Inspection on 03/03/09 for Cherry Tree Cottage

This inspection was carried out on 3rd March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cherry Tree Cottage 11/10/06

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Cherry Tree Cottage 6 Kinoulton Lane Kinoulton Nottinghamshire NG12 3EQ The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Richardson Date: 1 1 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. 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 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 34 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Cherry Tree Cottage 6 Kinoulton Lane Kinoulton Nottinghamshire NG12 3EQ 01159819080 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr John William Nunn care home 5 Number of places (if applicable): Under 65 Over 65 5 0 learning disability Additional conditions: No one falling within the category LD to be admitted into Cherry Tree Cottage when there are 5 persons of this category already accommodated The maximum number of persons to be accommodated within Cherry Tree Cottage is 5 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 34 A bit about the care home Cherry Tree Cottage is a care home providing long-term personal care and accommodation for up to five younger adults who have a learning disability. The home is one of several owned by Mr John Nunn and is run as a small business. The home is located in a rural area on the outskirts of a small village. The home is intended for those who prefer to live in the countryside. The home was opened in July 2006 is a former domestic dwelling. All of the homes bedrooms are single, and none have en-suite facilities. Four bedrooms are located on the first floor and one on the ground floor. The home has an enclosed garden with further land beyond where horses are kept. There is car parking available. Fees for the service range from 1262 to 1300 pounds per week depending on dependency needs. Additional charges are also made for additional individual time with staff. Care Homes for Adults (18-65 years) Page 5 of 34 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 34 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key inspection of this service and it took place over 9 hours as an unannounced visit to the premises by 2 inspectors. We talked to the manager and staff working in the home, to people who live there and we watched how the the staff act with people who live there. We also looked at records and documents. 1 of the requirements from the last inspection have been met, 2 requirements have not been met. We made 9 more requirements and 3 recommendations. We looked at Information from the Annual Quality Assurance Assessment (AQAA) and from surveys in this report. The AQAA is a self-assessment document that managers and owners of care services complete every year. It asks them to tell us how well they are providing services to people who live at the home. Care Homes for Adults (18-65 years) Page 7 of 34 We received 2 surveys from people living at the home. An expert by experience also visited the home with us. An Expert by Experience is a person from a voluntary organisation (in this case Barking and Dagenham Centre for Independent Living Consortium) who has experience of care. They look at areas we ask them to look at, but from an ordinary persons point of view. What the care home does well Assessments are completed before people move into the home. People say they have enough information before they move in. They told us they visited before moving in. Care plans are written about everyone who lives at the home. They tell staff how people like to be looked after. Care Homes for Adults (18-65 years) Page 8 of 34 People can make decisions about what they do each day. They told us, They can go out, and they often go shopping or to local entertainment places. One person told us, I go out to shops, watch TV, read a magazine, go ice skating. More swimming. People have good contact with their families and still see a lot of them. People have a choice of what to eat each day. Everyone we spoke to said they like the meals and the food is good. People are referred to health care professionals, like dentists, opticians and dieticians. These visits are recorded in their care records. People said they know who to talk to and how to make complaints. Care Homes for Adults (18-65 years) Page 9 of 34 There are enough staff so that people are looked after properly. Staff are friendly and help people. One peson told us, members staff treats everyone really well. What has got better from the last inspection What the care home could do better There are no records of meetings with people before they move into the home. This should be done so that people can see what they talked about and if they had any questions. Care Homes for Adults (18-65 years) Page 10 of 34 Not enough is done to help people take risks but stay as safe as possible. Risk assessments are not completed in enough areas. This puts people at risk because there is no plan for what to do if something goes wrong. Not enough is done to help people go to college or continue their education. People should go to a day placement to keep skills or learn new ones. They are not helped enough to carry out tasks that help them to live independently, like ironing or laundry. People can only have friends at the home if they are supervised by staff, they cannot see them there in private. People are sometimes put into situations where they are at risk of harm. Staff must look at ways to make sure this doesnt happen. There are areas in the home that are not safe. The hot water was too hot and so were some of the pipes. This could burn people. The laundry is not a safe place for people to wash and dry their clothes. Page 11 of 34 Care Homes for Adults (18-65 years) Staff members do not all get proper training. Not enough people have training in safe food handling or manual handling. Only one staff member is a first aider. Staff do not have supervision. This means they are not getting proper support or guidance to do their jobs. Some