Inspection on 27/08/09 for Bryher

This inspection was carried out on 27th August 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bryher 12/12/07

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Bryher 36 Post Hill Blundells Road Tiverton Devon EX16 4ND     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Vivien Stephens     Date: 2 7 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Bryher 36 Post Hill Blundells Road Tiverton Devon EX16 4ND 01884242457 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Bryhers@Guinness.org.uk Guinness Care and Support Ltd care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 6. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Bryher provides residential care for up to six people with learning and physical disabilities. The accommodation consists of a bungalow, with single room occupancy, shower room, bathroom, toilet facilities, laundry, kitchen, dining room and a sitting room. The home is accessible being on one level. The property stands in its own grounds, in a residential area on the outskirts of Tiverton. The inspection report is made available within the home; a copy is kept in the office for anyone to see. 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: A key inspection of Bryher took place in December 2008 but due to technical problems the report was not produced by the Commission. Therefore we decided to carry out another visit to the home. Towards the end of 2008 we asked the home to complete an Annual Quality Assurance Assessment, and we have used this document to inform this inspection instead of asking them to complete another assessment. We did not request any further surveys again as we obtained surveys before our visit in December 2008. Two inspectors visited Bryher. We looked at some of the records the home must keep. We also looked around the bungalow. We talked to the manager and staff and either talked to the people living there, or observed the way they interacted with staff. Care Homes for Adults (18-65 years) Page 5 of 27 What the care home does well: What has improved since the last inspection? What they could do better: While many aspects of the home are now good, there are still some important things that must be addressed. The care plans only gave basic information about the support each person needs. The staff team were stable and understood each persons needs well and therefore they did not need to read the care plans every day. However, the care plans should be developed to give a better explanation of each task people need support or assistance from the staff. This will ensure there is good information available for any new staff who may be employed in the future, or any agency staff the home may use. Care Homes for Adults (18-65 years) Page 6 of 27 The care planning process should also be used to review peoples social, educational and leisure needs to make sure people lead fulfilling and interesting lives, and have plenty of opportunities to do things they enjoy. Each person should have a copy of their care plan in a format they can understand wherever possible. The plans should explain any strategies for helping people cope with problems they may find difficult or distressing, and how to help people work towards greater independence. The manager has been in post for approximately 2 years but has not been registered with the Commission. This means we have not yet been able to check his fitness and suitability for the post. An application for registration should be submitted as soon as possible. The garden and the outside of the bungalow would benefit from more thorough and more frequent maintenance, especially to gutterings and paintwork. More could be done to make the garden a safe and attractive place to enjoy during warmer weather. Inside the bungalow the grouting around the shower needs some attention, and better storage facilities are needed for continence products. The staff told us they would like to receive training on topics that are relevant to the needs of the people living at Bryher. We heard that some training is planned in the next few weeks, but the home should look at the future training needs of each member of staff and a plan of how those needs will be met should be drawn up. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 27 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 8 of 27 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. Any person who may be thinking about moving into the home in the future can be confident that the home will follow careful assessment and admission procedures before any decision to move in permanently is made. Evidence: Since the last inspection no new people have moved into the home. Therefore we were unable to check their admission procedures. The home has a Statement of Purpose and Service user guide that gives people information about the home and the services they offer. The home also has an easy to read version of these documents that uses symbols that has been specifically drawn up for people who have difficulty reading text. At our last inspection we were given information about the homes admission and assessment procedure that showed that, if a vacancy occurs in the future, they would follow careful admission procedures gathering good information about the person before any decision to move in permanently is made. Care Homes for Adults (18-65 years) Page 9 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff know and understand each persons needs and wishes well, and people are consulted and offered choices in all aspects of their daily lives. Care plans do not provide sufficient information for care staff about how each person should be supported. Evidence: We looked at two care plans to see how the care was planned and delivered. We also talked to those people living in the home who were able to communicate verbally, and observed the way the staff interacted with others. We also talked to the staff on duty to find out if the information in the care plans was accurate and being followed by the care staff. One care plan file contained a brief but useful overview of the persons usual daily routine. There was also a care plan that had been drawn up using a template with headings covering a wide range of needs. Each section had been completed to give a brief but clear description of the persons needs. Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: The second care plan file we looked at only included a brief overview of the persons daily routine, but did not contain a detailed care plan document. We talked to the manager about the reason for this. He told us he planned to complete a care plan for each person in the next 2 or 3 months. The staff we talked to were able to give a very good explanation of peoples care needs and we were satisfied they were able to communicate well with people and understood how each person wanted to be supported. We also heard many examples of how people had been offered choices in all aspects of their daily lives. We looked at the daily records, monthly overviews and other records to find out what daily life was like for the two people whose care plan we looked at. While the records were generally good, we saw a few statements that were either negative or judgemental. These included a few negative comments about people such as mood swings or X was grabby. There was no information in the care plan file to help the staff understand how the person might have been feeling at that time, or any suggestions about how the staff could support the person at these times to turn the negative response from other people into positives. We suggested the home seeks professional advice to help them provide guidance on specific areas of peoples support needs. We saw some information that had been covered in different parts of the care plan files that was inconsistent. For example, leisure interests were covered in three places and each section give slightly different information. We heard that Guinness Trust were about to introduce new care plans that will be drawn up by each person (with support from care staff where necessary) in a format they can understand, for example, using symbols and photographs as well as text. Care Homes for Adults (18-65 years) Page 11 of 27 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. While the level of opportunity for people to participate in stimulating or interesting things to do has increased, there is still room for improvement. People receive a varied range of foods to suits their preferences and dietary needs. Evidence: We looked at the things people liked to do every day, and the places they liked to go. None of the people living at Bryher were able to hold paid employment, and none attended any colleges or educational courses. At our last inspection we told the home they must make sure that people living in the home are supported to make decisions and given choices in all aspects of their daily lives. We also told them they must support people to fulfill their social interests and engage in local and social activities. During this inspection we found people had been Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: offered more opportunities, but there was still much room for improvement. The home did not have individual plans or timetable of the things each person wanted to do every day. The manager told us about some of the things people enjoy doing on a regular basis including horse riding, visits to the sensory room at Alexandra Lodge, farm activities and regular activity sessions at a place called Grannys Meadows. He told us the overall level of activities has improved over the last year. The staff also offer various suggestions for things to do on an unplanned ad hoc basis. However, in our observations we found that there were still long periods when people were not engaged in meaningful or stimulating activities. The manager explained that they were limited by staffing levels most days. If one member of staff took one or two people out, this often left only one member of staff to care for the remaining three people in the home. On the day of our visit all six people were at home in the morning, and two people went out in the afternoon to a regular organised activity at a farm. The home has a minibus that is used to take people out. However, there are only three members of staff who can drive it, and this limits the amount of activities people can be offered outside of the home. We heard evidence of how people have kept in contact with families and friends. The home has encouraged families to visit and keep involved. We saw good evidence of how people have been consulted in all aspects of the daily foods they are offered. There was evidence in the care plans to show that staff offer people good choices for every meal. People have been able to choose the menus, and have been involved in all aspects of meal preparation as far as possible. Care Homes for Adults (18-65 years) Page 13 of 27 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 receive the support they need with health and personal care tasks, although the care plans should be improved to give better information to care staff about specific tasks. Medicines are generally stored and administered safely, although some further action should be taken to make systems even safer. Evidence: The care plans we looked at gave some information about the support each person needed with personal care tasks. The information in some plans was brief and did not give sufficient detail to explain exactly how the person preferred to be supported. However, there is a stable staff team at Bryher and the staff we talked to demonstrated a very good understanding of each person and the support they needed. We saw staff talking to the people who live in the home and people were relaxed and cheerful with the staff team. The staff were able to demonstrate good communication and understanding, even for those people with limited communication skills. We could see from the care plans, and from talking to care staff, that the home Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: referred people to health and social care professionals and people received treatment and regular check ups. We looked at the way medicines were administered. Only three people regularly took prescribed medication. Tablets were supplied by the pharmacy in monthly blister packs. They were locked in a secure cabinet. Medicines received into the home each month have been checked to make sure they were correct and any stocks carried forward had been counted and recorded to provide a good accounting system. The records of medicines administered were satisfactory and there were no unexplained gaps. There was no explanation either in the medicine administration records or in the care plans of the medicines each person regularly took, and any special instructions. For example, where medicines had been prescribed on an as required basis, there was no explanation about when they should be administered. The care plans did not explain how, where and when creams and lotions should be applied. We found some medicines, creams and lotions that had not been dated when opened and appeared to be out of date. We talked to the manager about checking the medication cupboard regularly and making sure they knew when medications and creams should be discarded or returned to the pharmacy. One medicine was listed by the pharmacy in the medicine administration record to be administered four times a day. The fourth time had been covered by correction fluid and the home had only administered three times a day. There was no evidence to show why the dosage had been changed, or who had ordered the change. The change had