Inspection on 05/03/09 for Cornview

This inspection was carried out on 5th 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cornview 30/03/07

Cornview 04/10/05

Cornview 13/06/05

Cornview 22/12/04

Cornview 07/07/04

Cornview 14/07/03

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Hillview Farm

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Cornview 124 Roman Road Basingstoke Hampshire RG23 8HS     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: Damian Griffiths     Date: 0 5 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. 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. 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 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Cornview 124 Roman Road Basingstoke Hampshire RG23 8HS 01256350827 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): cornview@liaise.loddon.co.uk Liaise Loddon Ltd Name of registered manager (if applicable) Mr Kefasi Mamhungu Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 4. 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). Date of last inspection Brief description of the care home Cornview is a care home providing personal care and accommodation to four young adults who have autism and associated complex behaviours within the category of learning disability. The home is owned and managed by Liaise Loddon Ltd. The home is a four bedroom detached bungalow with a communal lounge and dinning room that opens out to a paved patio and enclosed rear garden. The home is in the heart of Basingstoke and is close to all the local amenities, which are regularly used by service users. Care Homes for Adults (18-65 years) Page 4 of 33 care home 4 Over 65 0 4 Brief description of the care home Service users are supported by the home?s staff to access the community and engage in meaningful activities. 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 key unannounced inspection took place over a period of eight hours. The registered manager Mr Kefasi Mamhungu was available throughout the inspection process and represented the establishment. A tour of the premises took place and a number of documents and files including 3 service user care plan folders,staff recruitment files and the annual quality assurance assessment (AQAA) was examined as part of the inspection process. A selection of CSCI surveys were distributed during the inspection to service users and care staff and the local GP visiting the home also gave his views. Service users were unable to complete the CSCI surveys independently and were totally reliant on the care Care Homes for Adults (18-65 years) Page 6 of 33 staff to interpret and record their views. One service user chose not to contribute to the survey. A CSCI survey was also conducted over the phone with a relative of one of the service users. The results of the surveys are included in this report. Six care staff completed the CSCI surveys and another was received from a health care practitioner. A total of 10 completed CSCI surveys were received. Comments received during inspection and appearing in the homes annual quality assurance assessment That are also featured in this report. In the interest of confidentiality some words have been changed. The manager advised that the current fees ranged from 2800 pounds and 4100 pounds per week. This varied according to the level of support required. What the care home does well: What has improved since the last inspection? What they could do better: It was necessary to make three requirements following inspection of Cornview. These included; An accurate record must be kept of all medication administered to service users. The number of entries left blank on the medication administration record chart was not acceptable. In the interest of safe medication handling all medication must be stored at the correct temperature as directed. A thermometer must be kept in a medication cabinet. The medication cabinet used must be capable of maintaining the medication at the correct temperature levels as directed by prescription. Daily temperatures records must be made to ensure that the cabinet is keeping the medication within the correct range of temperature and that the quality of the medication held in it can be assured. The roles and responsibilities of the current management structure had fostered inconsistent management at the home and poor communication had resulted in low morale amongst staff that would not benefit the service users in the long-term. Care Homes for Adults (18-65 years) Page 8 of 33 A good practice recommended was made, that a copy of any personnel documentation relating to care staff ID that is in the process of being sent away for renewal should be retained in the personnel file. 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 –03000 616161. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A comprehensive procedure for assessing the needs and aspirations of potential new service users was in place however there had not been any new service users for some time. Evidence: Cornview, owned by Liaise Loddon Ltd provided The Statement of Purpose available at the home was helpful and informative. We were advised that a service user guide was also available and in a picture format that would assist the service users understanding of the facilities and policies existing at the home. The home is registered for four service users and one service user had left the home within the last 12 months. We were advised by the registered manager that there had been no new service users moving into the home, therefore, it was not possible to inspect any recent preadmission assessment. Due to the complex nature and challenging care needs of the service users at Cornview it would not be possible to consider any form of emergency placement or short-term arrangement without a full Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: and considered preadmission assessment. The manager went on to advise that the home was considering maintaining the current level of occupation of three service users. The manager descibed homes assessment process and advised that the local authority would usually fund the service users at the home, therefore, a full assessment of their care needs would of been developed over a period of time and involve the local authorities and social and healthcare practitioners. The home would conduct a preadmission assessment to establish the feasibility and suitability of the person living at Cornview. The existing service users care needs and their reaction to having a new resident would be a key point of consideration for the successful transition. The potential service user would be encouraged to visit the home as often as practically possible. Full consultation process would be required across the board, family friends social and healthcare practitioners would all be a part of the assessment process. Care staff assisted service users to complete CSCI surveys and two out of three surveys were completed and one survey was completed by a service users relative. We were advised that one of the service users did not wish to to participate in the survey. The remaining two service users completing the surveys indicated that they liked living at Cornview, felt cared for and one service user agreed that staff treated them well and that their privacy was respected. A relative completing the survey agreed that they had received enough information about the home and that their son/daughter, seemed happy there and staff always met the needs of their relative. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefited from the homes practice of regular care plan reviews that ensured residents care needs were catered for and any risk assessed was managed. Evidence: Service users assisted by care staff completing the CSCI survey confirmed that they were well cared for at the home indicating that the care plans designed to meet their care needs were working well. We inspected all the service users care plans, the information being drawn from the care need assessments. The home described the care planning process as, Person Centred Planning. Care plans were well informed and met the individual needs of the service user and assisted understanding for the care staff charged with supporting them. This was particularly relevant to any care agency staff employed. At the time inspection there was one agency staff supporting the homes permanent staff. Each care plan contained symbols to assist communication. Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: The service users at Cornview demanded particular skills from the care staff that involved an understanding of alternative communication methods such as makaton and the use of pictures and symbols to establish continuity of care. Communication method for such as these could be found in each care plan containing information such as; likes everything to be tidy and descriptions of service users preferred daily routines in order for the right support to be given. Each care plan was made up of the same sections to build up a foundation of knowledge this included; current information, statement of support, behaviour support plan review, independent living skills, communication, external consultation and summary, objectives and action plan. All care plans showed eveidence of a six monthly care plan review process in place. Care staff were observed working knowledgeably with each of the three service users at home during the inspection. Care staff communicated well with service users using a mixture of makaton and spech and were able to provide a communication channel for the service users when necessary, for example when a GP visited and answering questions from the Inspector. Care plans contained detailed assessment of risk involved in all activities including trips out. If service users became frustrated about something care staff were required to ensure that they were aware of what actions to take. This was recorded in the risk assessment that detailed what action was appropriate. Care staff consulted were able to describe what they were doing and why and were able to provide care support in a way that respected the service users individuality and dignity. A Behaviour Support Plan was in place detailing the needs of the service user, for example; making highpitched noise and laughing indicated the service user was anxious therefore a distraction technique was recommended. The home had produced an Annual Quality Assurance Assessment (AQAA) that stated; we ask for suggestions from service users parents, advocates, social workers to speak on their behalf (service users). The relatives CSCI survey confirmed that the home gave the support they expected their son/daughter to receive and agree with, commenting; they are pretty good, do wonders. Evidence of family involvement could be found throughout each care plan folder indicating regular visits and short stays away from the home. One out of the three service users consulted answered the question , do the staff treat you well, and agreed with the question. 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. Service users were supported to maintain their own independent living skills and had a choice of activities that ensured important daily routines were observed. Relatives were consulted about issues at the home that were important to ensure good quality of life was maintained. The service user received a wholesome and nutritious diet. Evidence: The homes AQAA stated; each service user has a daily activity timetable which is devised by both the service user and key people. The assessment process conducted prior to service users joining the home ensured that service users routines and expectations were supported and delivered on a daily basis. Details were available showing how care staff supported each service user to encourage and support their of daily Independent Living Skills, such as, washing , dressing, putting away laundry wiping down services, sweeping the floor. A service user, assisted by care staff to Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: complete the CSCI survey, had indicated that his privacy was respected. A relative completing the CSCI survey confirmed that the service users always received support to live the life they chose and said; I think it, they go out for walks and to the local eatery and get fed well. Each service user had received a Cornview Daytime Plan, beginning with; Bath and breakfast and finishing with Bath and relaxing. It also detailed the service users established daily routine and included their likes and dislikes activities included; a farm walk, karaoke in the lounge, outdoor games, massage, football in a garden, puzzles, music, visits to a local eatery, swimming, keyboard music. Care had been taken to to inform care workers of how to introduce interests at times when service users may be suffering from anxiety attacks. If for instance, a physical activity such as walking or if the service user had an interest in sports regular games of football were encouraged. This helps distract the service user from their anxiety attack. Two out of three service users who were asked if there were good activities at the home had agreed. Relatives asked whether the home respected service users different needs such as disability, ethnicity of faith and sexual orientation said; allways seems to be happy, indicating that staff were supportive and aware of the service users needs. This was particularly relevant due to the multicultural backgrounds of the care staff at Cornview. The relative completing the CSCI survey commenting on areas of improvement; would like more contact from the home, phone calls, but not about X has