checks and documents are obtained before new staff start working at the home. Some things are not looked at though. This must be done to make sure new staff are safe to work. Fire safety checks are not recorded when they are done. People are asked what they think about the care they get. But, there is nothing to show how this improves the service or the home over the year. The manager is also the manager of another home and does not have enough time to spend at the home. This means that checks are not completed properly, staff dont have enough guidance and people are at risk. Page 12 of 34 Care Homes for Adults (18-65 years) 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 Lesley Richardson Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA Tel: National Processing Centre: 03000 616161 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 13 of 34 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 14 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People have enough information before moving into the home, which means they are able to decide if they would like to live there. Evidence: Both of the people who we received surveys from said they had enough information before moving to the home. They said, I came for visits and the manager and members staff said I could get more information. Talking to the staff and manager. The manager told us that assessments are completed before people move into the home and assessments by health and social care teams are also obtained to provide more information. We looked at the care records of 1 person who has moved into the home since the last inspection. There is a detailed health/social care assessment on the care record that tells staff about the person. We spoke to the person and the manager, they both said that they had met before the person moved into the home. However, there were no records or assessments completed by the home from these meetings. This means that information about the persons needs that could go towards forming the care plan has been lost. Care Homes for Adults (18-65 years) Page 15 of 34 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 . Care records are completed in enough detail and when risk assessments are completed they show how the person can continue with something, while staying as safe as possible. Evidence: Both people who commented in surveys said they are able to make their own decisions and choices. We saw this during the inspection and that people are able to do what they want, when they want. One person was able to go out to the shops when she asked staff to do this and another person said he can go and visit his relatives when he wants. People we spoke to said staff are nice and while we were visiting the home, staff were polite and respected peoples right to decide what they want to do. 2 comments from the people who returned surveys were, I can do what I want usually but we have travel issues re shortage of driver. Need a new car and I go out to shops, watch TV, read a magazine, go ice skating. More swimming. Care plans for 3 people were looked at as part of this inspection. They show that each person has a plan that gives staff members information about what they need to do to Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: meet most of the identified needs. Risk assessments, for things like falls and moving and handling, are completed and reviewed regularly. Where risk assessments are written, they contain a good level of detailed information, however, risk assessments are not completed for all activities that people are involved in. There was some information in care records to show people have planned times when they carry out household tasks like washing and ironing, and shopping. We didnt see risk assessments for these activities and the laundry is not a safe environment for people to carry out this task. One person was planning to go on an overseas holiday with a parent. There are no risk assessments for this activity or contingency plans if anything should go wrong while the person is away. We spoke to the manager about this and he said that it was not their responsibility while the person was with the parent, who is also a vulnerable person. There are no risk assessments in peoples plans about whether they are able to safely use hot water. When we tested the temperature of the hot water in the ground floor shower and toilets, these were hot enough that they would have scalded (80 degrees centigrade). There were several different shampoos and shower gel bottles in the shower, indicating the area is used by more than one person. We found the care plans give staff members advice about how to meet most of peoples needs, and they are written in a good amount of detail. Care plans for care needs generally told staff how each person likes to be cared for and what their preferences are, and there were some plans that gave staff a lot of information about people. For example, one person who needs support with a gambling problem has a plan that shows clearly what the person is able to spend money on. It also tells staff what happens when things go wrong and how the person will try to get around planned restrictions. Another persons plan tells staff what they should do and how they should behave towards that person when she shows very affection behaviour towards specific staff members. Plans are reviewed and we saw that some information and changes are recorded, and the plans are rewritten to give staff updated guidance. People said they are able to make everyday choices about when to get up and go to bed, how to spend their days, whether that is in their own room, in the main lounge/dining area. There seems to be a lack of direction for people living at the home; they can do what they want, but it seems to be up to each person to decide what to do, which leads to periods of inactivity when people have nothing to do. At the end of the first day of inspection one of the people living at the home had asked to go shopping and staff said this could happen later in the afternoon. Until then, the