Inspection on 12/10/09 for Buttercups & Railway Cottage

This inspection was carried out on 12th October 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Buttercups & Railway Cottage 29/04/09

Buttercups & Railway Cottage 24/11/08

Buttercups & Railway Cottage 13/11/07

Buttercups & Railway Cottage 02/11/06

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Buttercups & Railway Cottage 8 Ford Road Arundel West Sussex BN18 0BH     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: Annette Campbell-Currie     Date: 1 2 1 0 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 30 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 30 Information about the care home Name of care home: Address: Buttercups & Railway Cottage 8 Ford Road Arundel West Sussex BN18 0BH 01903889643 01903884105 buttercups@consensussupport.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Corich Community Care Ltd care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 12. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Buttercups and Railway Cottage is a care home, which is registered to provide personal care for up to twelve service users in the category learning disability (LD) who are between the ages of 18 to 65 years of age. The service has been set up to provide care and accommodation for younger adults with autistic spectrum disorders and challenging behaviours. It is a detached property, which has been extended and adapted for its current use, and is located in the village of Ford. Although it is under one registration it comprises of two adjacent premises - one for three people and the other for nine. The property provides private accommodation to residents in single bedrooms located on the ground and first floors. The bedrooms include ensuite WC and bath or shower facilities. Communal accommodation is made up of a lounge and a Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 12 3 0 0 4 2 0 0 9 Brief description of the care home dining room in each of the premises; they are located on the ground floor. The smaller house has its own private courtyard that people living there can use. An enclosed secure garden, which is available to all residents, is located to the rear of the premises. The responsible individual acting on behalf of the organisation is Mr Maarten Vegting who is responsible for supervising the management of the care home. The registered managers post is currently vacant. The current fees for the service are from £1370.55 to £2300 per week. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that people who use the service experience adequate quality outcomes. The previous key unannounced inspection was carried out on 30th April 2009 when the quality rating of the service was zero stars which meant that people using the service were experiencing poor outcomes. We (the Commission) requested an improvement plan following the inspection and the company provided one. In July 2009 West Sussex Adult Services department took the decision to move the six people they had placed at the home because of the concerns about the quality of the service they were receiving. We carried out the site visit for the key unannounced inspection over six and a half hours. The previous manager left the home in August and the deputy manager has Care Homes for Adults (18-65 years) Page 6 of 30 been running the home since then. Sue Hooper, the registered manager from another home in the company, has been providing support in the past two weeks. The deputy manager and Ms Hooper assisted with the inspection and provided information and documents that were needed to help us to make an assessment of the service. The deputy manager completed an annual quality assurance assessment (AQAA) which was available on the day. The AQAA did not contain very much information to show how the service is currently being managed, whether or not the requirements that were made at the previous inspection have been met or what improvements have been made since the previous inspection. At the time of the site visit there were four people living in the home and one person is due to move in the next few weeks. There are twenty-three staff employed to cover shifts in the home. During the site visit the four people living in the home were seen and four staff were spoken with including the member of staff responsible for cooking the lunch. We saw the following documents: the case records for three of the people living in the home, the recruitment records for two people who had been employed in the past six months, the complaints records, training records, quality audit records, questionnaires that staff had assisted people living in the home to complete, incident reports, samples of policy documents and medication records. We also looked at the way medication is stored. The outcomes for people living in the home have been assessed in relation to twentyfour of the forty-three National Minimum Standards for Care Homes for Younger People; including those considered to be key standards to ensure the health and welfare of people living in the home. Six of the eight requirements made following the previous inspection have been met. The requirement to ensure that requirements and recommendations made at safeguarding meetings are followed up and acted upon no longer applies as the people referred to have moved out. The manager who was required to submit an application for registration has now left. The home is in the process of recruiting a new manager. Four requirements have been made following this inspection. An improvement plan will be requested with regard to the requirements made following this inspection. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The home must display an up to date registration certificate. It is an offence under the Care Standards Act 2000 not to do so. We have been told since the site visit that the current certificate is now on display. The registered providers must ensure that when the number of people living in the home increases then the quality of the service provided continues to improve and is kept under review. Requirements have been made regarding the following matters: The registered provider must ensure that when a manager with the appropriate qualifications and experience is appointed, they submit an application for registration Care Homes for Adults (18-65 years) Page 8 of 30 with the Commission without delay. The health and wellbeing of people living in the home must be protected by a programme of cleaning and upgrading of areas of the home where necessary. A record must be kept of complaints that are made to show that action has been taken within the agreed timescales and that the outcomes are recorded. A requirement was made regarding this matter following the inspection that was carried out in November 2008 and was met at the previous inspection. The quality auditing systems that are in place must be kept under review to show what progress is being made in the improvement of the quality of the service. 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 9 of 30 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 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs and aspirations assessed before a decision is made about them moving to the home, however the home has not consistently been able to meet the assessed needs of people living there. Evidence: There is a policy and procedure regarding the assessment process to be carried out before a decision is made about someone moving to the home. Since the previous inspection West Sussex Adult Services department took the decision to move the six people they had placed at the home because of the level of concern following a number of safeguarding investigations that had been carried out over the past twelve months, although they acknowledged that the number of safeguarding referrals had dropped since April. While pre-admission assessments were carried out before people moved to the home it was felt that the home was not consistently meeting each persons needs, this indicates that the management and staff team were not being provided with the Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: necessary skills and knowledge to meet the assessed needs of all the people in the home. There will soon be three people in the home and their care needs have been reviewed by the local authorities involved in the placement. There are no plans for these three people to move. Care Homes for Adults (18-65 years) Page 12 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs and aspirations documented in a plan of care that is kept under review. People are assisted to make decisions about their lives and supported to take risks within a risk assessment framework. Evidence: A requirement was made following the previous inspection that care plans should be person centred and provide clear and detailed information about all aspects of each persons health, personal care, emotional and spiritual needs. Staff should be provided with guidance about how peoples care needs are to be met and that care plans must be kept under review and changes made when a change of need is identified. The registered providers said in the improvement plan that all the care and support plans would be reviewed with the local authorities involved. Ms Hooper said that all the case records have been reviewed and updated and that each person has been involved in compiling their support plans so that individuals are at the centre of their care planning. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: We looked at the case records for the three people who will continue to live at the home. The records for two people were looked at in depth. Each person had an updated support plan that included all aspects of their care needs. The personal plans included details of the persons likes and dislikes, things they enjoy doing and would like to be able to do in the future. Parents had provided detail about the persons background, interests and key events in their life. There was a collection of photographs on each file to show the activities that people have enjoyed. Cultural and spiritual needs and wishes were included in the information. Peoples preferred forms of communication were identified and guidance provided for staff. There was some detail about the things that could cause people to become agitated and what signs staff should look for. Guidance was provided to staff about ways to manage behaviours in certain circumstances. There were detailed behaviour support plans that provided guidance to staff, it was clear that these are kept under review. There were sheets on the case files for staff to sign to say that they have read the support plans and guidance; these had not been signed by staff. The people working in the home who were spoken with said that they understand the care needs of the people in the home and a newly appointed member of staff said that she had been given the information she needed to know about people, when she started work. There was a statement on each persons file about their level of capacity to make choices or give consent. There has been an improvement in the way that people are supported to make choices and decisions in their daily lives. There was a preference check list on each case file that was based on the individuals views about their care. The deputy manager said that key workers had helped people to go through this checklist. Risk assessments had been carried out into aspects of each persons life where a risk had been identified. The guidance to staff has improved to ensure that risks are kept to a minimum. Some risk assessments were due to be reviewed and Ms Hooper said that she would make sure that this is done as a matter of urgency. The staff rota identified the staff member due to provide one to one support where this is needed. While the persons interests and preferred activities were noted, it was not clearly identified how this time should be spent each day with a programme for developing the persons independence skills, Ms Hooper said that she would support Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: staff to establish a more detailed programme for each person so that staff would have a clearer structure to guide them. She also said that she would review the way that case records are written to ensure that adult language is used at all times. Care staff have attended training in recording and reporting so that