Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 08/09/09 for Cartref Residential Care Home

Also see our care home review for Cartref Residential Care Home for more information

This inspection was carried out on 8th September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People living in the home said that they received enough information about the home before they were admitted and spent time at the home before moving in there. One person commented `I like living here and feel happy`. People who live at the home said they make their own choices about how they spend their day. One person said, `staff are brilliant and support me to be independent`. People receive good support with their personal and health care needs. The environment is clean and comfortable for people living there. People living at the home said they feel safe being there and all commented that they think they are treated well.

What has improved since the last inspection?

The owners of the home have opened a new building called Joy Hall`s Opportunity Centre. This is a day centre in the local community for people from the community. People living at the home said they enjoy attending the centre where they do activities and meet their friends. One person who lives at the home has a lot of involvement with a local football team and has been promoted into the role of kit man at the football club. This means that the person can travel with the team for away matches as well as the home matches. This person said that they are thoroughly enjoying their new role. A Health Action booklet is being introduced and is in the process of being completed for each person. This will encourage person centred care by seeking people`s views about their wishes about maintaining their health and if they become unwell. Some parts of the home have been redecorated so making the environment more comfortable and pleasant for people.

What the care home could do better:

Care planning information could be more detailed and kept up to date so that staff are clear about people`s current needs and what action to take to meet them. More consideration could be given as to how to support people to live their chosen lifestyle whilst taking into account any potential risks from this. Better arrangements could be put in place in making sure that every person at the home receives a cooked meal that is fresh and nutritious. The staffing levels could be improved in order to make sure the needs of people who live at the home are fully met. Every time a staff member is recruited, care could be taken to carry out all the necessary checks on the person before they start working there to make sure they are suitable to work with vulnerable people. This will help to protect people in the home. Better systems could be put in place so that people`s financial transactions are clearly recorded. This will help to safeguard people`s financial interests. The premises could be kept safer if door wedges were not used. These stop fire doors from closing if the fire alarm should sound, and increases the risk to people living in the home from the spread of fire.

Key inspection report Care homes for adults (18-65 years) Name: Address: Cartref Residential Care Home 1a Church Mount South Kirkby Pontefract West Yorks WF9 3QT     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: David White     Date: 0 8 0 9 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 31 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 31 Information about the care home Name of care home: Address: Cartref Residential Care Home 1a Church Mount South Kirkby Pontefract West Yorks WF9 3QT 01977643592 01977643592 david.h.hall@dsl.pipex.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Hall,Mrs Hall care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Cartref is a residential care home providing personal care and accommodation for six younger adults with learning disabilities. The home has five people who live at the home on a permanent basis with one place for short stay care. The enterprise is privately owned and the owners live on the premises. The accommodation is an adapted detached house situated in a residential area of South Kirkby, near Pontefract. People at the home have a single bedroom and there is a large living room and a dining kitchen. The building is in the process of being extended and there is a car park to the front of the building and a sitting area and garden to the rear. Information about the home is in the form of a statement of purpose and service user guide. This information along with the most recent inspection report is kept in the office and is available upon request. 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 31 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 key inspection was brought forward from planned timescales due to the commission receiving some concerns about the service. We went to the home without telling them we were going to visit. This report follows the visit that took place on 8th September 2009. The visit lasted for seven hours. Information has been used from different sources for this report. These sources include information that has been received about the service since the last inspection visit. We also recently received a self-assessment called an Annual Quality Assurance Assessment (AQAA). This assessment was completed by the registered manager of the home and told us how they think outcomes are being met for people who use the service. It also gave us some numerical information about the service. Surveys were also recently received from people who live at the home. During the visit time was spent talking to people who live at the home, staff working Care Homes for Adults (18-65 years) Page 5 of 31 there and the registered manager. Care plans were looked at, as well as a staff recruitment file, some policies and procedures and some records about health and safety in the home. Some time was spent watching the general activity to get an idea about what it is like to live at Cartref. The registered manager was available throughout the day and regular discussion took place with her during the course of the visit. She was provided with feedback at the end of the inspection. The previous inspection visit took place on 9th August 2007. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Care planning information could be more detailed and kept up to date so that staff are clear about peoples current needs and what action to take to meet them. More consideration could be given as to how to support people to live their chosen lifestyle whilst taking into account any potential risks from this. Better arrangements could be put in place in making sure that every person at the home receives a cooked meal that is fresh and nutritious. The staffing levels could be improved in order to make sure the needs of people who live at the home are fully met. Every time a staff member is recruited, care could be taken to carry out all the Care Homes for Adults (18-65 years) Page 7 of 31 necessary checks on the person before they start working there to make sure they are suitable to work with vulnerable people. This will help to protect people in the home. Better systems could be put in place so that peoples financial transactions are clearly recorded. This will help to safeguard peoples financial interests. The premises could be kept safer if door wedges were not used. These stop fire doors from closing if the fire alarm should sound, and increases the risk to people living in the home from the spread of fire. 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 8 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 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 are assessed, and are involved in their admission to the home. This helps in making sure that their needs can be met whilst living at the home. Evidence: Information about peoples care needs is collected from various sources before a decision is made about admittting them to the home. This supports the home in their decision-making about whether they have the skills and resources to meet the persons needs. The registered manager also undertakes an assessment of peoples needs that takes into account such things as the persons family history, dietary needs, likes and dislikes and any equipment or aids that the person may need. The care records show that the assessment process involves the person and their family or representative where this is possible. The registered manager said that the homes procedure for anyone coming to stay or live at the home would be for them to have a look around and spend some time with the people already living there. Two people who recently moved into the home said that this had happened before they moved into the home. Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: Surveys returned recently by people living in the home all said that they received enough information about the home before they were admitted. One person commented I like living here and feel happy. Care Homes for Adults (18-65 years) Page 11 of 31 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. People have some involvement in decisions that affect their lives. However, care planning information needs to be more detailed about peoples needs and more consideration needs to be given as to how peoples independence and personal skills can be developed whilst taking into account any risks from this. Evidence: There is information in peoples care records explaining their needs and the support they require to meet these needs. However, in some cases the care records were not dated and there was no evidence to show that information about peoples needs had been updated so it was not clear if the information reflected peoples current needs. The plans did include information such as peoples abilities and strengths and their likes and dislikes but overall needed to be more person centred. Care plan reviews are held on a periodic basis with people at the home, their family and representatives. A recent care plan review had been held for one person who has recently moved into the home and records from this showed that the person is settling Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: in well. People living at the home said they make their own choices about how they spend their day. One person said, staff are brilliant and support me to be independent. Another person commented that they enjoy being able to get up and go to bed when they choose. Surveys returned by people living in the home all said that they are able to make their own decisions at all times. Individual risk assessments are in place to encourage peoples independence and safety but improvements are needed in this area. One person enjoys football and plays with a local team. This person is also involved in a personal relationship. However, risk assessments had not been undertaken to look at how the persons independence and choices could be supported or to identify any possible risks to the person from their lifestyle choices. Through talking with the registered manager it was evident that staff attend to most daily tasks on peoples behalf. None of the people living at the home cook for themselves although some make their own drinks. Washing is also done on behalf of people although two people were attempting to help do this with staff support. It is acknowledged that people at the home have differing levels of capability. However, the registered manager agreed that improvements could be made in this area to develop a more positive attitude towards risk-taking in order to develop individuals personal skills and independence. Daily records are kept up to date to reflect the support being given. A member of staff said that they are kept well informed about any changes to peoples care. Care Homes for Adults (18-65 years) Page 13 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home are living a lifestyle that meets their expectations although they could be more involved in choices about this. Meals are enjoyed by people at the home although one aspect of food practice needs to be improved. Evidence: Individual care records include information about peoples goals and their leisure and social interests. One person who lives at the home has a lot of involvement with a local football team and has been promoted into the role of kit man at the football club. This means that the person can travel with the team for away matches as well as the home matches. They also play football with a local team. Others at the home attend Joy Halls Opportunity Centre. This was opened by the registered providers in January 2009 in the community for the benefit of members of the community. The registered manager overlooks the facility and has appointed a manager to run the centre so that Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: she can spend more time at the home. People said that they are not pressurised into attending the centre and commented that they like going there and enjoying activities such as sewing, knitting and bingo. One person said, I enjoy going and I am never bored. Another person also attends a different day centre and has obtained awards for computer skills. People said they enjoyed recent shopping trips out and a caravan