person had nothing to do and spent the time walking aimlessly about the home. Care Homes for Adults (18-65 years) Page 17 of 34 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 . Although activities are available and people can choose what they do, there is no structure or routine and some limitations mean that people do not keep or develop independent living and socialising skills. Evidence: None of the people living at the home take part in day placement, workshop activities or college during the day. One persons relative told us about this and that her relative has not attended anything like this since she has lived at the home. She said this had been requested at the last 3 review meetings, but nothing had been arranged. The manager told us that 2 people used to attend college or day placement, but these have stopped because of the size of the groups and travelling distance. Both of the people who returned surveys said they can do what they want during the day, in the evenings and at weekends. Two comments we received from them were, I can do what I want usually but we have travel issues re shortage of driver. Need a new car and I go out to shops, watch TV, read a magazine, go ice skating. More swimming. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: People are able to go to their rooms alone and their movement around the home is not restricted. We talked to 2 people about their rooms, they both said they are able to spend time in their rooms. Staff said they support people to take part in housekeeping tasks, and they supervise those people who are at risk. We received information from one persons relative during the inspection that makes us think that people are supported as much as they could be with independent living skills, such as laundry. This person told us her relative is losing these skills that she had learnt before coming into the home, because she is not helped to continue them. We saw a basic sheet of information in the care records of one person, but there was nothing else to show us that people are encouraged to learn or maintain these skills. The laundry is not a safe place for people to do this and there are no risk assessments to show how staff are making these skills safer. People living at the home are able to take part in activities, such as swimming and ice skating, at local venues, and attend entertainment venues aimed at the general public and their peer group. Both people who returned surveys said they are able to do what they want at all times during the week. We talked to 2 people about what they like to do and the expert by experience also talked to people. These people told us about where they spend time during the week. People are able to keep in contact with family and friends, and they are able to have people visit them at the home. However, both people and staff members told us that if they wanted boyfriends or girlfriends to visit, this could only happen under staff supervision and if other people living at the home were not affected. The person the Expert by Experience spoke to said they, could have friends in but a member of staff must be present. This doesnt give people an enabling environment where they can pursue relationships if they wish to. There was good information in care records to show who people have contact with regularly, especially family members. One person told us about a 21st birthday party that family members had organised. Another person has contact with both parents and there is good information in the care records telling staff what they should do if difficulties arise during one of these visits. The people who live at the home go with staff members on shopping trips and help with food preparation. Snacks are available throughout the day and people, who are able to, can make drinks when they wish. One persons relatives told us that people have no choice when they go food shopping and often the food that is bought is the cheapest available. We spoke with staff members who said they used to buy a lot of Asda green stripe food products, but this has mostly stopped and is now limited to rice and pasta. Care Homes for Adults (18-65 years) Page 19 of 34 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 . Care and medication records are completed in enough detail to ensure the health and welfare of people living at the home. Evidence: There is information in care records to show health care professionals, such as specialist nurses, opticians and chiropodists, are contacted for advice and treatment. Medication administration records (MAR) were looked at for all of the people whose care records we looked at. The MAR sheets are completed and there are no records with entries missing. Entries for medications that have not been given show the reason for this. Amounts of medication remaining in blister packs of medication tally with the amount the MAR indicates are remaining. Information in the MAR folder also shows which staff have received training on the safe administration of drugs given by alternative routes. Most of the staff currently working at the home have received this training. The manager has improved where medication is stored and this is now in a secure area in a room that can be locked. The Controlled Drug register does not show the dispensing pharmacy for controlled drugs received into the home. We spoke to the manager about the need for this, Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: although he told us that there is only one controlled medication and was able to tell us which pharmacy supplied the medication. There are also no temperature checks for medication storage areas in the home. This must be done to make sure that medication is stored at a temperature below the manufacturers recommended maximum and is still clinically effective. People who returned surveys told us that staff treat them well, one person said, members staff treats everyone really well. Another person, who spoke to the Expert by Experience said they like one particular member of staff to attend to them. There are usually enough