Inspection on 24/03/09 for Copper Beech Services

This inspection was carried out on 24th 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Copper Beech Services 12/02/07

Copper Beech Services 24/01/06

Copper Beech Services 23/08/05

Copper Beech Services 10/02/05

Copper Beech Services 18/10/04

Copper Beech Services 22/03/04

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Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Copper Beech Services Ravenswood Village Nine Mile Ride Crowthorne Berkshire RG45 6BQ 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: Stephen Webb Date: 2 4 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. Care Homes for Adults (18-65 years) Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (20092008) 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 36 Information about the care home Name of care home: Address: Copper Beech Services Ravenswood Village Nine Mile Ride Crowthorne Berkshire RG45 6BQ 01344755555 01344773174 copperbeechannexe@norwood.org.uk bucketsandspades@norwood.org.uk Norwood Ravenswood Ltd T/A Norwood care home 16 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) : Number of places (if applicable): Under 65 Over 65 16 0 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) The maximum number of service users to be accommodated is 16 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 36 A bit about the care home Copper Beech Services is part of Ravenswood Village and is now registered to provide support and care for eight adults with learning disabilities. The service is now provided on one site. The service has evolved and developed into a specialist residential resource for people whose needs are within the autistic spectrum. The home is a purpose built single storey building. All of the service users are accommodated in single bedrooms. The home has equipment to assist the more dependent service users. Within the service two of the bedrooms are located within individual flats, to enable their more complex needs to be met through the provision of dedicated staffing and higher ratios, though they may also spend time with the group. The home manages a wide range of need, including challenging behaviour, epilepsy, and autism. The aims and objectives of the home are to provide a secure and comfortable home; encourage and support residents to make decisions and choices in their lives; support and assist service users to make and maintain satisfying relationships; assist service users to develop their skills; and enable service users to engage in valued day time occupation and use the community facilities. Care Homes for Adults (18-65 years) Page 5 of 36 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 36 How we did our inspection: This is what the inspector did when they were at the care home This inspection included an unannounced site visit from 10.00am until 15.30pm on the 24th of March 2009. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with the manager. Residents were unable to provide verbal feedback but the inspector also observed the interactions between residents and staff at various points during the inspection. The inspector examined the premises, including residents bedrooms. The service appeared to have lacked clear day-to-day management for a significant period until the recent appointment of the current manager who has begun to make some significant improvements and instigated some positive changes within the home. What the care home does well Residents are supported by staff to make day-to-day decisions about their lives, within the context of Mental Capacity Act assessments, and are also supported to take some risks, as part of maximising aspects of their independence. Residents are enabled to take part in a Care Homes for Adults (18-65 years) Page 7 of 36 range of on and off-site activities and to be a part of the local community. Contact with families and friends is encouraged and supported wherever possible. Residents rights are respected and they are encouraged to make decisions and choices in their daily lives. They are offered an appropriate and varied diet within the overall context of Kosher requirements. The healthcare needs of residents are generally met through regular routine healthcare checks and referral to external healthcare specialists where necessary. An appropriate complaints procedure is in place to address any concerns raised, though it was not possible to judge its effectiveness, due to the absence of any recent complaints. Residents are supported by a permanent staff team who are familiar with their needs. The provider has a recruitment procedure which safeguards residents appropriately, and provides support to them during transfers between its homes. What has got better from the last inspection Significant steps have recently been taken by the newly appointed manager to address the identified shortfalls to ensure that the home is run in the best interests of the residents. Care Homes for Adults (18-65 years) Page 8 of 36 What the care home could do better Both the Statement of Purpose and Service User Guide are in need of updating as they are out of date and do not reflect the current service. A preadmission assessment must be carried out before a resident is admitted, whether they are moving from a home within or outside the Village, in order to establish their current needs and wishes. Residents were being supported by the staff based on their individual and shared knowledge of their needs and wishes, since the care plans were out of date and needed review to ensure that they reflected the current needs, wishes, likes and dislikes of residents. The manager did not have access to the residents personal monies or records thereof, to manage these effectively