holiday in Mablethorpe. The home has a minibus to support people with their transport needs. One person has a concessionary travel pass to help them to travel around independently and to assist with transport costs. Most people need staff support when going out. Because of the current staffing difficulties this was limiting the range of opportunities for people to spend time out of the home and for people to have individual time with staff. Whilst people said that they enjoy the activities there was little evidence to show that they are involved in activity planning. One person commented that staff mainly made decisions about where to go for outings. People said that they can keep in contact with their family and friends. One person said they kept in touch with a relative by telephone. Others commented that most of their friends attend the day centre so that they get to see them most days. Everyone spoken to said that they enjoy the meals. A cooked meal is provided at the day centre for those who go there. One person attends an alternate day centre for three days a week and takes a packed lunch with them. This person then has a cooked meal on returning to the home. However, the registered manager explained that this meal is cooked at the Joy Hall centre earlier on in the day and is then plated up for the person to eat later. This was discussed with the manager who gave assurances that she will be making alternative arrangements to make sure the person receives a freshly cooked meal. Care Homes for Adults (18-65 years) Page 15 of 31 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. Peoples personal and healthcare needs are satisfactorily met. Evidence: Peoples care plan describes how support is to be given to each individual. People said they feel they are treated with respect. Most people need assistance in getting in and out of the bath and those spoken to said this support is given in a way that does not cause them any embarrassment. People have their own bedroom keys so that they can go to their bedroom at any time to have privacy. People have a GP (General Practitioner) and have access to other healthcare services as needed. Staff support people to attend appointments and referrals are made to specialist services as and when required. Healthcare information is recorded in the records. The home is about to introduce Health Action Plan booklets and VIP (Vulnerable In-Patient) cards. The Health Action Plans will provide information about peoples health and their individual wishes about maintaining their good health and how they wish to be supported if any health problems arise. This will be good in making sure people receive person centred care in accordance with their wishes if they become unwell. Likewise the VIP card will provide important information about the Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: person in the event of an accident or needing to go to hospital in an emergency. The home now receives medication from the local chemist through a blister pack system. This means that peoples medication is already pre-packed unless there are reasons why this should not happen. No one at the home is able to self-medicate. One person had attempted to do this unsuccessfully and is now being supported by staff to receive their medication. Staff who administer medication at the home have undertaken appropriate training to enable them to administer medication safely. Care Homes for Adults (18-65 years) Page 17 of 31 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. Systems are in place for dealing with concerns and abuse. Evidence: The home has a complaints procedure explaining what people need to do if they have any concerns. The registered manager explained that a summary of the procedure is given to people when admitted to the home. Surveys returned by people living at the home and those spoken to all indicated that people know what to do and who to speak to about concerns they may have. One person has communication difficulties and staff said that through knowing the person well they are able to recognise through observation any changes in the persons behaviour which could cause concern. The home had not received any complaints since the previous inspection visit. The Care Quality Commission has recently received some information in which concerns were raised about how the home is being run and the impact of this on the outcomes for people who are using the service. This prompted this site visit to be carried out earlier than was previously planned. The home have obtained a copy of the local authoritys policies and procedures for safeguarding people from abuse. The records show that there have been no safeguarding referrals made since the previous inspection visit. The homes incident book show that there have been no incidents recorded. Staff spoken to were aware of Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: their roles and responsibilities in responding to and reporting abuse. However, a member of staff said that they had never had any formal training about abuse and this needs to be arranged. Staff had undertaken training on dealing with physical and verbal aggression. People living at the home said they feel safe being there and all commented that they think they are treated well. The home has links with local advocacy services and the registered manager stated that two people are currently receiving advocacy support to assist them with their decision-making. People living at the home receive Disability Living Allowance. Part of this allowance is to provide assistance to people who have mobility problems with their mobility costs. The owners act as appointees on behalf of two people at the home. The manager explained that until recently mobility monies received on behalf of these people had been paid into the appointees account for costs incurred in travel expenses through the use of the homes minibus in escorting these people to the day centre and for other activities. This practice does not properly safeguard peoples financial interests and potentially puts people at risk from financial abuse. The registered manager explained that following meetings with representatives from the local authority this practice has now changed so that the two peoples mobility allowances are paid directly to the individuals. Care Homes for Adults (18-65 years) Page 19 of 31 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. The home provides a warm, clean and comfortable environment for the people living there. Evidence: The home has ramped access to and from it to accommodate people with mobility problems. There are handrails to the stairs