staff at the home to be able to provide support when people want it. People told us during the inspection that they can go to bed when they want, one person gets ready for bed quite early, but then comes back downstairs to watch television. Another person told us they like living at the home, the staff are nice and they can do what they want. Care Homes for Adults (18-65 years) Page 21 of 34 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 know how to make complaints and concerns known and staff generally deal with issues properly. Evidence: Both of the people returning surveys said they know who to speak to and one of them said they know how to make a complaint if they have to. Everyone we spoke to during the inspection also said they know what to do if theyre not happy about something. One of the people who returned a survey said staff members listen to what they say and act on it, the other person said this only happens sometimes. One comment we received said, my Mum, staff, I talk to the manager when I get the chance. The Expert by Experience spoke with one person who told him they know how to complaint, but that they could also raise issues in house meetings. The person has made a complaint and they are satisfied with the action taken about it. The Expert by Experience also talked to a staff member who was able to say how he would deal with any complaint he received. Staff members who returned surveys also said they know how to deal with complaints. The home has a complaints procedure and keeps a record to show how they have looked at and the outcome of complaints that have been made. We were not given any information before the inspection about the number of complaints the home has received in the last 12 months. The Commission has not been notified directly of any complaints about the home in the last 12 months. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: The staff training matrix shows that nearly all staff members, except a very new staff member, have received training in safeguarding (adults protection). We talked to a senior carer who confirmed they have received training in safeguarding people. This staff member found it difficult to explain what he would do if an allegation had been made and said he would refer to the homes procedure for guidance. Information provided to the Commission before the inspection shows there have been two safeguarding referrals and investigations in the last 12 months. The Commission was notified of these by staff at the home and by health care professionals. The information given to us shows that appropriate action was taken on both occasions. The Expert by Experience spoke with one person, who told him they feel safe at the home. However, during the inspection we received information from a visitor to the home. This person said that her relative is sometimes put into situations and close proximity with another person living at the home, when there are clear guidelines that this shouldnt happen. Staff members told us that sometimes this is difficult to avoid, especially when both people have to use the car at the same time. People should be kept safe and must not be placed at risk of harm. A requirement was made at the previous inspection about keeping people safe by providing them with a procedure to follow. This has been done, but staff do not always understand when people are at risk and therefore the previous requirement will remain. Care Homes for Adults (18-65 years) Page 23 of 34 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 . The home is generally clean, but does not always provide a safe environment, which means people living at the home are at risk. Evidence: The home is an adapted residential house situated on the outskirts of the village of Kinoulton, close to the A46. People living at the home have access to a combined lounge/dining room, a kitchen with seating and a large garden area at the back of the property. The general decor in most parts of the home is satisfactory, and it was clean and tidy, with no offensive smells. Both people returning surveys said the home is clean and fresh sometimes. Both people commented that, it depends on the member staff and depends who is on shift. We looked around the home but found that although this was the case there are other issues that need to be looked at. On the first day of our inspection the lounge furniture was worn, coming apart in places and 3 cushions were ripped and torn. Water pipes in one of the ground floor toilets and a shower were exposed and too hot to touch for any length of time. The inspector was not able to hold her hand under the hot water from these pipes. Temperatures of the pipes and hot water were taken on the second day and found to be 56.5 degrees and 80 degrees respectively. These temperatures are hot enough to cause significant scalding and injury. There were a lot of different toiletry products in the shower cubicle, but there were no names to show who they Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: belonged to. Lights in the toilet, shower room and kitchen had no covers and were exposed to the air. Light bulbs in areas where there is the risk of spray with water should be covered to reduce the risk of damage. The laundry was cluttered and disorganised. It was also being used as a storage area for items either no longer or rarely used and among other things, had a mattress leaning against the washing/drying machines. This is not a safe place for people to carry out these household tasks and staff told us there are no risk assessments showing how the risks have been reduced. One part of the carpet on the ground floor outside the bathroom was beginning to lift and was beginning to be a trip hazard. This must either be repaired or replaced to make sure people are not at risk of tripping when they walk in this area. There was mildew and mould along the bottom of the shower cubicle and in the grouting around the tiles and the landing window sill and frame had mould and mildew. This must be removed to prevent further mould developing and