Inspection on 27/08/09 for Conroy Close (2)

This inspection was carried out on 27th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Conroy Close (2) 29/08/07

Conroy Close (2) 20/09/06

Conroy Close (2) 14/02/06

Conroy Close (2) 11/10/05

Conroy Close (2) 15/03/05

Conroy Close (2) 20/07/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood Hall

Muston Road (70)

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

Key inspection report Care homes for adults (18-65 years) Name: Address: Conroy Close (2) 2 Conroy Close Easingwold North Yorkshire YO61 3NS     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: Rachel Martin     Date: 2 7 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Conroy Close (2) 2 Conroy Close Easingwold North Yorkshire YO61 3NS 01347821488 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): h1002@mencap.org.uk www.mencap.org.uk Royal Mencap Society Name of registered manager (if applicable) Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Service Users to include up to 6 (LD) and up to 6(LD(E)) up to a maximum of 6 Service Users. Date of last inspection Brief description of the care home Number 2 Conroy Close is registered to provide residential care for up to six people. It is registered to provide care for younger adults with learning disabilities, although the home is also registered to provide care for older people providing their needs are primarily those of someone with a learning disability. The registered provider is Mencap, who leases the building from a landlord and provides the care. The home is a single storey bungalow, providing single bedroom accommodation and suitable communal space. There are pleasant patio and garden areas. Conroy Close is situated in a residential area, close to the local services and amenities of Easingwold. Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 6 6 Brief description of the care home At the time of this inspection the homes fees were £911.85 per week. Up to date information about the homes fees and terms and conditions should be sought directly from the homes manager. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection of Number 2 Conroy Close. The site visit was completed on 27th August and was completed by one inspector. We looked at a selection of records, observed care practice and meal times, looked around the building and talked to people who live at the home, the staff and management. Before our inspection visit we reviewed all of the information we had received about the service since the last inspection and we asked the home to complete a selfassessment. This was completed well and returned to us on time. It provided the information we had asked for and told us what the home did well and what could be improved. We also sent surveys to a selection of people who live at Conroy Close, a selection of staff and some of the health and social care professionals (such as doctors and district nurses) who work with the home. Six people who live at the home completed and Care Homes for Adults (18-65 years) Page 6 of 33 returned surveys, with the help of their support staff. Four of the homes staff and three health or social care professionals also returned surveys. The survey results have been included throughout the report where appropriate. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Better assessment records are needed, so that detailed information about peoples needs is written down and is available to staff when the person moves in. Care Homes for Adults (18-65 years) Page 8 of 33 Although staff are working to improve peoples support plans, not everyone living at the home currently has a detailed support plan setting out their needs, wishes and preferences. This is important so that staff have detailed information about the persons care needs and how they want their support to be provided. Medication recording practice needs to improve to ensure that people receive the medication they are prescribed and are protected from the risk of medication errors. At the moment staff are not recording everything they should and the records do not provide accurate information about the medication people are prescribed. Training records need to improve so that it is clear what training staff have completed, what additional training they may need and when training up dates are due. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are introduced gradually to the service, to help make sure it is the right place for them to live and to help them get to know the other people who live and work at Conroy Close. However, better assessment records are needed, so that detailed information about peoples needs is written down and is available to staff when they move in. Evidence: In their self assessment the manager told us that they have a flexible admissions process in place, which includes assessments. They also told us that they want to improve the service by developing more consistent assessment records, including more detail & life history in peoples records and by improving links with the local authoritys care managers. Since the last inspection a vacancy has become available at Conroy Close and a new person has moved into the service. We talked to staff about this process. They told us that the home had worked with the local authority, the person who was moving into the home and their family, over a long period of time before they moved in. This had Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: included short visits to the home so that the new person could meet the other people who live there and meet the staff. There were also meetings with other professionals to plan the move and make sure that Conroy Close was the best placement for the person. We met the person and they told us that they liked living at the home and that they were getting used to it. We looked at the new persons records to see what assessments and records had been completed before they moved in. There was a record of a meeting with other professionals, planning the persons gradual introduction to the home and there was a copy of a brief care plan that had been provided by the local authority. However, there were no comprehensive assessment records to demonstrate that a full assessment of needs had been completed before the person moved in. This is important, because detailed written information about the persons individual needs should have been available to staff when the person first moved in to the home. There also wasnt a detailed support plan available for this person and this is discussed further in the individual needs and choices section of this report. Care Homes for Adults (18-65 years) Page 12 of 33 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. Although staff are working to improve support