on behalf of most of the residents. the current arrangements around the management of residents finances fall short of offering the proper safeguards. Although the home has an appropriate system in place to manage the medication on behalf of residents, a further system to enable any errors or omissions to be identified and addressed promptly, should be considered. Care Homes for Adults (18-65 years) Page 9 of 36 The premises do not currently provide a homely, comfortable and safe environment for residents owing to the identified decorative and repair shortfalls, some of which potentially compromise the health and safety of residents and staff. The manager needs to review the training provided to all staff to ensure that all have received the required mandatory training and relevant recent updates in order to ensure they are aware of current good practice in meeting residents needs. The home has not been effectively managed for a significant period until the recent appointment of the new manager. The identified shortfalls need to be addressed in the coming months to bring the service back up to a satisfactory standard. There is little evidence of the operation of an effective quality assurance process, to underpin the ongoing development of the service. No report of an overall review of the service or of its planned future development was available for inspection. In a number of identified areas, the health, safety and welfare of residents has not been promoted and protected effectively by the service. Care Homes for Adults (18-65 years) Page 10 of 36 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 Stephen Webb 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 11 of 36 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 36 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. Accurate information on the service is not available to prospective or current service users or their representatives, because both the Statement of Purpose and Service User Guide are out of date and do not reflect the current service. The home has failed to review the previous assessment for a recent admission, to ensure that their current needs and wishes are reflected, with result that their care plan remains in need of updating in order to fully meet their current needs. Evidence: The home had both a Statement of Purpose and a Service User Guide, but neither document appeared to have been reviewed since the copy seen at the last inspection in February 2007. Both documents need to be updated to reflect the changes made to the service, to organisational senior management, and more recently the management and staffing of the home. The provider has a satisfactory preadmission assessment procedure for prospective new admissions. Copies of assessments undertaken when individuals were first admitted to a home in the Ravenswood Village, were present on the files examined, as were some original care management assessments. However, at the point of the recent transfer of one resident into Copper Beech from Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: another home in the village, no updated assessment appears to have been done, with the result that the care plan on file (from the previous home), is out of date and does not reflect the current needs of the resident. One part of the plan was dated 2003 and another part was last reviewed in 2004. The previous assessment or care plan should have been reviewed prior to the transfer to ensure that the current needs and wishes of the resident were reflected therein. The possible impact of this omission has been lessened by the transfer of some staff from the residents previous home along with the resident, but this is not a substitute for the transfer of full and up to date information on the individuals needs. There are plans to admit a further resident to the vacant flat, from another home in the village once the flat has been refurbished for her needs. The most recent assessment or care plan must be reviewed ahead of this move, to ensure her current needs are known to the staff at admission. Care Homes for Adults (18-65 years) Page 14 of 36 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. It was not clear that the current needs and wishes of residents were represented within the care plans on file as some documents had not been subject to regular review for extended periods. Residents are supported by the staff to make day-to-day decisions about their lives, within the context of Mental Capacity Act assessments, and are also supported to take some risks, as part of enabling aspects of independent lifestyle. None of the residents is able to manage their own funds and at present the manager does not have access to the personal monies or records thereof, to manage these effectively on behalf of most of the residents. Evidence: As noted above, in the case of one resident who transferred from another home in Ravenswood Village, no reassessment or review of the care plan appears to have been completed ahead of the move, resulting in an out of date care plan still being on file at the time of inspection a week after their transfer. Hand written notes on some care plan elements also confirm that the information is not up-to-date and needs to be revised. Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: The care plan formats varied but had not been fully consolidated since the previous inspection as was suggested to be in process at the time. A variety of formats remained, some being more useful than others in terms of providing information on how the identified needs should be met. The essential lifestyle plan (ELP), format and some of the guidelines around particular activities or times of the day, were the most useful, though the ELP on one file was dated 2003. Some documents were undated, making it hard to know whether they were up-to-date and when they should be reviewed. Given that one resident had transferred from another home, there were also differences between the format of their care plan file and those of other residents. This care plan did contain useful information identifying the significant people in the residents life, and aspects of care that were important for and important to the resident. The home operates within the cultural and spiritual standards and expectations of the Jewish culture as does the entire Ravenswood Village, but there was evidence in one file of an appropriate exemption having been sought from one aspect of these expectations, in order to meet the specific needs of one resident. The new manager felt that the staff familiarity with the residents had meant that despite the need for the care plans to be reviewed, the residents current needs were known by staff and were being met from day to day. The transfer of some staff from one residents previous home to Copper Beech, will also have helped to enable continuity of care in their case. However, the care plans for all residents should be reviewed and updated to ensure that they reflect the current needs and wishes of each individual. There was evidence on file of an appropriate response to the Mental Capacity Act, in the completion of tests of capacity when working with an individual around the closure of their previous home and in planning their move to Copper Beech. There was also some other evidence of the views and opinions of resident having been sought and of them being encouraged to make decisions in their day-to-day lives, and examples of individual decision making being encouraged by staff, were also seen during the inspection process. None of the residents is able to manage their own funds. The records of the management of these on behalf of most residents were not available to be examined, due to these records and funds not having been made available to the new unit manager, despite her having been in post since the 2nd of February. This issue is dealt with in more detail under Standard 23, (Protection), later in this report. Only the cash book for the one resident who had transferred from another home, was available, none of the other records could be produced for inspection. The manager explained that she was currently having to spend petty cash to address any personal allowance needs on behalf of the other residents, and was retaining the appropriate receipts for later reconciliation against the residents funds/records when they become available. The records on behalf of the one transferred resident were appropriate and provided an ongoing balance as well as details of any expenditure on behalf of the resident. Receipts were numbered and retained, corresponding to any expenditure made. The risk assessments on the files examined were detailed and identified more of the necessary information on how the identified issues should be addressed, than some Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: other aspects of the care plans. These documents had also been reviewed more recently than others, mainly in 2008. Care Homes for Adults (18-65 years) Page 17 of 36 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. Residents are enabled to take part in a range of on and off-site activities and to be a part of the local community. Contact with families and friends is encouraged and supported wherever possible. Residents rights are respected and they are encouraged to make decisions and choices in their daily lives. They are offered an appropriate and varied diet within the overall context of Kosher requirements. Evidence: Each resident has an individual activities diary on file, though it was not clear whether these were current in all cases, owing to the identified issue of a lack of regular review of care plans. The plans did indicate a varied programme of activities, mostly provided on-site but some opportunities for off-site activities are also provided, including trampolining, drives out to local venues, one day-services provider and some clubs. Some residents also go off-site with another day-service provider for specific one-toone activities. The manager acknowledged that the majority of activities take place during the daytime, and there is room for further development of early evening Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: activities All off the residents had either one or two holidays last year in small groups or individually with staff support, and planning had begun for this years holidays. Two of the residents are involved with the Special Olympics and attend a range of training and performance events thorugh this organisation. The spiritual needs of Jewish residents are catered for via the on-site Synagogue, and the following of Jewish culture and festivals in all of the homes in the village. Should a resident have other spiritual needs these would be addressed through contact with relevant places of worship in the locality. Some documents within the care plans identified significant relatives and friends in the residents life and how contact with them was supported. In some cases key family members live abroad, and the home uses e-mail where possible to support ongoing contact, as well as letters and visits whenever relatives are in the country. Staff will support visits to family at times. Two residents have no family in contact, one of whom has occasional contact with an advocate, and the other is supported by a religious community support group. The home has a residents computer located within the dining room. It is planned to enable this for residents to use with support, to maintain