deterioration of the window frame and shower cubicle. When we returned on the second day of the inspection we found that some areas had been changed or replaced. The lounge room has new furniture, the ground floor toilet has been made into a staff toilet so that people living at the home dont have access to some of the pipes that are too hot. The owner told us that a new thermostat was being put into the boiler on the second day of inspection and that the pipes would be covered by the end of the week. Because action had been taken to improve some areas we are not going to make a requirement for everything we found. However, staff must have a clearer understanding of what risks to people are and must look at reducing these risks without the need for an inspection to identify them. We have talked about this again in the section on Conduct and Management of the Home. Care Homes for Adults (18-65 years) Page 25 of 34 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 . There are enough staff members most of the time, but they do not all have the supervision, training and skills to be able to care for people properly. Evidence: New staff members are given induction training by the home. We looked at the records for one new staff member and they showed that the induction, apart from one section on policies and procedures, had all been completed on the same day. The manager said this was a brief talk through all the topics rather than training on the subject. He said induction training is provided through the Leicestershire Social Services First Steps programme. We talked to the manager about covering such a large range of topics in such a short time, which could lead to staff not remembering quite a lot of it. The training matrix shows that not all mandatory training has been given to all staff members. There are few dates on the matrix, which doesnt give a good indication of when the training took place. Other indication is a X in a box by the staff members name. The matrix shows only 2 staff members have received food hygiene training and only one person has received moving and handling training. Although none of the people at the home need help with mobility, at least one person has a medical condition that means they may need to be moved out of danger at a time when they cannot do it themselves. There is also only one staff member who has had first aid training. However, all staff members except the newest staff member have received Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: medication training and safeguarding (adult protection) training, and training in epilepsy and rescue medication. There is no information though, that any of this relates to giving a sedative rectally, which is prescribed for one person. We talked to the senior carer who told us there are instructions for giving this, although the senior carer was not able to find the instructions. Staff also receive training in how to safely manage challenging behaviour and physical intervention. The matrix shows that 3 of the 6 staff members have received the first part of this training and 2 of these 3 staff members have received the second part. Only one staff member who hasnt had the training doesnt have dates booked in to complete the training. We talked to the manager about needing to keep clear records for all the training that staff receive while they are working at the home. We spoke to staff who told us they have National Vocational Qualifications at level 2 or above, and information in the AQAA tells us that 75 of the staff have the qualification. However, the senior carer told us they were still working through the NVQ3, but hadnt yet completed it. They also said they had no other NVQ at a lower level. The recommended number of staff with a NVQ is 50 . There are enough staff members available when they are needed and that they get the care and support they need. One comment from the surveys were, members staff treats everyone really well. People we spoke to during the inspection said there is usually enough staff on duty. The training rota shows there are 6 staff members, 2 of them are new staff members. The Annual Quality Assurance Assessment (AQAA) also shows that 1 staff member is no longer employed by the home and 4 staff members have transferred to work in other homes in the same group. At the time of this inspection there were 3 people living at the home. Information in the AQAA shows staff need to give people little help with personal care, although there were 60 incidents when restraint was used in the last 12 months. We looked at recruitment records for the 2 new staff members employed since the last inspection. They contained most of the appropriate recruitment documents including references, application forms, and POVA/CRB checks. Gaps in employment histories werent looked at for either person, which is important so that there is an account for the time when people are not employed. We were not able to look at staff supervision records as there were none available. The manager said he has not completed these with staff, he said he had, Not got time to do this, no staff to delegate to. Staff supervision is an important part of staff management, it gives staff members and the supervisor the opportunity to discuss practice issues and learning and development needs in a private, confidential way. Staff must be properly supervised, so that they are supported to carry out their roles and to be able to meet the needs of people at the home. Care Homes for Adults (18-65 years) Page 27 of 34 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 . Health and safety checks are not always carried out, which means the home is not always a safe place to live. Although people are asked their opinion, there is nothing to show how this improves the service for them. Evidence: An annual quality assurance survey is not carried out by the home. People who live at the home are asked their opinion of the service during their person centred planning and circle meetings. However, the manager said information about the service provided