plans, not everyone living at the home currently has a detailed support plan setting out their needs, wishes and preferences. Evidence: In their self assessment the manager told us that individual support plans are in place and are reviewed regularly, that the support plans include risk assessments and are completed with input from the individual and significant others, such as family and professionals involved in their care. They also told us that person centred reviews are coordinated by a trained person, include the individual and look at their wishes and aspirations. The manager told us that they want to improve the service by including more detail in support plans, giving staff more time to review and develop the support plans and by ensuring that new staff are trained in person centred planning. We talked to staff about peoples support plans and how people are given choices and helped to make decisions. Staff comments about the homes care records and support plans included now we are all involved and have an understanding of things like the Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: support plans and obviously weve never done them before, so its taken a lot for staff to do them, but I do feel more confident now. Staff also told us that people have keyworkers, who help people to make decisions about their daily lives (such as activity timetables and holidays) and are involved in reviews. We saw peoples person centred reviews in their records. These showed that people had been involved in discussions about their care and what their wishes and aspirations for the future were. Not everyone at the home has had a person centred review yet, but Mencap aim for everyone to have one each year. We looked at two peoples care records and support plans. One person had moved into the service this year, but they didnt have support plans in place yet. Risk assessments and some information about their care needs were available, but there wasnt a detailed support plan in place telling staff about the persons care needs, wishes and preferences. The other persons records did contain more detailed support plans and included pictures to make the information easier to understand. These records did provide staff with information about the persons needs and preferences. Discussions with the manager confirmed that staff are working on improving the support plans at the home, but that this is still work in progress at the moment. During our visit we observed staff offering people choices about their daily lives, such as what they wanted to do, if they wanted to go out, what they wanted to eat and where they spent their time. People who live at the home told us that they do get to make choices about their daily lives and that staff try to help them to do things safely, with comments including yes I do and but I have to have someone to go with me. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily life in the home and the activities organised outside in the local community meet peoples needs. Evidence: On the day of our visit three of the six people who live at Conroy Close were out at day placements. The other three were having a day at home, with one person going out for a walk with staff in the morning. During our visit people spent time in their rooms or in the communal lounge and dining areas, depending on what they preferred to do. Staff interacted well with people, helping them play the organ, read books, listen to music in their rooms or tidy up their jewellery collection. Staff we spoke to confirmed that they work flexibly to fit in with peoples lifestyles. For example, staff said staff here are very flexible to accommodate peoples appointments, trips and holidays, they get absolutely all over and sometimes if there is a party we mightnt finish until after 11 oclock. The local community support team also visits the home to Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: support people and help them do the activities they want during the week. One person told us how they wanted to go horse riding and that staff were trying to organise this for him, although staff told us that it was proving difficult to find anywhere near by that could provide this activity. Two people who live at the home are soon going on holiday and were looking forward to this. One person is interested in gardening, having always helped with the garden at home. As a result of this a new vegetable patch has been made in the homes garden and the manager is buying a greenhouse for the person to use. Staff comments included we are very flexible to meet the needs of our residents, we are working to enable our residents to reach their goals and dreams. In surveys all six people who live at the home told us that they could do what they wanted during the day and in the evenings. However, only two people said that they could do what they wanted at weekends. Comments made to us about about what the service could do better including community support on a weekend for service users to go out, I would like to get out more on a weekend, they take me out when staffing levels allow it and I would like more staff on at the weekend. We talked to people about the meals provided at Conroy Close. People who live at the home told us that the food was nice and that they got a choice, with comments including the food is very nice, but I dont like to get too fat, I like when staff cook and I can help and they make a good cup of coffee and make nice meals. Staff comments about the food included the new manager has made it more about the residents choice, they eat very well, they all get a choice and are involved in picking what they want and its a cooked dinner every evening. One staff member now helps to make up the homes menus, which are used as a guide for the main meals and shopping. Each day a different person who lives at the home gets to choose what the main meals are, with alternatives always being available if other people dont want the same thing. We looked at the current menus and saw that a variety of meals are provided and that a different person was being asked to choose the main meal each day. We saw drinks being offered during the morning, with staff offering to make people who live at the home drinks when they were making one for themselves. We also joined in with the lunch time meal. Staff made people hot drinks and sandwiches, with a choice of fillings and bread, depending on what people liked or wanted. We tried the sandwiches and found them tasty and nice to eat. The staff and people living in the home ate together in the dining room, making the meal a pleasant, social occasion. One person uses a special plate, spoon and cup to help them eat independently and the staff on duty were aware of this. Chocolate biscuits were offered after the sandwiches as a pudding. The main meal is served in the evening. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: The homes self assessment told us that staff dont use nutritional screening as part of their assessment and support planning processes. Staff we spoke to and the records we looked at confirmed this, although the support plans we looked at did contain information about the support people needed with eating and drinking. Using nutritional assessment tools would help staff to identify people who need support to maintain their weight or a healthy diet and enable more preventative action to be taken if needed. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the help and support they need with their personal and health care. However, medication recording practice needs to improve to ensure that people receive the medication they are prescribed and are protected from the risk of medication errors. Evidence: During our visit we observed staff providing care and support to people. The staff we saw were friendly and polite, treating people well. We also talked to people about the care and support they received. Comments made to us during our visit and in the surveys people completed included oh the staff are nice, they are good at looking after me, I like that I can have a bath everyday and the staff are very friendly. Comments made by health and social care professionals who returned surveys included generally well trained staff, seek help appropriately from GP practice, I believe the service provides a good standard of care and proficiency and very pleased with quality of care they give to my customer and the communication they make with me. All three professionals also said that the service always sought advice approriately and acted on it to meet peoples health and social care needs. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: We talked with staff about how care and support was provided. Staff told us about the keyworker system, where each person living at the home has a named person who helps to organise their care. For example, helping to make sure records are kept up to date, that people have the toiletries and clothes they need, advising and helping people organise their work timetables and planning holidays and events. Staff also told us how they tried to work flexibly to fit in with peoples preferred routines. Staff comments included most get a bath every day, one gets one at least every other day, some like morning, others like evening, it depends and I think we give a high level of care really. The records we looked at contained some information about peoples needs and preferred routines, to help staff know what support people needed. The records we looked at also contained information about any specialist health needs the person had. For example, information about epilepsy, seizures and the persons treatment. The involvement of other professionals, such as the doctor, occupational therapist, chiropodist and persons care manager, was also recorded. The manager is currently working with staff to improve the consistency and detail contained in peoples support plans and this is discussed more in the individual needs and choices section of this report. We did notice that there were some unlabelled toiletries and communal bars of soap left in the bathrooms. The use of communal toiletries doesnt promote peoples privacy and dignity and people should always use their own personal toiletries. The manager told us how she was aware of this issue and was already working with staff to improve this practice. We looked at the way medication is stored at the home and how staff record information about medication. The home currently uses the Boots blister pack system, which is supplied by a local pharmacist. Medication was appropriately stored in a locked room with locked cupboards. However, we found that staff were not recording information on the medication administration records (MARs) properly. For example, medication that was received into the home was not being signed in on the MAR and when we tried to check stock balances against the recording on the MAR we found that they didnt balance up. Medication that had been discontinued was still written up on the MAR, with no record of it having been discontinued. This is potentially dangerous as people could be given medication they no longer need. Some medication that needed to be disposed of within a certain time period had not been labelled with the opening date. This meant that staff wouldnt know when it expired and should no longer be used. We also found some medication that had been put up in an unlabelled Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: dossette box and it was unclear who or what these were for. This suggests secondary dispensing may sometimes take place, which is an unsafe practice. We discussed these issues with the new manager, who agreed to urgently improve these practices and seek the guidance of a pharmacist, so that safe medication systems are put in place. Care Homes for Adults (18-65 years) Page 20 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the homes systems for handling complaints and concerns. Evidence: In their self assessment the manager told us that the home has in place a complaints procedure, which is displayed in the home and made available to people who live at the home and their families. One of the improvements the new manager wants to make is making the complaints procedure more visually accessible to all of the people who live at the home. For example, using pictures and different wording. There have been no complaints about Conroy Close made directly to us since the last inspection. In their self assessment the manager told us that there have been no formal complaints made directly to the home either. The manager confirmed this during our visit. People we spoke to told us that they could speak to staff if they were unhappy about something. Comments included Ive done that when I was upset. In their self assessment the manager told us that the induction training undertaken by all staff includes training on safeguarding adults. They also told us that all staff have received more training on safeguarding adults within the last year. Staff we spoke to confirmed that they have been trained on abuse and safeguarding and knew how to report any concerns they had. Comments included I feel that if they do have any problems theyre not scared to report it, put it that way. People we spoke to felt that the new manager would deal with any problems properly. There have been no Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: safeguarding issues at the home since the last inspection. Staff at the home act as appointees for five people who live at Conroy Close. Peoples money is kept in individual bank accounts, with small amounts of personal money being stored in the homes safe. Staff check the money and records each day to make sure they are correct and that all cash is fully accounted for. Checks are also done on a regular basis by the manager and area manager. This help to protect people. We checked one persons records and cash tin and found that they were correct, with receipts available for purchases. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live and work in a pleasant and homely environment, which is well maintained and a safe place for people to live. Evidence: During our visit we looked around the home, including spending some time with people in their rooms. Number two Conroy Close is a purpose built bungalow, with pleasant outside patio areas and a good sized garden. The communal areas consist of a lounge, dining room, kitchen, utility room, toilet and two bathrooms. There are also six bedrooms, a staff bedroom/office and small clinic room. The home is decorated and furnished in a comfortable and homely style. People had individualised their bedrooms, with people choosing their own bedding and furniture. The home was generally well decorated and maintained, although some of the communal areas are now due to be redecorated. Mencap are currently in negotiations with the landlord over whose responsibility this is. Specialist equipment, such as assisted baths, accessible toilets and lifting and handling equipment are in place. The manager told us about improvements they are hoping to make to the home. These improvements included plans to install a shower and refurbish one of the bathrooms, giving people the choice of a shower or bath. Further plans for Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: improvements included adapting the kitchen with adjustable height units, so that it was more accessible for people using wheelchairs. The manager told us how people living at the home like to help with the cooking and washing up and that better facilities would make this easier for people. We noticed that the majority of doors had self closing devices fitted, meaning that people can prop doors open safely, knowing that they will shut automatically if the fire alarm goes off. However, some doors hadnt yet had these fitted and they were sometimes being held open with stuffed toy animals, so that people could get in and out of rooms more easily. We found that the home was clean and tidy during our visit. The home doesnt have domestic staff, with support staff doing the cleaning and supporting the people who live at the home to assist with domestic tasks where this is appropriate. Staff told us how each persons laundry is washed separately and that people have their own bedding and towels to use. This is good practice, promoting infection control and peoples privacy and dignity. Domestic washing machines are available in the utility room and at the time of our visit were considered suitable for the needs of the people living at the home. The managers self assessment told us that eight out of thirteen permanent staff have completed infection control training. Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive care and support from staff who have been carefully recruited and provided with the training they need to do their jobs. Evidence: In their self assessment the manager told us that robust recruitment procedures are in place. We looked at the recruitment records for two staff who had started to work at the home in the last year. The records showed that people had to complete an application form and attend an interview before they were offered a job. The new staff didnt start to work in the home until the required checks and written references had been obtained. New staff then had a six month probationary period, during which their performance was monitored through regular reviews. Prospective staff meet the people who live at the home as part of the interview and selection process. However, in their self assessment the new manager told us that they want to improve things by involving people more in the recruitment of their staff. On the day of our visit there were three people at home, with three staff and the manager on duty during the morning. We talked to staff about staffing levels at the home. Comments included I think we are quite well staffed here, although sometimes it is difficult, for example on a weekend with two staff and weekends are a lot better when theres three on. Staff also told us that the manager had recently raised staffing Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: levels at weekends to three, where this was possible, and that they were recruiting more relief staff to make covering shifts easier. In their self assessment the manager told us that 50 of staff working at the home have achieved a National Vocational Qualification (NVQ) in care. During our visit we confirmed that all but two new staff have either achieved an NVQ or are working towards one. Staff we spoke to were positive about the training they were provided with, saying theyd covered things like manual handling, first aid, infection control, dementia, epilepsy and medication. They also told us that they updated important training regularly. One staff member told us how they had requested dementia care training and that this had been arranged for them. Staff comments included the training with Mencap is fantastic and its quite good with training, were quite up to date with that really. All four staff who returned surveys said that they were given training that was relevent, kept them up to date and helped them understand and meet peoples needs. They also told us that their induction training had covered everything they needed to know very well. Staff do have individual development files and the two we looked at confirmed that the staff had completed their induction training and important training such as safe manual handling, fire and safeguarding. However, it was difficult to get a full picture of the training that all staff had completed from the records available at the home. The new manager had started to put together a training matrix, showing all of the staff and the training they had completed, but this wasnt yet fully up to date. Staff we spoke to felt that the manager supported them well and confirmed that they now received supervision and attended regular team meetings and development days. Comments included very supportive and staff morale and team work is better now. Records we looked at suggested that the new manager has started to implement staff supervision sessions, although they arent yet taking place at two monthly intervals. Comments made by staff who completed surveys included we have high standards and all the staff