e-mail contact with family where this is possible. Residents were seen to be encouraged to make day-to-day choices in their lives and are encouraged to take some part in the routines and household tasks where possible, though the level of enthusiasm for this varies. Some residents will take part in tidying their bedroom, taking their washing to the laundry and some food preparation and shopping, though others cannot cope in crowded shops. Two of the residents will shop for their clothes with staff, though sometimes choices and decisions are made back at the house from a range of options, with the rejected items being returned later. Residents may choose to be a part of the group or to spend time alone in their bedroom or elsewhere, though for one resident, a separate flat is provided to meet their needs as they often find being with the group very difficult. This resident will spend most of their time based in their own flat, when in the home. Another separate flat at the opposite end of the home is being prepared to meet the needs of another prospective resident. The flats are each provided with their own separate area of garden. The provider has recently developed an inclusion recruitment project to develop the involvement of residents in the process of staff recruitment. As yet none of the residents from Copper Beech have taken part, but the manager plans to put forward some of the staff and residents for training in the process to try to develop their involvement. Residents are offered a planned menu which has been compiled based on their known preferences, with staff maintaining a healthy eating remit and trying to adapt and provide healthy options or additions. The staff may use pictures to support residents to make menu choices, and residents were seen to be offered a managable number of options to enable them them to make choices of drinks and food. One resident is supported to manage their own daily intake of coffee via the use of a personal chart. Their diet is adapted to address swallowing difficulties for one resident. Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: Some of the food is still centrally purchased for the Village and distributed to the homes from a central stores, but the home can now go shopping to provide a more individualised menu to meet its residents preferences, whilst remaining within the overall Kosher requirements of the organisation. Care Homes for Adults (18-65 years) Page 20 of 36 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. Residents are supported by the staff based on their individual and shared knowledge of their needs and wishes; though the care plans and associated documents are not sufficiently up-to-date in all cases to provide current information and maximise consistency of approach. The healthcare needs of residents are generally met through regular routine healthcare checks and referral to external healthcare specialists where necessary. The home has an appropriate system in place to manage the medication on behalf of residents, though a further system to enable any errors or omissions to be identified and addressed promptly, should be considered. Evidence: Although some of the care plans had not been subject to recent review, the staff appeared to be aware of the current support needs of individuals, though in the absence of current information on their wishes and preferences, the likelyhood of inconsistencies in approach across the staff team was increased. Where it is up-todate, the care plan information provides clear guidance to staff about the individual preferences and wishes of residents regarding how they are supported, including where the individual is able to manage aspects of their care themselves or with minimal support/encouragement. However, there remains a need for review and Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: consolidation of the care plan-related records into a consistent and person-centred format to ensure all staff have the necessary information available to them in order to provide consistent support in accordance with individual preferences and needs. Useful information was also available in some cases, about the range of communication methods used by individuals, but it was acknowledged that there was the potential for further development of assistive communication methods, and to this end, the manager indicated she was involved in a series of meetings with a speech and language therapist to further develop this. Two residents have specific behaviour management plans in place, (physical intervention and withdrawal plans), these had both been subject to regular review, and there had been no instances of such interventions having been needed recently. Healthcare records were seen on the files examined, which indicated appropriate referals to external healthcare professionals and in most cases, regular routine checkups as would be expected. The home has an appropriate system in place to manage the medication on behalf of the residents, none of whom are able to manage this for themselves. The medication file includes a photo of the resident, together with the current Medication Administration Record (MAR) sheet, and information on their prescribed medication, and the relevant GP and pharmacy contact numbers. Specific PRN (as required), guidance is also in place for as required medication, as well as details of any approved homely remedies. Where specific administration methods are used, these are also documented within individual guidance. The MAR sheets include a record of the quantities of medication received by the home in order to support the required medication audit trail, along with a returns log. However, examination of the records indicated some gaps on one day, where