not been signed or witnessed. No controlled drugs, or medicines that needs to be kept cool, were held in the home at the time of our inspection. The storage facilities for these medicines may not meet current legal requirements. We advised the manager to check the storage facilities with the pharmacist, and to ensure that safe systems are in place if any such medicines are prescribed in the future. Care Homes for Adults (18-65 years) Page 15 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are safeguarded by good systems and well trained staff who know what to do if people are unhappy, or if they suspect a person may be at risk of harm or abuse. Peoples cash and valuables are looked after safely by the home. Evidence: No complaints or concerns have been received by the Commission since the last inspection. The home told us in the last annual quality assurance assessment about the way they ensure people are safe - We have the complaints procedure set out in the service users guide and statement of purpose, this is also in widget format. Any complaints would be acted upon immediately in accordance with General Social Care Council procedure. All staff receive safeguarding adults training as part of their mandatory training and the home has policies and procedures to ensure that all staff are aware of their responsibilities. Also General Social Care Council have their code of conduct to help prevent any abuse taking place. Many of the people living at Byher have poor communication skills and may not be able to tell staff if they are unhappy. We were satisfied through talking to staff and observing the way they supported people that they knew people well and may be able to tell if a person was unhappy or distressed. Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: We looked at the records of cash held by the home on behalf of two people living there. The records showed each transaction, balances held, and the items purchased. Receipts had been retained. Records were signed to show which member of staff had dealt with the transaction. Care Homes for Adults (18-65 years) Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. While the inside of the home has been attractively decorated and furnished and provides a comfortable place to live, greater attention is needed for routine maintenance, especially to the exterior of the bungalow. Evidence: Bryher is a detached bungalow situated in a semi rural area on the outskirts or Tiverton. There are good sized gardens surrounding the bungalow and plenty of car parking. We carried out a tour of the bungalow and found that the interior had been very well maintained. Each person had their own single bedroom that had been attractively decorated and furnished to reflect their personality and tastes. Where possible staff had helped people to choose the decoration and furnishings themselves and staff explained how people had also chosen the lighting, pictures and ornaments. Those people who could not make a positive choice we heard how staff took time and effort to choose colour schemes and furnishings that reflected the personality of the individual. Each room was clean, tidy and reflected the pride taken by the staff to make Bryher a comfortable and homely place to live. Each person had a lock on their bedroom door they could use if they wanted to. Each Care Homes for Adults (18-65 years) Page 18 of 27 Evidence: bedroom had a name plate or sign to show whose room it was. The lounge and dining rooms were comfortably furnished and attractively decorated and there was attractive and interesting artwork and pictures on the walls that were relevant to people in the home. All areas inside the home was generally well maintained with the exception of the grouting around the floor of the shower room. We also suggested that continence products should be stored discretely in the bathroom. The lawned areas of the garden have been mown by contractors. However, there were overgrown areas around the outside of the gardens and no flower beds or attractive areas to sit. The guttering was filled with leaves and twigs and staff told us the guttering and drains have not been cleared regularly to prevent flooding or water damage to the bungalow. Some of the exterior woodwork was showing signs of wear and we heard the exterior had not been pained for several years. All areas inside the home were clean and free from any odours. Care Homes for Adults (18-65 years) Page 19 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a stable staff group. The number of staff employed usually meets the needs of people living there, although increased staffing levels may enable people to do more interesting and meaningful activities. The level of specialist training and staff supervision has been poor, although there are plans to address this. Evidence: No new staff have been recruited since the last inspection and therefore we did not look at any staff recruitment records during this visit. The last Annual Quality Assurance Assessment completed by the home explains their recruitment procedure Our recruitment process is thorough and in accordance with the national minimum standards, all staff are POVA and CRB checked and references (two) are taken up before a position of employment is offered to the person. Our induction meets present standards and mandatory training and any other training is supplied to individuals that is applicable to the home and will help them in meeting the needs of service users. NVQs are supplied to staff (NVQ 2 for care staff & NVQ 3 to senior support staff). At the time of our visit the home did not have internet computer access and they were unable to provide us with information about the training each member of staff had received (these records are held at Guinnesss office in Exeter). We were told that staff have received regular training on health and safety related topics. The staff we Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: talked to said they had not received any training relevant to the health and personal care needs of the people living at Bryher although we heard that training has been booked for the very near future on equality and diversity, professional boundaries and autism. At the time of this inspection there were 6 full time and 3 part time staff employed on a permanent basis, plus a part time manager. 