between the ground and first floor but there is no lift. Aids and adaptations are available such as a bath chair in the bathroom to assist people who have mobility problems with their bathing. People said they like their bedrooms. One person is a football fan and is having their bedroom decorated in the teams colours. Bedrooms are personalised to suit peoples individual tastes. Most people have their own televisions in their bedroom. They also have access to a large screen television in the lounge. One person said they particularly liked watching satellite sports channels on this television. The registered manager explained that people had previously contributed towards the cost of this service until recently and people spoken to said they had been happy with this arrangement. However, people are now no longer having to pay towards the cost of the satellite channels. The home was clean and tidy. Some decor has been updated to some bedroom areas Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: and in a bathroom and hallway. Other work is to be carried out as planned. The home has separate laundry facilities where peoples personal clothing and bedding is attended to. Hot water temperature checks are carried out on a regular basis to make sure people are not at risk from scalding. The registered providers are proposing an extension to the building with the aim of creating additional beds. This work has been ongoing for some time. The registered manager who is also the joint owner of the service explained that the owners are planning to move out of the house and into a refurbished barn that is set in the grounds of the home. This is planned to take place by December 2009 when the work on the barn should be completed. However, the extension work can not continue until they leave the house as their bedroom is to be revamped as part of the planned changes to the home. The registered manager said that the extension work should be completed by 2010. Whilst the extension work does not have any detrimental effect on the people living in the home, the sight of the building work and bricks in the garden area does have impact on the pleasantness and comfort of the environment for people living at the home. Care Homes for Adults (18-65 years) Page 21 of 31 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. People receive care from staff who understand their needs although more staff are needed to make sure peoples needs are fully met. Recent recruitment procedures that have been followed do not protect people from unsuitable workers. Evidence: There are currently five people who live at the home on a permanent basis. The bed that is used for respite care was unoccupied at the time of the visit. There have been some recent staff changes. Three staff had left the home and two new staff were in the process of being appointed. The manager said that adverts have also gone out for four other staff. At the time of the site visit the staff team consisted of the owners and one permanent member of staff. They worked together to make sure there are always two staff on duty at all times. The owners reside on the premises so are accessible through the night. The current staffing numbers are insufficient in making sure all peoples needs are met. One person needs a lot of 1:1 time. Staff carry out cleaning, washing and meal preparation duties so are having less time to spend with people. As most people need support when going out this is meaning that people are restricted in having individual time out of the home. The registered manager said that the recruitment of the right person for the job is more important than filling a vacancy but acknowledges that the Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: current staffing situation needs to be improved and is taking actions to address this. The home does not use agency staff. The registered manager explained that two people were about to be appointed to work at the home pending satisfactory pre-employment checks. One of these people was visiting the home at the time of the site visit. The person explained that they will be having an induction period on starting work at the home. Through discussion with various people it emerged that this person had accompanied a member of staff to escort the five people from the home on a visit to a local town centre the previous day. The registered manager confirmed that the CRB had only just been applied for and no references had been obtained on behalf of the person. The registered manager also explained that another person who works at Joy Halls Opportunities Centre had covered the home for a few hours in her absence on one particular day. Whilst a CRB check had been completed on this person this related to another service and had not been carried out by the registered manager of the home. These practices put people at risk from potential unsuitable workers and this was discussed with the registered manager who gave assurances that these people will not undertake any further duties until all the necessary checks have been satisfactorily obtained. The registered manager explained that prospective staff members are asked to spend time with people at the home . People from the home are then asked to offer their opinions about the person so that their views are considered as part of the recruitment process. Staff receive training in areas relevant to their work. The registered manager explained that induction is based on common induction standards. A staff member said that they are currently doing NVQ (National Vocational Qualification) at level 3 and described staff training as good. The registered manager arranges training updates when these are needed so that staff are kept up to date with safe working practices. The registered manager has also undertaken different training to keep her knowledge and skills updated. Care Homes for Adults (18-65 years) Page 23 of 31 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 registered manager is experienced in managing the service. However, improvements are needed to the way the home is run in order to make sure that peoples interests are fully safeguarded. Evidence: The registered manager has the necessary qualifications and experience to run the home. People living at the home said they like her and staff surveys indicated that people feel well supported by the registered manager. The registered manager explained that she is committed to acting in the best interests of people and providing good outcomes for them. There are systems in place to find out the views of people about the running of the home. Questionnaires are sent out to people using the service and relatives. Comments from recent questionnaires returned by people living in the home showed that people have been listened to and their views acted on. Relatives and professionals who are involved with people at the home are invited to attend care plan reviews. A staff member said that their opinions are encouraged and valued. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: People living in the home said that they keep their own monies and have locked facilties in their bedroom to enable them to do this safely. The home does hold some monies on behalf of people. One person had recently accrued some monies from benefit entitlements that had been backdated. These monies were being stored in the safe. Because there had been a delay in these monies being paid to the individual, the registered manager explained that the home had used their own monies to subsidise any expenditure in the interim period. Whilst the home kept receipts of any purchases or monies spent, these were not recorded. Therefore accurate records could not be maintained about incoming and outgoing monies, so the persons financial situation was not clear. The registered manager also discussed opening a bank account on behalf of the person because of the amount of money involved. However, the person has someone from outside of the home who has been appointed to help them manage their financial affairs. Discussion was had with the manager that this appointed person is responsible for supporting the individual with decisions about their finances. The registered manager gave assurances that she would speak to the appointed person about this matter. Recent information received from the registered manager in their self-assessment (AQAA) information showed that the necessary health and safety checks are up to date. Fire alarm tests are carried out weekly and fire drills are periodically held. Hot water temperatures are monitored so that any problems can be reported. Some improvements will help to maintain peoples health and safety. Proper recruitment procedures need to be followed in all cases. Risk assessments need to be undertaken to make sure that action is taken to minimise potential risks to individuals from their chosen lifestyles. At the site visit a bedroom fire door was being held open with a wedge. This means that if a fire were to break out, and the fire alarms sound, the door would not close independently. This increases the spread of fire and puts people at unnecessary risk. The manager explained that the wedge was in place as the person in there liked to spend time in their bedroom but be able to watch people walking by. Following discussion the wedges were removed. Attempts were made by the joint owner to fit a door guard device that had already been purchased but this was unsuccessful. The manager gave assurances that another door guard would be fitted as soon as possible and that she will contact the fire authority for any further advice about this. Care Homes for Adults (18-65 years) Page 25 of 31 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 31 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 Arrangements must be put in place to make sure that care plans provide sufficient and up to date information about peoples needs and the actions needed to meet these needs. This will help in making sure that people receive the care and support to meet their needs. 08/11/2009 2 9 13 Risk assessments must be undertaken in order to support people with their chosen lifestyle. This will help to support people to be independent whilst taking into account any risks from this so that any appropriate action can be taken. 08/11/2009 3 17 16 Alternative arrangements must be put in place so that cooked food is not plated up for people to eat later. 09/09/2009 Care Homes for Adults (18-65 years) Page 27 of 31 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 So that people receive freshly cooked and nutritious food and are not put at any risk from the food safety practices in the home. 4 32 18 The registered person must take action to make sure there are suitably trained staff available in sufficient numbers to meet the needs of people living at the home at all times. This will help in making sure that people receive the care and support they need. 5 34 19 Proper recruitment 08/10/2009 procedures must be followed so that satisfactory police checks and two written references are obtained before new staff start working at the home. This will help in making sure that only suitable people are employed to work at the home. 6 41 17 Clear and accurate records must be kept of all financial transactions undertaken on behalf of anyone living in the home. 09/10/2009 08/11/2009 Care Homes for Adults (18-65 years) Page 28 of 31 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 So that peoples financial interests are safeguarded and monies can be easily accounted for. 7 42 23 Fire doors must not be kept 09/09/2009 open by unauthorised means unless this arrangement has been agreed and formalised with the fire authority. This will enable fire doors to close freely in the event of fire so improving peoples safety. 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 Care plan records should always be dated to in order to maintain accurate and up to date details about peoples care and to provide an audit trail. Measures should be put in place in order to develop staff skills and attitudes about positive risk-taking to help support people who live at the home with their choices and independence. People living in the home should be more actively involved in activity planning. This will enable activities to be organised in a more person centred way to suit peoples preferences. Staff should have formal training on how to safeguard people from abuse. This will help in making sure they are aware of different types of abuse and how to respond to it. Reviews should be held on each individual and involve the person, their relatives and people who are involved in their 2 9 3 12 4 23 5 23 Care Homes for Adults (18-65 years) Page 29 of 31 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 to discuss and agree issues about mobility costs in order to safeguard peoples interests. 6 24 The extension work should be completed as soon as is practicably possible to enhance the comfort and pleasantness of the environment for people. Care Homes for Adults (18-65 years) Page 30 of 31 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. 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. Care Homes for Adults (18-65 years) Page 31 of 31 - 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!