medication had been given but not recorded. The manager agreed to investigate this further. It is suggested that the introduction of a handover check of medication records might be helpful in identifying any such issues in timely fashion. Care Homes for Adults (18-65 years) Page 22 of 36 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. The service has an appropriate complaints procedure in place to address any concerns raised, though it was not possible to judge its effectiveness, due to the absence of any recent complaints. Systems are in place to safeguard residents from abuse, for the most part though the current arrangements around the management of residents finances fall short of offering the proper safeguards. Evidence: The home has a satisfactory organisational complaints procedure, and there is a picture supported version within the Service User Guide, to be used when explaining the process to residents. The complaints log had no recent entries, with the last one being dated July 2003. It was not possible, therefore, to examine the operation of the complaints procedure in operation. The manager had noted four complaints within the completed AQAA questionnaire, which were really expressions of concern from relatives, about the plans for the reconfiguration of the service, which were addressed appropriately at the time. No complaints about the service have been brought to the Commissions attention for forwarding to the provider since the last inspection. A copy of the latest multi-agency Vulnerable Adults Safeguarding protocol was available as well as the organisational safeguarding and whistle-blowing policies. The provider has their own safeguarding coordinator who liaises with the external safeguarding teams where appropriate. There had been no safeguarding issues about the home reported in the last twelve months. Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: However in one aspect of safeguarding, the provider was potentially failing to satisfactorily protect residents. The recently appointed manager had, after seven weeks in post, still not been given access to residents held funds or the records of their previous management, and residents needs were being provided for via loans from the homes own funds, in the interim, to ensure they were met. During the inspection, the manager was able to obtain the records of the management of funds on behalf of the one resident who had recently transferred into the home, which indicated appropriate recording of expenditure and the retention of receipts. However, no evidence was available of the management of the remaining residents funds since the last inspection, and therefore the manager did not have access to these records in order to manage them herself. This issue is also highlighted within the March Regulation 26 monitoring visit report. The manager must be provided with the records of management of residents monies to enable their effective ongoing management. Care Homes for Adults (18-65 years) Page 24 of 36 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 premises do not currently provide a homely, comfortable and safe environment for residents owing to the identified decorative and repair shortfalls, some of which potentially compromise the health and safety of residents and staff. Due to the above the home does not provide satisfactory standards of hygiene in all areas. Evidence: Since the last inspection the service had been reconfigured with the closure of one of the two previous buildings and now offers eight beds within one building, two of which are provided within separate flatlets at either end of the building, to meet the assessed needs of specific residents who do not function well within a larger group setting. One of these flats was empty at the point of inspection though a prospective resident had been identified within the Village. The standard of decor in the communal areas was generally satisfactory, and the bedrooms were individualised to suit their ocupants. However, one of the bathrooms was in a poor state of decor and repair with mould on areas of the walls and torn flooring, and a further shower room and a toilet also needed re-flooring. One of the bedrooms was also in need of redecoration, and one had a stained carpet. These works need to be addressed to bring the premises up to a satisfactory standard. The condition of the identified bathroom, in particular, presents potential health and safety concerns, and the damaged flooring in these areas could limit the effectiveness of cleaning and infection control regimes as well as presenting a potential trip hazard. The march Regulation 26 monitoring report also highlights some of the above issues and others which need to be addressed. There were plans for the Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: complete refurbishment of the empty flatlet in preparation for the identified residents move into the home, including work to provide an area of wheelchair-accessible garden space. The planned works include appropriate provision to address the prospective residents identified needs. The home has a pleasant garden space, though its useability has yet to be maximised by the provision of paths and an area of patio or decking to improve accessibility. The two separate flatlets each have a small separately fenced area of garden for the exclusive use of their residents. The home has an appropriately equipped laundry to meet residents needs, and standards of hygiene seen on the day of inspection were good aside from the issues identified above, which potentially compromise health and safety. Care Homes for Adults (18-65 years) Page 26 of 36 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. Residents are supported by a permanent