communication records are clearer and key information is now being passed on. Care Homes for Adults (18-65 years) Page 15 of 30 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. People are provided with a programme of activities that is due to be further developed to help support them with their independence. People are supported to maintain contact with their families. A varied diet is provided, however peoples nutritional needs are not always monitored and reviewed. Evidence: The activity room has been cleared, heaters have been provided and new flooring fitted so that this room provides an additional space for people to use. The deputy manager said that there is a plan to provide some sensory materials and other activity items so that people have a better choice of ways to spend their time. There was information in the case records that we saw about the activities that people enjoy. The people currently living in the home have the opportunity to attend college courses. There was a detailed activity sheet on each case file and a list of the persons Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: preferred activities in their person centred plan. There were a number of outings on each persons programme during the week. It was not clear whether or not the outings and activities are changed each week with different opportunities being offered. During the day of the site visit three people were taken to a park for cycling in the morning and everyone went for a ride to Arundel Park in the afternoon. There was little guidance about structured activities in the home or ways to support people in developing their independence, such as involvement in food preparation or cooking. Activities provided in the evenings and weekends are limited at the moment. Ms Hooper said that she would follow this up with the staff team to make sure that activity planning meets the needs of people in the home. People have some opportunity to use local community facilities. People are supported to maintain contact with their families. Relatives have been encouraged to be more involved in the care of their family member and invited to attend case reviews and social activities. The home has a policy to provide guidance to staff about supporting people in their sexuality and relationships and individual needs would be noted in their support plans. The full time cook has recently left the home and care staff take it in turns to cook the meals. The member of staff who was cooking the lunch said that only one of the four people living in the home is involved in shopping for food. A hot meal is provided at lunch time and a snack in the evening. We were told that people going to college or out for the day or go out for lunch, the cost of the meal is paid for by the individual. A packed lunch is provided by the home, should that be the preferred option. It was not clear that a hot meal is provided when people return home if they choose to have a packed lunch at mid day. The menu for the week was seen and showed that a variety of meals is provided. Guidance about the special dietary needs of people in the home is kept in the kitchen. The case records showed that a concern has been raised that one person in the home was losing weight. It was not clear that weight checks have been carried out for anyone in the home in recent months and there was no note on this persons support plan to show that his weight loss may be of concern and how often his weight should be monitored or whether or not guidance from a dietician was requested. There was some evidence to show that there was some daily record of the persons food intake but there was no guidance for staff about how this should be recorded or what amount of detail is required. Where there is a concern about someones nutritional health, this should be documented and clear guidance provided to staff to show how this will be monitored and reviewed for the persons well being. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive their personal care in the way they need and prefer. Peoples healthcare needs are being re-assessed and documented. The medication policies and procedures protect people in the home. Evidence: The people living at Buttercups and Railway Cottage need help and support with their personal care. All rooms that are being used have en-suite shower and toilet facilities so that people have privacy with their personal care. There is also a bathroom for people who prefer to have a bath. Staff are provided with guidance about the way to provide personal care as part of their induction. The support plans that we read included details of the way that each person prefers their care to be provided. There are male and female staff so people would be able to choose whether to have a man or a woman to provide their care if this was an issue for them. Health action plans are being compiled so that the information about peoples health care needs is clearly documented. There was some updated information about health Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: care appointments that are due. Ms Hooper said that she would be reviewing all case records to make sure that people have up to date appointments to see the health care professionals as required and that these appointments are documented and the outcomes monitored. The grab sheets to be taken to hospital in an emergency have been completed and provide key information about peoples allergies, communication and care needs. The medication policies and practices in the home have been reviewed and updated. All the required policies to ensure that staff understand how to protect the welfare of people in the home are now in place. The information and guidance that staff need is available in the medication folder so that it can be used for reference. The staff who administer medication have all received updated training and an assessment of their competence. The storage facilities for controlled medication now meet requirements. Samples of medication records were seen and were in good order. A senior member of staff has now been given responsibility for monitoring and reviewing medication policies and practices in the home. Care Homes for Adults (18-65 years) Page 