4 staff held a nationally recognised qualification known as NVQ and 2 more staff had just started this training. The staffing levels have been improved since the last inspection and we heard that staffing levels were generally sufficient to meet the needs of the people living at the home although it was unclear if the homes fire risk assessment had looked at night staffing levels (see Conduct and management of the Home). We also heard that, at times, an additional member of staff would enable people to be engaged in more interesting and meaningful activities. Care Homes for Adults (18-65 years) Page 21 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. While the management of the home is generally satisfactory the failure to register a manager is a matter of concern to the Commission. There are some systems in place to check the quality of the service but these could be developed to provide better evidence to show the home is acting in peoples best interests at all times. Evidence: A manager has been employed at Bryher for just under two years. However, no application to register him has been processed by the commission. We talked to the providers about the reasons for the delay and we were told that an application for registration is expected to be made in the near future. The manager works at Bryher approximately 20 hours per week and also manages another home in Exeter for 20 hours per week. There is a deputy manager at the home who works full time. While the overall level of management cover was satisfactory, there were some management tasks such as staff supervision and care planning that had not been completed as regularly or as fully as recommended, and might indicate that management cover was low. Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: The home told us in their last Annual Quality Assurance Assessment about the way they assessed the quality of the service they provide - Due to the severity of communication, we use occupational therapists and care managers to ensure that the views of individuals are acted on and wishes met. Individuals who use our service cannot communicate their views,, so we have used professionals with good knowledge of the service users to help ascertain their views and to act on them accordingly. We also heard that the providers have recently employed a specialist company to carry out a quality audit of the home but the results had not been made available at the time of this inspection. At the last inspection we found that most radiators had been covered but the tops were not, and this may present a risk of scalding. During our visit we found that one radiator was on despite the warm weather, and the surface temperature was hot. We we asked the manager and staff to look at the possible risk of scalding and burns for all radiators and take action where necessary. We talked to the manager about the homes fire risk assessment. We heard that no risk assessment was in place, although one was in the process of being drawn up. Therefore we could not see evidence to show the home had considered the evacuation in case of a fire, particularly at tonight. One waking night staff is employed overnight and the staff we talked to were unsure if one person would be able to evacuate the home if a fire occurred at night. We asked them to consider this as part of the fire risk assessment. Care Homes for Adults (18-65 years) Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 20 13 (2) You must make suitable 12/03/2008 arrangements for recording, handling, safe administration and safekeeping of medicines, including: Medicines must be stored securely and at the correct temperature to ensure they work effectively, and regular fridge temperatures must be recorded. Two staff must sign and date handwritten entries on medication records to verify the accuracy of such entries. The home must have written protocols for the use of when needed medicines, and staff must receive training in the safe administration of such medicines, particularly in relation to seizures. The home must ensure that medication stocks are managed appropriately and that large quantities of unprescribed medicines do not accumulate. (Previous timescale 31/01/06 & 31/01/07 not met) Care Homes for Adults (18-65 years) Page 24 of 27 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 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 6 Each person should have a care plan that gives sufficient detailed information to care staff about how the person wants to be supported. The plan should be drawn up with the person, and they should have a copy of the plan in a format they can understand. The home must consult with people about the things they would like to do and offer a wider range of interesting things to do and opportunities to learn new skills and participate in meaningful activities. People should be offered choices and supported to make decisions about the things they want to do. You should consider ways of increasing the level of access to the local community by helping them to use local facilities such as clubs, swimming pools, cinemas etc. The level of detail in the care plans should be improved to give better instructions to care staff about how each person wants to be supported with personal and health care tasks. The home should seek advice from health or social care professionals on strategies they could follow when supporting people who may display behaviour that might upset or worry other people. Page 25 of 27 2 12 3 13 4 18 Care Homes for Adults (18-65 years) 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 5 20 There should be information about each medicine administered by the home including any special information the care staff may need to know about the way the medicines should be administered, the time of administration, possible side effects, and when as required medicines should be administered. Creams and lotions should be dated when opened and discarded promptly when out of date. If controlled drugs or medicines that must be kept cool are prescribed to people in the future the home should seek advice on safe storage to ensure they comply with current legislation. Any changes to the administration instructions should be crossed out, signed, and double signed by a witness to confirm it is correct. There should be good evidence to show which health professional authorised the change, and when. Attention should be paid to regular maintenance tasks such as clearing gutterings and drains, exterior paintwork, and gardening. Continence products should be stored discretely to protect peoples dignity. The grouting around the base of the shower should be replaced or made good. Staff should receive regular training relevant to the care needs of the people living at Bryher. In order to ensure that people are cared for by an appropriately trained staff team, staff training and development should be linked to the homes goals and and peoples individual needs and plans of care. A manager meeting the criteria for registration should be registered with the Commission. Risk assessments should be carried out on all radiators to give evidence that the home has taken all possible measures to reduce the risk of accidental burns or scalds. 6 24 7 8 9 10 27 27 32 35 11 12 37 42 Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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