staff team who are familiar with their needs. The provider has a recruitment procedure which safeguards residents appropriately, and provides support to them during transfers between its homes. The manager needs to review the training provided to all staff to ensure that all have received the required mandatory training and relevant recent updates in order to ensure they are aware of current good practice in meeting residents needs. Evidence: At the point of inspection there were no staff vacancies, with all post holders being permanent staff. Two full-time and one part-time staff had transferred from another home in the Village at the same time as the resident who also recently transferred. The usual staffing at the time of inspection was four staff throughout the waking day, with two staff on waking night duty nightly. This will be increased when the current vacancy is filled, and some staff will also transfer across to Copper Beech from the other home at the same time as the resident transfers to support the continuity of care through the transition. New rota systems have recently been introduced by the provider, which no longer provide for a planned overlap between shifts for handover for all staff, replacing this with a short planned handover between one individual each from the outgoing and incoming shifts. It is recommended that this new system is kept under review in terms of the continuity of information, the sharing of ideas, and practice consistency within the team, to ensure that no detriment can be indentified from its introduction. Of the eighteen staff in post, ten were reported to have attained NVQ level 3, with a further three working towards this and two more due to commence Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: this in the near future. The manager stated there had been no recent external recruits to the home, with all staff having been employed within homes in the Village for over three years. (Prior to the last key inspection). There were therefore no recent recruitment records to examine. Previous inspections of recruitment practice have indicated that the provider has an appropriate process and recording systems in place. This will be re-examined at the next inspection. The provider has developed an inclusive recruitment project which has been operating for the last eight months, which provides for the training of some residents to take part in recruitment processes for new staff and training for key staff in supporting them to do so. The manager plans to explore residents interest in taking part in this scheme. The available training records were cumbersome and did not provide easy access to information on the last dates when all members of the team received relevant training and updates. There appeared to be some gaps in the mandatory training provided and some long intervals between refresher courses in some cases. The manager should review the position with regard to all mandatory training and any specifically relevant courses with the home, in order to ensure that any shortfalls are addressed so that all staff are enabled to remain up-to-date with their knowledge and practice at all times. The manager indicated that a new cycle of regular supervison was about to commence, and that all staff would be receiving an appraisal in the next six weeks. Available evidence indicated that supervision had not been provided consistently in the period leading up to the appointment of the new manager. Care Homes for Adults (18-65 years) Page 28 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has not been effectively managed for a significant period until the recent appointment of the new manager. There are identified shortfalls in various areas which need to be addressed in the coming months to bring the service back up to a satisfactory standard. Significant steps have recently been taken by the newly appointed manager to address the identified shortfalls to ensure that the home is run in the best interests of the residents. There is little evidence that the views of residents or other stakeholders have been sought within the context of a quality assurance process, to underpin the ongoing development of the service. No report of an overall review of the service or of its planned future development was available for inspection. In a number of identified areas, the health, safety and welfare of residents has not been promoted and protected effectively by the service. Evidence: The home has had a new manager since February the 2nd 2009 following a period where it was not directly managed by a dedicated manager, but was one of two services being managed by the previous post holder. There is evidence that during that period the service was not overseen with sufficient rigour under the management arrangements that were in place. No records of regular staff supervisions and Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: appraisals during the period were available, and team meetings were not held consistently. There were gaps in recorded mandatory training, elements of required records were not available for inspection, and the care plans had not been reviewed and revised effectively following the previous inspection. No annual development plan for the service was available for inspection, and no evidence was available of a recent quality assurance survey having been undertaken. The new manager has worked to re-establish a range of appropriate systems in the short time since being appointed and has reinstated more regular team meetings. She has plans to reintroduce regular supervisions and appraisals. The new manager continues to attend regular training updates to maintain her knowledge of current practice. She has submitted an application to become