19 of 30 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. There is a complaint policy however not all complaints have been recorded to show how they have been investigated with the outcome. The policies and procedures to help protect people from harm or abuse have been improved. Evidence: There is a complaints policy and procedure that is given to relatives or guardians of people living in the home who are not able to make complaints for themselves. Ms Hooper said that more time is being spent with people to make sure they have an opportunity to indicate any concerns or complaints they may have. There is a procedure for recording complaints. The deputy said in the AQAA that six complaints have been received and investigated in the past twelve months. A complaint that was made to the home by a parent was not recorded to show what action had been taken or what the outcome had been. A record must be kept of complaints made to the home to show how they are investigated, what action was taken and what the outcome was. Complaints must be responded to appropriately and in a timely manner. A requirement has been made regarding this matter. The home follows the West Sussex multi agency policy and procedure for safeguarding vulnerable adults. Staff have all attended training in safeguarding people and reporting procedures; a fresher workshop has been held in the past two weeks. A requirement was made at the previous inspection that recommendations and Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: requirements made at safeguarding meetings must be followed within agreed timetables. The improvement plan that we received indicated that an action plan had been drawn up so that the issues would be addressed. There was no evidence to show that an action plan had been drawn up and implemented. Most of the people who were subject to recommendations at safeguarding meetings have now left the home so this requirement has not been repeated. One of the requirements made at a safeguarding meeting was that night spot checks should be carried out by the manager to ensure that staff on duty at night are clear about their role and responsibilities. There was no evidence to show that this has been done since the previous inspection. Ms Hooper said a programme for night time spot checks would be set up and implemented without delay. The records in the home showed that there have been a number of safeguarding alerts in the past six months and that these have been investigated by the home in consultation with staff from Adult Services, as level 1 safeguarding incidents. The home has informed the Commission of two incidents, one of which was not reported as an alert initially and involved a service user being found with an unexplained red mark on his arm. The home must continue to make sure that the safeguarding policy with regard to reporting procedures are followed and that the Commission is kept informed of incidents and alerts. Each person in the home now has a behaviour support plan to provide detailed guidance to staff about how to manage challenging behaviours. There is a programme in place for monitoring one persons behaviour patterns that is being kept under review. Staff have been provided with guidance about how to observe and record behaviours so that the persons well being can be monitored and guidance drawn up. Care Homes for Adults (18-65 years) Page 21 of 30 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. There was no recorded system for monitoring the safety and hygiene of the environment to make sure that people are protected from harm and the risk of cross infection. Evidence: The providers have informed us that there are development plans for the building. The activity room that is in the grounds of the home has been cleared and heaters provided. New floor covering has been fitted so that the room can now be used by individuals or small groups. The safety issues that were raised at the previous inspection have now been addressed, however there is no recorded system to ensure that a regular check of the building is carried out to make sure that the home is safe and clean. There is a list of cleaning tasks to be carried out, however there are areas of the home that are in need of a deep clean and refurbishment. One persons shower did not work efficiently without water leaking onto the persons floor. The grouting around two of the showers should be cleaned or replaced. The area surrounding one persons shower was dirty and unhygienic. The providers must ensure that a programme of cleaning and refurbishment is in place and kept under review by the management team. A requirement has been made regarding this matter. Care Homes for Adults (18-65 years) Page 22 of 30 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. People are supported by sufficient numbers of staff who are provided with training for their job. The recruitment policy and procedure protects peole in the home. Evidence: The deputy manager said that ten of the twenty-nine staff who are on the staffing list have a National Vocational Qualification (NVQ) at level two or above. Ms Hooper said that staff study for an NVQ designed for staff who work with people who have a learning disability. The system for staff rotas has changed and there is now a three weekly rotation so that staff know in advance which shifts they are due to cover. There are four people living in the home at the moment and four staff on duty including a senior carer. The deputy manager said that if there are plans to go out additional staff would be included on the rota because a higher ratio of staff is needed to support people while they are out. There are two staff on waking night duty and there is an on call system so that a manager is available at all times in the event of an emergency. The staffing rota that we saw showed that staff were allocated each day for one persons one to one support. The recruitment procedure has been improved since the previous inspection. We read Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: the recruitment records for two people who have been recruited since the previous inspection. It was evident that an application had been completed and that interviews had been