are very flexible so the residents are put first. There is good communication between staff and managers, the level of care in my opinion is high. We are very flexible to meet the needs of our residents. We go on various training which is relevant to our roles and it is a good friendly environment to work in, where the clients are always put first, with good practices and helpful management. Care Homes for Adults (18-65 years) Page 26 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate management arrangements are in place, ensuring that the home is run in the best interest of the people living there. Evidence: Since the last inspection there has been a change of manager at the home, with the new manager being in post for approximately three months. The new manager was on duty when we visited and was fully involved in the inspection. Staff were positive about the new manager, telling us that they could approach her. Comments included Diane is very down to earth and approachable, I think everybody has adjusted quite well and yes, I can definitely go to the manager, shes very supportive. We talked to the manager about the home and felt that she already has a good understanding of the service and the improvements that are needed. In the homes self assessment she clearly showed the direction she wants the service to develop in and has good plans in place for improvement. Staff we spoke to were also positive about the changes that the new manager was making. Comments made to us included its changing slowly but surely, but it takes time, I enjoy coming to work again now, to Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: be honest before I didnt, you can see the difference with things, can see the benefits of what Diane is trying to do and it was totally upside down, I personally feel more comfortable because I know what Im doing more now. However, the new manager hasnt yet applied for registration with us and must do so as soon as possible. In their self assessment the manager told us that important maintenance inspections and services of the homes equipment had been completed and were up to date. We randomly checked some of the homes maintenance records and confirmed that this was the case. For example, the gas safety and electrical wiring certificates were up to date. We also looked at the homes fire safety files. A fire risk assessment was completed in April 2008, but hadnt been updated since. Records showed that staff were up to date with yearly fire training, but the home needs to hold more fire drills or practices to make sure that everyone knows what to do in the event of a fire. Records showed that the fire alarm and fire equipment are checked each week, to make sure they are working correctly. The fire alarm had been serviced in May 2009. Other health and safety checks were also taking place, such as hot water temperature checks. Staff told us that they received important training, such as manual handling, first aid and infection control and that this training is updated regularly. In their self assessment the manager told us we have recently introduced a new quality monitoring framework which will incorporate the views of service users and where appropriate families. We talked to the manager about these systems and the changes she is making in the home. She is aware of what needs to improve and has plans in place to make things better. The manager also wants to improve the quality assurance system further by getting more feedback from other people who visit the home, such as health and social care professionals. Care Homes for Adults (18-65 years) Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 A full assessment of needs 31/10/2009 must be completed and be available at the home before someone moves into the service. Although an appropriate assessment and introductory process was carried out, a full written assessment that pulled together all of the information gathered during this process was not completed or available. This meant that staff at the home did not have access to detailed written information about the persons needs when they moved in. 2 6 15 Each person living at the home must have in place an individual plan (support plan) detailing their support needs and preferences. The individual support plan should form the basis of the 30/11/2009 Care Homes for Adults (18-65 years) Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action care and support provided, in agreement with the person living at the home. It should be a working document that provides staff with detailed information about the persons individual care needs and preferences. 3 20 13 Secondary dispensing of medication must not take place. Secondary dispensing is an unsafe practice. Alternative safe practices should be discussed with a pharmacist and put in place where necessary. 4 20 13 Medication Administration Records (MARs) must be kept up to date and accurately reflect the medication that people are prescribed, what medication they have been given and what medication has been received and is available in the home. If the MARs are not kept up to date and accurately reflect the medication people are prescribed, people are at an increased risk of not receiving the medication they need and experiencing medication 31/10/2009 31/10/2009 Care Homes for Adults (18-65 years) Page 31 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action errors. An accurate audit trail of medication should also be available so that staff can check that people are receiving the medication they need. 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 3 16 17 29 The service should look at how choices about activities and outings can be improved at the weekends. Nutritional Screening and reviews should be developed as part of the homes support planning processes. Appropriate automatic door closure systems should be fitted to the doors that do not already have them fitted. This will ensure that doors are not propped open inappropriately and that people are protected in the event of a fire. Up to date staff training records should be available at the home. A training matrix would enable the manager to easily see the training that staff have completed, including what training is still required and when updates are due. Formal staff supervision should take place on a two monthly basis. The new manager should apply for registration with us as soon as possible. Although regular fire training is provided for staff, people would benefit from regular fire drills or practices to ensure that they know what to do in the event of a fire. The fire risk assessment should be reviewed on a yearly basis. 4 35 5 6 7 36 37 42 8 42 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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