registered manager, has NVQ 4 in management, and is undertaking NVQ 4 in adult care, having had previous experience with children with learning disabilities within the provider organisation. No evidence was available of a recent quality assurance survey of residents, relatives, staff and other stakeholders. There were records of some management audit processes having taken place but these do not seem to have led to the shortfalls identified within this inspection being addressed. Two different formats for monthly Regulation 26 monitoring visit reports were present, one of which does not address the required observation of interactions with residents or provide for records of feedback of conversations with staff, and is in the form of a tick-box management audit sheet. One recent report (4th of March 2009), in a more detailed format including qualitative commentary, also identifies the need for the care plans to be updated, raises the issue mentioned below regarding the non-closure of the office fire door and other issues raised within this report, and as such is a useful signpost to senior management of some of the issues facing the new manager. Some of the issues raised within regulation 26 reports had been addressed but the office fire door still did not self-close as required. The manager provided a copy of an e-mail sent to the in-house maintenance department on the 19th of March to pursue this matter, but this still remained unresolved on the day of inspection, having been outstanding since early in February. An effective quality assurance system needs to be established and a survey of the views of stakeholders undertaken to provide a baseline for the new service. The outcomes should be summarised in a report which is made available to contributors and should feed into the creation of an annual development plan for the home over the next year. Examination of a sample of health and safety-related service certification indicates that appropriate servicing has taken place of gas and electrical appliances, the fire alarms and extinguishers. The new manager had reviewed the majority of risk assessments though the fire risk assessment had yet to be reviewed, but was in place. The last recorded fire drill took place in November 2007, so a regular cycle of fire drills needs to be reinstated. (Also noted within the March Regulation 26 report). The manager had already reinstated the weekly fire alarm testing, which had lapsed. Accident records indicated a low level of accidents. Copies were filed collectively, separated by resident, with a copy also being placed on the relevant residents file. Some of the previous accident records were not filed in date order, but the manager Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: agreed to address this. The health and safety issues identified earlier in this report around the bathroom and toilet facilities also need to be addressed. Care Homes for Adults (18-65 years) Page 31 of 36 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 39 24 The provider must establish 12/04/2007 an appropriate quality assurance system to seek the views of relevant parties about the operation of the home, in a systematic way. A summary report of the findings of the survey, should be made available to participants. Care Homes for Adults (18-65 years) Page 32 of 36 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 2 14 The manager must ensure that the current needs and wishes of the prospective resident are identified and documented prior to admission. 23/05/2009 In order to ensure that their current needs and wishes are identified for inclusion in the care plan. 2 6 15 The manager must ensure 23/05/2009 that all of the residents care plans are reviewed. To ensure that each represents the current needs and wishes of the resident, and how these should be met. 3 23 17 The provider must ensure that appropriate records of the management of 23/05/2009 Care Homes for Adults (18-65 years) Page 33 of 36 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 residents funds are maintained and available for inspection. In order to evidence the proper safeguarding of residents funds and to enable the manager to manage these effectively. 4 24 13 The identified shortfalls with 23/05/2009 respect to decor and repair within bathing and toilet facilities must be addressed. In order to address the potential risks to the health and safety of staff and residents. 5 37 12 23/10/2009 The provider must ensure that the manager is supported to address the various shortfalls identified in the previous management and systems within the home. In order to demonstrate that the home is being run in accordance with the principles of Regulation 12. 6 39 24 The provider must establish an effective quality assurance system which provides for the seeking of the views of relevant stakeholders, on the 23/07/2009 Care Homes for Adults (18-65 years) Page 34 of 36 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 operation of the home, and reports on the outcome. In order to demonstrate that the views of residents and other stakeholders underpin the development of the home. 7 42 13 The provider must ensure 23/06/2009 that the identified health and safety issues are addressed promptly. In order to ensure that the health and safety of residents and staff are safeguarded. 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 35 The manager should review the mandatory and other training provided to all staff to ensure that they remain aware of current good practice at all times. Care Homes for Adults (18-65 years) Page 35 of 36 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). 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. 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