff must be provided with specialist training to meet the needs of the people currently living at the home. They must also be provided with regular supervision sessions so that they are adequately supported to do their job. Although the home has a quality assurance system to gain peoples views this needs to Care Homes for Adults (18-65 years) Page 8 of 32 be implemented in a consistent manner. There also needs to be a robust system to audit the quality of the service being provided. This includes evaluating the homes environment and the implementation of the policies and procedures, such as care planning. This will enable the management team to make sure that the home is being satisfactorily maintained and policies and procedures are being followed robustly. The provider needs to visit the home at least once a month and produce a report of their findings. This will enable them to assess if the home is operating in a satisfactory way. Three other areas would benefit from some attention. Documents telling people about how the home operates should be regularly reviewed and updated to make sure that the information they receive is current. Care plans need to contain information about recent legislation that is designed to protect peoples rights and choices. This is so that the home can show that they have looked at the effects the legislation has on the residents lives and planned their care accordingly. To make sure that staff understand their role in this process they need to receive appropriate training in this subject. The induction programme for new staff should be recorded consistently so that there is a good record of what it included. 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 9 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 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to information about how the home intends to operate, but some of the content is out of date. A satisfactory assessment process helps to make sure that the home can meet the needs of the people who decide to live there. Evidence: People have access to information about the home and how it intends to operate. However the Service Users Guide and Statement of Purpose had not been reviewed and updated since 2007. Therefore information about how to contact us was out of date. A review of all information available prior to this visit, and the content of people care records, showed that the home does not admit people without an assessment of their needs being completed. The assessment record of a new resident showed that information had been collected about their needs and potential areas of risk. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in care planning and risk assessment documentation puts residents at risk and could lead to residents care needs not being met, however at the present time health needs are being satisfactorily met. Evidence: We looked at six care plans for people with differing needs, two in the Lodge and four in the main building. The content of the plans did not identify all care needs and did not provide sufficient information to enable staff to provide comprehensive care. For example, one resident exhibited challenging behaviour, but there was no care plan to address this. Another person had communication difficulties, but the care plan did not tell staff how to manage this issue. Staff had arranged for a specialist nurse to visit one resident on the day of our visit to assess her wound care, however records pertaining to this were inadequate. In general plans were very brief with minimal space allowed to record the support required in any detail. They did not tell staff about how people wanted their support delivering, their abilities, or their likes and dislikes. Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: There was no evidence that residents or their representatives had been involved in the care planning process. There was a record of a monthly evaluation of the planned care taking place but these often contained entries such as no change. Therefore they did not evaluate the effectiveness of the planned care or state whether there was any progress or deterioration in the residents condition. Some files had additional records which are used to record changes in the care plan, however this information was not always incorporated into the plans. This meant that plans contained out of date information. Risk assessments had been completed to identify some potential risks to residents and staff, but not all risks identified in assessments were included. Details were minimal and did not always outline management strategies to instruct staff on what action they need to take to minimise potential risks. The risk assessments for subjects such as pressure damage, nutritional needs and manual handling had not been reviewed and updated regularly. Therefore changes had not been highlighted. For example the manual handling assessment for one person said that she was able to walk with a frame and one carer, but current information indicated that she remained in bed and was unable to walk. The home has not yet included the content of the Mental Capacity Act into the care planning process. This is new legislation that is aimed at protecting peoples rights and choices. In the main residents told us that they were happy at the home and that staff were meeting their needs. Some said that they were able to make decisions and choices about their daily lives. Staff were knowledgeable about the people they supported and interacted positively with them. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples preferred social and leisure requirements have not been used to formulate a formal programme of activities and stimulation to meet their individual needs. Some residents are able to go into the community if they choose to. Meals provided are nutritious and offer choice. Evidence: The home has someone who is employed to provide activities between the 2 buildings for 35 hours a week. However on the day of the visit no organised activities were evident and no programme of stimulation was available. The manager said that this was because people did not attend the sessions so it was stopped. Some people said that the activities coordinator sometimes had to work care shifts and they felt that this minimised the time devoted to activities. People told us, I asked to go to the cinema but she never arranged it, we went along Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: for a sing a long at the village hall, that was good, and not really much to do we watch TV and play games. Although peoples files contained some information about what they liked to do this was minimal and had not been used to provide a plan of how the home intended to meet each persons individual social needs. One resident said that they went out shopping and some staff told us that about 6 people had recently taken a trip to Cleethorpes. However staff working at The Lodge said that they did not know about the trip. We saw 2 residents playing games on the television and others were watching television in another part of the lounge. People living and working at The Lodge said that they rarely saw the activities person, but people could go over to the main building if the wanted to attend occasional entertainment. The manager said that two people attended Pelican, which is an organisation that helps to train people for jobs in the community and then assists them to find a suitable job. Another person attends a day centre. A visitor told us that they visited when they wanted and were made welcome. When we asked if activities were available she said that they happened occasionally. We observed lunch being served at The Lodge. Meals were delivered in a heated trolley and serviced by a member of the kitchen staff. We spoke to people in both buildings about their satisfaction with the meals available. They told us that two options were offered at lunchtime and on the whole they enjoyed the meals available. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to health care support, but inadequate assessment and monitoring records means that people are at risk of their needs not being met. People are able to manage their medications themselves if they can, but if they need help staff are trained to support them with it in a safe way. Evidence: People told us that they were happy with the way staff supported them regarding their health needs. Residents have access to outside agencies such as doctors, chiropodists and the tissue viability nurse and we saw specialist equipment such as pressure relieving mattresses being used. However records pertaining to health care did not reflect the care being delivered or monitor any progress or deterioration. For example staff comments and daily records showed that one person had pressure damage, however there was no specific care plan outlining how this was being treated. Wound mapping records had not been maintained, this means that the size, treatment and progress of the wound was not being assessed or monitored. There were no health action plans on peoples files, these are used to record peoples medical history and plan for future health involvement such as well women/men Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: checks. We spoke to 3 health professionals visiting the home. They said that they were happy with the support provided to the people they visited, but one commented about care plans not always being updated. They told us that staff communicated well and always consulted them if they had any concerns. Residents said that a physiotherapist was available at the home to provide one to one support. One person confirmed that he had sessions twice a week, which met his needs. Records and discussion demonstrated that the home has satisfactory policies and procedures concerning the receipt, storage, administration and disposal of medications. Medications are supplied by the GP practise so no periodic pharmacy visits are made to ensure that systems are robust and procedures are followed. The manager said that she was introducing an internal audit to assess these areas. Care Homes for Adults (18-65 years) Page 17 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected by the home policies and procedures, but complaints records have not been adequately maintained. Evidence: The home has a complaints procedure, which tells residents and relatives how to make a complaint and how it will be handled. A copy is given to all new residents as part of the Service User Guide and displayed in the home. However the information in these documents needs to be updated regarding our new contact details. Information provided by the manager stated that the home had received no complaints since the last inspection, but some areas of concern highlighted to the owner, manager and us had not been recorded as complaints. The manager said that the system was currently being changed but in the meantime a record of all concerns would be maintained. Most people we spoke with said that that they were happy at the home and had no complaints. However one person highlighted concerns about the number of staff on duty and another about the time that people went to bed and got up. We discussed these issues with the manager. The home has a policy and procedure about safeguarding people from abuse so that staff know what they should do if they have any concerns in this area. Training Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: records, as well as staff comments, demonstrated that some staff had received training in this subject and others were booked on a course over the next 2 months. Care Homes for Adults (18-65 years) Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a spacious and comfortable home, but some areas are not adequately maintained and decorated. Evidence: We took a partial tour of the home which included looking at communal areas and some of the bedrooms and bathrooms. Parts of the home looked tired and shabby with some bedrooms, bathrooms and corridors in need of redecoration. Some bedrooms were personalised, but others were not. Carpets were generally stained in both buildings and the corridor carpets on the upstairs main building were ill fitting. It was noted that a radiator was missing in one of the bathrooms, we were told that this had been taken off over a year ago and had not been replaced. Bathrooms and toilets in general were clinical in appearance some with equipment stored in them. Communal areas were on the whole satisfactory, but some did not feel as homely as others. The management team have not undertaken an environmental audit to assess which areas need to be addressed urgently and plan for future improvements. The manager said that she intended to complete one shortly. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: Staff told us that the home employs outside contractors to provide its domestic services. One person said that they thought cleanliness had deteriorated since this had been started, even though some of the staff remained the same. We found that although carpets were stained there were no unpleasant odours detected on the day of the visit. Care Homes for Adults (18-65 years) Page 21 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. Residents dependency levels and the layout of the home are not taken into consideration when deciding the number of staff that should be on duty throughout the day and night. The system for the recruitment of staff is robust therefore offers protection for people living at the home. Staff have access to basic training to help them meet the needs of the people they care, but specialist training and regular support sessions are not taking place. Evidence: We asked people their opinion about the staffing levels as some people had highlighted this as a concern. Some people told us that the number of staff on duty was not always adequate to meet the needs of the people living at the home. One person said that they felt that this had affected the standard of care they could provide. We checked the staff rota which showed that there were occasions in the past where the number of staff assessed by the manager as being necessary to meet peoples needs were not met. It also showed that planned long term sickness had not been taken into account for the current week leaving shortages that had not been covered. The home has a recruitment process that includes completing an application form, obtaining written references and a C.R.B. (Criminal Records Bureau) check. We looked Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: at the recruitment records for 2 new staff, both files contained application forms, written references and evidence that a C.R.B. (Criminal Records Bureau) check had been completed before they had started to work at the home. These help to make sure that prospective staff are suitable to work with vulnerable people. The AQQA says that new staff receive an induction to the home. Although one person told us that she had received a good induction, including supernumerary time and essential training, her induction record had not been fully completed, even though she had worked at the home for a year. Some staff said that they felt that the training provided was good and others said that not much specialist training had been provided recently. The home has recently developed a training programme to ensure staff received mandatory training. This included, manual handling, fire awareness, protecting people from abuse and food hygiene. However there was little evidence of any specialist training being provided recently in subjects such as physical disabilities and conditions affecting older people. Training has not yet been provided concerning new legislation such as the Mental Capacity Act and Deprivation of Liberties, which are aimed at protecting peoples rights and choices. However the former was included in the training plan for the next 3 months. The manager encourages staff to undertake an N.V.Q. (National Vocational Qualification) in care. Information provided in the AQAA said that of 34 care staff 24 have completed an NVQ and others are currently doing the award. This was confirmed by one of the staff we spoke with. Records and staff comments failed to demonstrate that all staff had received regular supervision sessions. Annual appraisals had taken place and the manager said that a new system for regular supervision sessions was to be introduced shortly. Observation of care practises at the home demonstrated that staff were supporting people in an appropriate manner. They were seen to interact with residents positively and encouraging independence. People told us that they were overall happy with the level of support they received and the way staff delivered care. One person said, they look after me very well, but they are ground down into the floor as they are overworked and expected to pick up shifts. Another residents told us, the staff are good. Care Homes for Adults (18-65 years) Page 23 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Leadership, guidance and direction are provided to staff on a day to day basis, however some of the systems in place are not robust enough to ensure full protection to residents. Evidence: The homes manager is a qualified nurse who has experience in the care industry. Although residents were in the main happy with the service they were receiving, some people highlighted that there were staff shortages at times. Some things that needed addressing or maintaining from a management point of view, such as staff supervision, an audit of the homes environment and gaining peoples views had not taken place. Monitoring to make sure that staff were following the homes policies had not taken place. Therefore shortfalls in areas such as care planning and risk assessment had not been detected and actioned by the management team. When asked their views about the home people commented, Sue the manager is lovely and things are okay. Staff said that they were happy working at the home. One said, we dont see much of the owners, but Im happy working here. Two other Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: staff who returned surveys said that they thought the home provided an excellent standard of care and one said, it has a friendly atmosphere. The home has a quality assurance system to gain the views of people who use the service, but this has not consistently been used. People said that they had not been recently asked if they were happy with the service they were receiving. Records and peoples comments showed that resident and staff meetings had taken place