carried out. There is a format for recording interviews to show that an equal opportunities approach is taken to recruitment. There is no indicator on the form to show that any gaps in employment have been checked during the interview. Two written references were on file and evidence to show that an enhanced Criminal Record Bureau (CRB) check was received before the date that each person had begun work. There is an induction and training programme in place. The training records showed that people have attended mandatory training sessions. Some training is carried out through e learning on the computer. The staff spoken with said that they had been provided with an induction programme and that other training had been provided. None of the staff have had appraisals yet to identify their ongoing training and support needs. Care Homes for Adults (18-65 years) Page 24 of 30 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. The organisation is in the process of recruiting a manager. The quality assurance systems should be kept under review so that improvements to the service are made in a timely manner. There is an improvement in the way that the health, safety and welfare of people living in the home and of staff is protected. Evidence: The manager who had been in post since December 2008 left the home in August. He had not made an application for registration with the Commission. The deputy manager is responsible for the day to day running of the home. Ms Hooper, who is the registered manager of a sister home, has been to the home twice to provide support. She was available during the site visit and agreed to follow up a number of issues that are in need of management attention; for example ensuring that an up to date certificate is displayed and that health and safety checks of the building are in place. We have been informed that the company are in the process of recruiting an experienced and suitably qualified manager for the home. A new manager must submit an application for registration without delay following their appointment. Until Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: such time as a manager is in post the providers must ensure that the deputy manager is provided with a suitable level of support to make sure that improvements to the service are maintained and further developed and that the National Minimum Standards and Regulations are met. An improvement plan will be requested with regard to the requirements made following this inspection. Detailed quality audit reports have been provided and Regulation 26 visits have been carried out by the responsible individual for the company. The reports for the last two visits were not available. Although a detailed improvement plan was provided following the previous inspection; not all the actions that were agreed have been put in place. There is no clear evidence to show how the management team review agreed actions that have been highlighted as part of the quality assurance process. Progress has been made in involving people living in the home in providing feedback about their care. People have been assisted by their key worker to provide their views about the service and this information has been collated. A work shop was planned for staff to help them to involve people in the running of the home in a meaningful way; however this has not yet been arranged. The deputy manager stated in the AQAA that the equipment in the home is serviced as required. A fire risk assessment is in place and revised guidelines about what to do in the event of a fire have been provided. The safety issues in the home that were raised during the previous site visit have now been addressed. There is no system for ensuring that the safety and cleanliness of the building is checked on a regular basis; Ms Hooper said that she would ensure that this is put in place in order to protect people in the home. Incidents are recorded and samples of incident reports were seen, it was not clear that there is a system in place for monitoring the incident reports and ensuring that measures are put in place if necessary. Behaviour support plans have been updated to provide staff with the guidance that they need to support people who have behaviour difficulties. Care Homes for Adults (18-65 years) Page 26 of 30 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 24 13 The registered providers 30/05/2009 must ensure that the home is kept safe and hygienic in order to protect the health and wellbeing of people living there and of staff. 2 39 24 The registered providers 30/05/2009 must ensure that the quality assurance systems are effective in identifying where improvements to the service should be made and making sure that these shortfalls are addressed in order to keep people safe and provide a good quality of care. Care Homes for Adults (18-65 years) Page 27 of 30 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 22 22 The registered providers 30/11/2009 must ensure that complaints are recorded to show how they have been investigated with outcomes and timescales in order to show that peoples concerns and complaints are listened to and acted upon. 2 24 13 The registered providers must put measures in place to ensure that the safety and hygiene of the home is monitored and subject to ongoing improvement to protect people from harm and prevent the risk of cross infection. 30/11/2009 3 37 8 The registered providers 30/11/2009 must recruit a manager who is suitably qualified and experienced to run the home and an application for their registration must be Page 28 of 30 Care Homes for Adults (18-65 years) 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 completed without delay following their appointment to ensure that the home is efficiently run and that the Regulations and National Minimum Standards are met. 4 39 24 The quality asssurance 30/11/2009 systems must be kept under review to ensure that improvements to the quality of the service are maintained and developed to ensure that people living in the home experience a good and safe quality of life. 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 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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