Inspection on 07/01/10 for Chantry Care Services

This inspection was carried out on 7th January 2010.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Chantry Care Services 03/12/08

Chantry Care Services 10/12/07

Chantry Care Services 07/03/07

Chantry Care Services 20/06/06

Chantry Care Services 01/03/06

Chantry Care Services 25/07/05

Chantry Care Services 11/09/04

Chantry Care Services 28/04/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Chantry Care Services 46 Dean Street Crediton Devon EX17 3EN The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Vivien Stephens Date: 0 3 0 2 2 0 1 0 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 32 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Chantry Care Services 46 Dean Street Crediton Devon EX17 3EN 01363772301 01363772348 intotal@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Chantry Care Services Name of registered manager (if applicable) Mrs Michelle Jane Dermott Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 16 4 0 0 care home 16 learning disability physical disability Additional conditions: Date of last inspection 0 3 1 2 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 32 A bit about the care home The Chantry is an old detached property that has been listed as having architectural interest. It is close to the centre of Crediton. The home is laid out over two floors and has an annexe known as The Coach House at No. 47. At the time of this inspection The Coach House was empty. There is a large garden behind the house. There is some private parking. The home offers accommodation and care for up to sixteen people with learning disabilities. There are lounges, a study/activities room and dining room on the ground floor. None of the bedrooms have en suite facilities, but all have wash hand basins. Since there is no lift between floors, those people with a bedroom on the first floor must have good mobility. Whilst the Home is registered to care for people with physical disabilities, careful assessments would be needed should any further admissions in this category be considered. The Home has its own transport. On the notice board in the hall there is information telling people that a copy of the inspection report is available for them to read. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 Care Homes for Adults (18-65 years) Page 6 of 32 How we did our inspection: This is what the inspector did when they were at the care home Several weeks before this inspection took place we asked the home to complete an Annual Quality Assurance Assessment (AQAA). They returned the completed form by the date we requested and it form gave us useful information about the way the home is managed. This visit took place over two days. On the first day there had been a heavy fall of snow and the manager and some staff who lived in more rural areas had been unable to get to work. There were enough staff to make sure the people living there were safe, warm, and received the support they needed. We returned to finish the inspection at a later date when the snow had gone and the manager could be present. During the two days of our visits we spoke to, or observed, all of the 10 people living there. We also spoke to the manager and six staff. We also carried out a tour of the home and looked at some of the records the home is required to maintain. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well What has got better from the last inspection Two bathrooms have been refitted. Care Homes for Adults (18-65 years) Page 8 of 32 What the care home could do better People should be given information about the home, and copies of all important documents relating to their care, in a format they can understand, for example by using symbols, pictures or audio formats. The care plans we looked at contained a very good level of information but some parts had not been updated when needs had changed. There was a new staff group and we found it difficult to see clear evidence to show that the staff had read and followed all of the instructions in each care plan. Daily reports provided some evidence, but more work is needed to make sure there are good monitoring systems in place so that the manager can check all important tasks have been carried out. While people have a range of activities they can take part in each day more could be done to consult with each person individually to draw up a plan of the things they want to do, and the support they might need to help them work towards living more independently. In the last year some people have raised concerns about things that have happened to them. Health and social care professionals have held safeguarding meetings to look at what has happened and decide how they can help the home to make the improvements necessary to make sure people are safe at all times. Care Homes for Adults (18-65 years) Page 9 of 32 The home told us they are going to do more decorating and changes to the home to make it more attractive and comfortable. They should also make sure that doors and fire safety features are checked regularly to make sure people are safe at all times. There is a new staff team in place. These staff will need a wide range of training, support and supervision to help them gain the knowledge and experience they need to provide the support each person needs. The staffing levels and management structure in the home should be reviewed to make sure the staff are well supervised and monitored, and to make sure that all management tasks are carried out promptly when necessary. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Vivien Stephens Colston 33 Care Homes for Adults (18-65 years) Page 10 of 32 33 Colston Avenue Bristol Avon BS1 4UA 01179307110 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 11 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has good assessment procedures in place, including opportunities to visit and get to know the home before they move in. The information given to people who may be thinking about moving in is not suitable for people with poor reading skills. Evidence: In the last year one new person has moved into the home. We looked at the information gathered by the home before the person was admitted and we found they had carried out a full and detailed assessment and had looked at all aspects of the persons health, personal care and social needs. They were able to confirm they would be able to meet all aspects of the persons needs. We were satisfied they had good admission procedures in place offering people plenty of opportunity to visit and get to know the home before any decision to move in permanently was made. The Statement of Purpose has recently been updated and gives a range of information about the home. It is written in a formal style and is suitable for people who have good reading skills. The home have not provided information in other formats that may be suitable for people who may have difficulty reading. Page 13 of 32 Care Homes for Adults (18-65 years) Evidence: Care Homes for Adults (18-65 years) Page 14 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have been given some opportunities to say what they want to do each day. This has been affected by recent changes in the home, including new staff team who have had to start afresh to build relationships with each person. Some care plans may need to be updated more regularly and care must be taken to ensure that all staff have read and understood all aspects of the care plans and any changes and updates. Evidence: We looked at four care plans files to find out how people had been consulted and involved in the support they needed in all aspects of their daily lives. We found each file was very large and included a wide range of information about the person. This made it more difficult to find the information and documents that the staff may need access to on a day to day basis. Large documents were placed in plastic pockets and if staff wanted to find information quickly the whole document had to be removed from the pocket. We talked to the manager about the possibility of re-organising the files to make important information needed on a day to day basis easier to find. Since the last key inspection there have been a number of significant changes in the Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: home. The owner has placed the home into administration (see also Conduct and Management of the Home). Many of the staff team have left and new staff have been appointed. This has caused considerable disruption to the home in previous months, but at the time of this inspection a number of new staff had been employed and they were beginning to establish some positive working practices. The care plan files included documents signed by the previous staff team to show that they has read and understood all sections of the care plan files. Some of the new staff had not signed the forms and therefore it was unclear if they had read and understood the care plans. We talked to the manager about the importance of making sure that all of the staff team were following the care plans. She agreed to implement this. The home has recently introduced a communication diary that has been used to notify staff of changes in peoples care needs. Some of these changes had not been transferred to the main care plan. We talked to the manager about the importance of having an up to date care plan at all times. During each visit to the home we saw staff supporting people to do a variety of activities. People were given choices about what they wanted to do and staff were positive and encouraging. We found good evidence to show that peoples health needs have been well met through good communication with all relevant health professionals. People have been referred to their GP promptly at the first signs of illness. Health risk assessments have been carried out. Peoples weight has been monitored regularly. Nutrition and dietary needs have been considered. We looked at peoples spiritual and cultural needs. Some people have chosen to attend church regularly and the staff have supported them in their wishes. Where people may prefer to follow a non-Christian religion this has been considered and families and individuals have been consulted closely. Care Homes for Adults (18-65 years) Page 16 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are offered a range of interesting things to do every day, and the level of activities is increasing, although more needs to be done to ensure all individual interests and development needs are met. Evidence: On the first day of our inspection there had been a heavy snow fall and some staff living in outlying areas had been unable to get to work. However, we found there were sufficient staff on duty to ensure people were safe. Some of the regular activities outside the home that people may have usually done that day could not be followed due to the weather and lower staff numbers. However, the staff team were still able to provide alternative activities to suit most people within the building. There was a happy atmosphere as people were involved in various arts and crafts. On the second day of our inspection the weather was good and there was a full complement of staff. Some people went out in small groups to various activities outside the home during the day, while others did various things in the home of their choice. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: There was a board on the wall in the dining room that had previously been used to show the activities planned for that day. This board was not being used at the time of our first visit, but was in the process of being re-introduced at the time of our second visit. There were pictures showing the activities people could expect to do. We talked to the manager and staff to find out how many people would benefit from this board and heard there were a number who may not benefit. We recommended the staff look at ways of supporting every person to have a method of helping them know what things they would be doing each day/week. Some timetables seen in individual care plan files were not up to date - this should be reviewed. Around the walls of the dining room there were pictures and crafts completed by the people living there. We also saw picture frames purchased to display further artwork. People living in the home were proud to show us some of the things they had made, and to talk about the things they liked doing. We saw some people helping to make milkshakes, and helping out in the kitchen. Individual care plans showed that in the past some people had enjoyed various activities outside of the home including horse riding, swimming and gardening. These activities had stopped several months ago. We talked to the manager about reviewing individual care plans to show their educational and development needs, and to plan their weekly activities to take this into account. The home has one vehicle available to take people out, and we heard that there were plans to provide a second vehicle in the near future. We looked at the meals provided to people living in the home. The menus have been developed taking into consideration the likes, dislikes and dietary needs of each person. The staff we talked to said the standard of the menus has improved in recent weeks and they felt people received well-cooked and tasty meals produced in the home by staff who have good cooking skills. On the second day of this inspection we sat with people at lunch time and shared a lunch of salad and home cooked quiche. The meal was tasty and well balanced. Care Homes for Adults (18-65 years) Page 18 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs have generally been well met, although some aspects of the care planning and daily reporting systems could be improved to ensure staff have clear and up to date information about health care support and medication needs. Evidence: We have received evidence to show that the home has sought advice, support and treatment appropriately from heath care professionals. There is a good relationship between the home and health care professionals. The care plans contained good information about health care needs. However, in some instances there was no evidence to show that care workers had followed instructions or provided care according to the care plans. For example, the care plan showed that one person was at risk of weight loss. However, the care records did not provide a regular record of the persons weight. Daily reports suggested the person had not eaten well for a period, but there was no record of their weight being checked more frequently, or guidance on any specific action to take. One care plan showed that the person was at risk of gingivitis and therefore care workers should be particularly careful when supporting the person to clean their teeth. We talked to the manager, Michelle Dermott about the need to ensure staff follow the care plans on a daily basis and provide evidence in the Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: daily reports that important tasks have been carried out. Since the last inspection a concern has been raised by a health care professional regarding the lack of specifically trained staff who are able to administer emergency medication for people who suffer epileptic fits. This was due to the recent high turnover of staff. We were given assurance at this inspection that staff had been trained in this task, or would be trained in the near future. The care plans we looked at showed that regular health checks have been carried out by relevant health care professionals to make sure that any potential health problems are detected and acted upon promptly. We looked at the way the home stores and administers medications. The home uses a monitored dosage system supplied by a local pharmacy. They were stored securely and the medication cupboard was tidy. At the time of this inspection all but three care workers had received training on the safe administration of medication. The home has secure facilities to store medications that need to be kept cool. At the time of this inspection the home did not hold any controlled medications. They did not have secure facilities in place for any controlled drugs they may be prescribed in the future and we advised the manager that they must ensure that, if controlled drugs are prescribed, they must have secure storage facilities in place. Records of medicines administered were checked and found to be in good order. The medication administration records provided some information about the medications and any special instructions. However, the level of information about each persons medications, including possible side effects, or when to administer medicines that have been prescribed on an as required basis could be improved by additional information in the care plans. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the home will take appropriate action on any concerns or complaints raised. However, recent changes in the staff team and the lack of a strong management team structure may result in poor practice or concerns not being recognised. Evidence: Since the last inspection there have been a number of safeguarding alerts made to the Commission and to the local authority relating to the health and safety of some of the people living at The Chantry. The alerts have been raised by the manager of the home, and this has demonstrated that she has a clear understanding of the safeguarding process and the procedures that must be followed. At the time of this inspection the safeguarding procedures had not been concluded. Two staff have been suspended. Concerns have been raised through the safeguarding procedures about low staffing levels, high staff turnover, and the failure to appoint a deputy manager (see Staffing section and Conduct and Management of the home) that may have contributed towards the recent safeguarding alerts. We found evidence to show that people with communication skills have been able to speak out if they have felt worried or upset about anything, and that they have been listened to, and the home has taken the correct actions. However, some of the concerns raised through the safeguarding process showed that some previous staff had not felt able to speak out if they saw or heard about poor practice by other staff. In recent Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: months there have been a number of changes in the staff team and the staff we talked to during this inspection spoke very positively about the atmosphere within the home and were very certain they could speak out about any concerns they may have in the future. The changes in the staff team have resulted in a new team who may not have the depth of knowledge or understanding particularly of those people who have poor or no communication skills. These people have been particularly vulnerable during this people while staff may not have had skills or understanding to recognise possible signs of abuse. The home told us that all staff have attended adult protection training. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some recent improvements to the home have resulted in many areas of the home being comfortable, homely and attractive. However, further work is needed to bring the whole home up to an acceptable standard. Evidence: In a tour of the home we found that, in the last year, there have been some improvements in some areas of the home. Two bathrooms have been completely refurbished. A cob wall in the garden had fallen down during the winter and a specialist building firm were rebuilding the wall. The lounge and dining rooms appeared comfortable, although the flooring throughout the ground floor communal areas was showing signs of wear and beginning to appear shabby. The decoration in the entrance hallway was damaged and shabby, but we were given assurance that this area will be redecorated in the near future. A maintenance man has recently been employed and we saw the maintenance book that showed staff had recorded any items they felt needed to be repaired, and we were able to see that these had been actioned. A the time of our first visit we found a fire door leading from the main hallway had come off its hinges and could not be shut properly. On the second visit to the home we found Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: the door had been repaired. On our first visit we also found a bedroom door that could not be shut due to the carpet. This problem had also been addressed before our second visit to the home. Each person has their own bedroom and we looked in all of the bedrooms and found they have been individually decorated and furnished to suit each persons interests and preferences. They were bright, comfortable and homely in appearance. One bedroom wall has developed a crack in the plaster and we suggested that the cause of the crack is investigated. The kitchen was clean and tidy. Equipment in the kitchen was in working order, although some of the doors and drawer fronts on the kitchen units were broken or missing. There were good standards of cleanliness throughout the home. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. While people are supported by sufficient staff to meet their basic care needs, for some people the staffing levels may not be adequate to meet their emotional needs. Recent high staff turnover has resulted in a new staff team, some of whom may not have received adequate training or gained sufficient experience to fully understand each persons care needs. Evidence: On the first day of this inspection there had been a heavy fall of snow and many rural roads were impassable. The manager and some of the staff team had been unable to get to work. However, 4 staff who lived near the home had been able to walk to work and we found people had received the support they needed to follow most normal daily routines apart from activities outside of the home. Group activities had been organised inside the home for those who wanted to participate and people appeared cheerful and relaxed. The manager was in communication with the staff team by telephone. On the second day of this inspection the manager was present and also a senior care worker who had been given the title of trainee deputy manager. Four other staff were also on duty. The staffing levels on that day enabled people to go out to their regular outside activities, and also allowed staff to work with small groups inside the home on planned activities. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: While staffing levels were sufficient to ensure people were safe, and to ensure that basic personal care needs were met, was saw evidence to show that those people who demanded a great deal of staff time diverted staff attention from those people who were quiet or less demanding. The safeguarding investigations that began shortly before this inspection took place highlighted that some people living in the home may need more individual attention from staff. The manager said she had been negotiating with the local authorities who funded those peoples care to obtain adequate funding to meet their individual support needs. At night there are two members of staff sleeping in the home. Concerns have been raised by some health and social care professionals that some people may regularly wake during the night and need staff who are awake to support them and make sure they are safe. The manager said that those people who regularly wake at night usually wake a member of staff, and therefore they have received the support they needed. We talked to six members of staff during the two days of this inspection. We found the staff were positive and happy in their work. They said they felt well supported and felt there were good systems in place to ensure the home ran smoothly. We looked at the staff recruitment files of 5 staff recruited in the last year. We found that good practice had been followed in all aspects of their recruitment. All required checks and references had been obtained before the staff had started working in the home. All staff had completed a nationally recognised induction training procedure. We saw evidence of induction booklets that had been completed to show the topics covered. A number of staff had only been in post for a few months and therefore not all of the required health and safety training had been completed. We were given assurance that the training would be booked within the next few days. Training on topics relevant to the health and personal care needs of the people living in the home had not been provided to many of the staff. Training on epilepsy had been booked to take place at the end of February 2010. Other topics such as autism and gently teaching had not been arranged. Information provided by the home before this inspection showed that staff have received supervision at least once a month. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. While the overall management of the home is good, the failure to provide strong management cover in the home when the registered manager is not on duty may place people at risk of harm or abuse. Evidence: The manager, Michelle Dermott, holds a relevant qualification in care and has had many years of relevant experience. We have heard praise from health and social care professionals for her dedication and her determination to ensure people living in the home receive the care they need. The staff team we spoke to assured us they were happy with the way the home was managed by Michelle Dermott. In recent years the home has attempted several times to recruit a deputy manager. Where people have been appointed to this post they have failed to stay for long, and therefore for much of the last year Michelle Dermott has continued to manage the home on her own. This has meant that when she has not been on duty there have been many hours in the week without management cover, although staff have been able to ring Michelle for advice and support if necessary. Recent safeguarding alerts have raised the possibility that the lack of management cover in the home may have allowed bad practice Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: among some staff to go undetected. Since the last inspection the home has been placed in the hands of administrators by the owner. The administrators have told us they plan to improve all aspects of the home and the service before considering the long term options for the home. Michelle Dermott told us she has received regular visits from the administrators and good support from them in the last year. The home told us they have held monthly client meetings to seek their views on all aspects of the services and care provided. They told us they also send out annual questionnaires and have sought the views of relatives and advocates. The home has a range of policies and procedures in place covering all required topics. The home has told us that relevant health and safety checks on all equipment have been carried out. A the time of our first visit we found a fire door leading from the main hallway had come off its hinges and could not be shut properly. We raised this concern with the manager and asked her to address this promptly. We also notified the fire authority. On the second visit to the home we found the door had been repaired and the fire authority had visited the home and given advice on the actions necessary. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes  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 Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description 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 Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 People should be given clear and accessible information about the home in a format they are able to understand eg pictures, video or audio. Care plans to be provided to each person in a format they can understand. Each person should be given information to show what regular activities they will be supported by staff to follow on a daily/weekly basis. The level of activities both inside and outside of the home should be increased in order to ensure all individual educational and development needs are met. Daily reporting systems should be improved to provide clear evidence that staff have followed instructions in the care plans in relation to key personal and health care needs. The level of information about each medication prescribed should be expanded to make sure care staff have easy Page 30 of 32 2 3 6 11 4 19 5 20 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations access to all of the information they need about how, where, why and when each medication should be administered, and any possible side effect. This is particularly important for creams and lotions, and any medications prescribed on an as required basis. 6 23 The home should reflect on the causes of recent safeguarding alerts and consider ways of preventing further concerns. This may include staff training, staffing levels, and the management of the home. A programme of repairs and maintenance should be drawn up to address areas of the home that have become worn, broken or shabby. The home should ensure they have a staff team with the qualifications and experience to meet each persons needs, and should ensure there are at least 50 staff with a relevant National Vocational Qualification (NVQ) or equivalent. Staffing levels should be reviewed to ensure there are sufficient staff available at all times of the day and night to meet the needs of each person living in the home. The home should ensure the staff team have regular training and development on all mandatory topics, and that there is a training plan in place that ensures the staff are able to fulfill the aims of the home and meet the changing needs of the people living in the home. The management structure within the home should be reviewed to ensure there is strong management and leadership in the home when the registered manager is not on duty. The home should have systems in place to recognise when fire safety measures (especially fire doors) may no longer function as intended. 7 24 8 32 9 33 10 35 11 37 12 43 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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