over the last year, but these were not on a regular basis. One person told us that residents meetings had not taken place this year. There is a system in place for residents monies to be held in safe keeping by the home. This includes keeping a running total of all transactions and obtaining receipts and two signatures. The home owner, or his representative, is required to visit the home monthly and complete a report detailing their findings at the home and how any concerns or issues are to be addressed. However no reports were available and peoples comments indicated that these visits were not taking place. The home has health and safety polices and procedures to guide and instruct staff. There is also a programme in place to service and maintain equipment in the home on a regular basis. Information provided in the AQAA and sampling on the day of the visit demonstrated that checks on equipment, such as fire equipment and hoists had taken place. However the annual check on the portable appliances in the home had not taken place even though this had been highlighted in Council report in July 2008 it was still in the process of being completed when we visited. The Environmental Health Officer awarded the kitchen a 5 star rating for the systems in place, this is the highest rating available. Care Homes for Adults (18-65 years) Page 25 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 26 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 6 15 Care plans must include all areas of need and be in sufficient detail to enable care staff to provide comprehensive care. Including peoples choices and preferences. They must also be be reviewed and updated regularly. This helps to make sure that staff have to access up to date information and can therefore meet peoples needs. 29/06/2009 2 9 13 Comprehensive risk 29/05/2009 assessments must be completed that identify all potential risks associated with peoples care. This must include management strategies to minimise identified risks. This will help to make sure that staff have a clear picture of their role in Care Homes for Adults (18-65 years) Page 27 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action managing and minimising any potential risks. 3 14 16 Care plans must demonstrate what peoples daily routines and recreational needs are and what level of support staff should provide to meet their wishes. This will help to make sure that staff know what people want to do and their role in supporting them. 4 19 17 Care plans must contain details of residents medical needs including wound care. This must include comprehensive descriptions of the wound and evaluate the progress and/or deterioration of the wound. This will help to make sure that staff have access to current information about how wounds are to be treated and monitored. 5 22 22 All complaints and concerns must be documented and a record maintained in the home. This will help to demonstrate how many complaints have been received and actions 18/05/2009 22/05/2009 06/07/2009 Care Homes for Adults (18-65 years) Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action taken to address peoples concerns. 6 24 23 All areas of the home must be decorated, furnished and maintained to a satisfactory standard. This will enable people to live in a suitable environment which is decorated and furnished to suit their needs There must be sufficient staff on duty to meet the assessed needs of the people living at the home. This must take into account peoples dependency levels and the layout of the home. This will help to make sure that there are enough staff available to meet peoples needs. 8 35 18 The training programme must include specialist subjects to meet the needs of peoples living at the home. This will help to make sure that staff have the knowledge and skills to meet the needs of the people living at the home 9 36 18 Staff must receive regular supervision. 08/06/2009 26/10/2009 05/10/2009 7 33 18 08/06/2009 Care Homes for Adults (18-65 years) Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will help to ensure that they are adequately supported in carrying out their job. 10 37 10 The care home must be 29/05/2009 managed with sufficient care, competence and skill, which must include thorough audits and checks of all aspects of the home. This will ensure that residents needs are being met and they live in a safe and well maintained environment. 11 39 24 There must be a an effective 15/06/2009 system in place to evaluate the quality of the service being provided. This will help to make sure that peoples views are taken into consideration and the homes policies and procedures are being followed. 12 41 26 Monthly visits to the home must be made by the proprietor and a report completed detailing their findings and any actions to be taken to address any issues found. These reports must be forwarded to CQC. 29/05/2009 Care Homes for Adults (18-65 years) Page 30 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will provide an ongoing evaluation of how the home is operating and any areas that need addressing 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 All information available to people about the running of the home should contain up to date information, this includes the content of the Statement of Purpose and Service Users Guide. Care plans include reference to the Mental Capacity Act, 2007 and the effects it has on residents lives. This is to help to make sure that their rights and choices are protected. The home should consider the use of health action plans. These will provide staff with information about each individual person and enable people to maintain ownership of their medical history. Records pertaining to the induction undertaken by staff should be fully recorded and signed to show that they have completed all topics outlined. Staff should have appropriate training about assessment and recording in relation to the Mental Capacity Act 2007. This will give them a better understanding of their role in supporting people appropriately. 2 6 3 19 4 35 5 35 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. Care Homes for Adults (18-65 years) Page 32 of 32 - 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!