during these meetings isnt measured. This means that even if information about the service is obtained, it is not brought together to show what people think as a group and what the home has done to change and improve the service they provide. We asked the home to complete and return an Annual Quality Assurance Assessment (AQAA) before the inspection. They did this within the time we asked for it and they gave us the information we asked for. Information provided before this inspection shows equipment, like electrical equipment and fire-fighting equipment has been serviced or tested as recommended by the Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: manufacturer. We looked at fire check records, including emergency alarm testing, emergency light testing and training records. These showed that checks are not recorded as being completed a often as they need to be. Fire alarm testing was carried out every week for 6 weeks in January and February 2009, but there are no entries since then and it was only completed sporadically before this 6 week period. Emergency lighting checks havent been completed since October 2008 and there are no records of fire training. We spoke to the senior carer who told us that fire alarm testing is carried out every week and said that the emergency lighting checks were also included in this. We spoke to the manager about the importance of recording this information. The manager is also the registered manager of another care home owned by the same provider. At the last inspection this situation was reported as a temporary arrangement so that the home could become established. It was thought at the last inspection that a new manager would then be appointed, although this has not happened. The manager said he spends more time at the other home and doesnt have enough time to oversee this home properly. We have found throughout this report that staff do not complete health and safety checks or understand when risk assessments should be completed, or even what risks to people who live at the home are. The manager told us that staff do not receive supervision because he does not have enough time to carry this out and there is no-one to delegate the responsibility to. It is because the manager is not able to do this that staff do not have enough guidance and support to make sure people are safe. A full time manager should be appointed to run the home. There are no records of the hot water temperature from taps throughout the home. During the inspection we took the temperature of hot water from 2 taps and found the temperature was 80 degrees, which is hot enough to cause a severe burn through scalding. Staff have not completed risk assessments to show that people living at the home can safely use water that is this hot. The manager has completed the Registered Managers Award, has a City and Guilds qualification in Advanced Care Management and has a degree in Management. He has many years experience in managing care homes. Care Homes for Adults (18-65 years) Page 29 of 34 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 1 23 12 The registered person must ensure that residents are protected from abuse and self harm 01/12/2006 2 42 12 The registered person must 01/11/2006 ensure the health and safety of residents is protected and promoted Care Homes for Adults (18-65 years) Page 30 of 34 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 1 9 13 Risk assessments must be completed where people are exposed to risks. 31/08/2009 So that people are able to continue making decisions about what they want to do, while staying as safe as possible. And, so that staff have an action plan if the risk becomes too great. 2 15 23 People must be able to meet 31/08/2009 friends in private if they wish. So that they can develop relationships of their choosing. 3 20 13 Temperatures of medication 31/07/2009 storage areas must be taken and recorded. This is so that medication is Care Homes for Adults (18-65 years) Page 31 of 34 kept at a temperature that makes sure is remains clinically effective. 4 34 19 Gaps in employment histories must be looked at before new staff are employed. 31/08/2009 This is to make sure there is an account for periods of time when the prospective employee was not employed. 5 35 18 Staff members must have 31/08/2009 mandatory health and safety training, and other training that is relevant to the work they do. Training must be given to staff, so they can safely care for people and meet their needs. 6 36 18 Staff must receive adequate supervision. 31/08/2009 This is so that they can discuss practice issues, and learning and development needs in a private environment, so they are supported to carry out their role in the home. 7 39 24 A system for measuring how 31/08/2009 well the home is providing a service to people living there must be developed. This is so that peoples are taken into consideration and an annual development plan is made to show how the Care Homes for Adults (18-65 years) Page 32 of 34 service is improving. 8 42 13 Risk assessments must be completed for hot water and use of equipment that poses a risk. 31/08/2009 This is so that people are able to live safely, while still being able to carry out everyday tasks. 9 42 23 Safety checks (including fire safety)must be recorded. 31/08/2009 This is so that people living at the home know equipment to help them and keep them safe is working properly. 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 2 Meetings with and assessments about people wishing to live at the home should be recorded so that this information can go towards forming the care plan if the person decides to live at the home. People should be able to take part in college or other education programmes to develop skills and knowledge, if they want to. The manager should be in full time day to day control of the home, so that staff are able to receive proper guidance, support and so that managerial responsibilities are met. 2 12 3 37 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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