had an accident etc but just about what they have done to day for instance. Menus were selected by the Director of Care within the organisation on a monthly basis and took into account each service users preference. We were advised that service users received a questionnaire every three months requesting updated information about their preferences, choices and special dietary needs. Information was compiled by staff recording service users preferences from their daily diaries and from regular care plan reviews. The organisation had access to qualified dieticians and healthcare practitioners and evidence was available to show that care had been taken to ensure that individual needs were respected and special diets were provided such as,a gluten free diet that was provided for one service user at lunchtime. During lunch staff were observed assisting service users and it was noted that a service user requiring no dairy products had been given a suitable different meal of soya mince. The menu for the day was quiche salad and chips. The homes AQAA confirmed that; service users are offered special meals under their Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: health specialist. Service users completing the CSCI survey agreed that they enjoyed the food. Parents were regularly consulted about service users nutritional needs. Comments received from a relative of service user and the home confirmed that they were always kept up-to-date with important issues. 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. The homes method of recording how the service users wished to receive healthcare support ensured that service users were treated with respect and dignity and in the way they preferred. The home ensured that service users received their medication as prescribed but the home had not taken precautions to ensure that an accurate account of medication was kept at the home. Evidence: The homes AQAA stated that; all service users are listed with the general practitioners and specialists and the manager at Cornview has regular contact with specialists to review the medication or do health assessments. It was observed that a GP visiting the home understood the care needs of the service user he was attending. It was explained that this was due to the GP knowing the service user from the time they were at school. The GP commenting about the home felt that Cornview always contacted the surgery when required and felt that the service users healthcare needs were well met by the home. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: Service users had a Health Action Plan (HAP) in which every healthcare issue had been recorded including visits from the dentist GP and other healthcare practitioners. The HAP was readily available in case of emergency such as a trip to the accident and emergency department of the local hospital. The homes AQAA stated that; there is a detailed policy for the safe handling of medication. Medication is not administered without to people observing and countersigning. All the risk factors are considered before administering the medication. Service users were observed receiving their medication from two care staff. Medication was given and recorded in the Medication Administration Record (MAR) and countersigned by a member of staff witnessing the administration. Care staff administering medication were able to put the service users at ease during the medication administration process. Each time medication was administered it was noted in the MAR. After administering the medication the staff members washed their hands before administering medication to another service user. On inspection of the MAR there were some errors noted,these included; A number of tablets counted exceeded the amount recorded. The MAR chart did not contain an accurate account of the number of tablets that had been taken since being prescribed. One entry in the MAR,from the day before, had not been countersigned by staff. One of the MARs did not describe the medication being recorded. The MAR of a service user no longer at the home had not been completed to indicate that the medication had been taken with the service user. Medication was not kept in a cool environment and there was no way of measuring the correct temperature in the place where the medication was situated. There was a strong possibility of it becoming too hot as it was being stored in the kitchen area and in an ordinary kitchen cabinet that had been fitted with a lock. This constitutes a breach of regulation and the home is required to ensure that; Medication is properly and consistently recorded on a daily basis and that an accurate account of all the medication being kept at the home is made available. That it is securely stored and medication that is required to be stored at a constant temperature can be monitored and kept within the recommended temperature. Care Homes for Adults (18-65 years) Page 19 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. Service users were supported to make their needs known if they were unhappy and care staff were confident of assisting in this matter due to training they had received. Care staff were aware of all the issues relating to safeguarding of the service users at the home. Evidence: The homes AQAA confirmed that the home had not received any complaints and there had been no complaints reported to CSCI in the last 12 months. The AQAA also stated that the organisation had a detailed complaint procedure that was made available to staff and that; staff members are given detailed induction training which included awareness of complaints procedures. Whistleblowing in particular training on promoting rights and preventing abuse in safeguarding are really emphasised. The service users completing the CSCI survey, assisted by care staff, indicated that they knew who to speak to if they were unhappy. Observations of service users indicated that they were able to make their needs known, verbally or by physical means. A service users relative completing the CSCI survey confirmed that they were aware of the complaints procedure and commented; we did have a newsletter about it, but dont remember. I would ring up and speak to the Director of Care . Staff were asked about how they would perceive the service users needs if they were under duress or discomfort. Care staff were confident in identifying service users Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: behaviour and this was observed during the inspection whereby a service user was seen by the GP following indication that he had sustained a minor injury. The member staff was able to support the service user and direct him to a place where he could show the GP is injury. The home ensured that CSCI were notified of any significant incidents that affected service users health and welfare. The home had policies on physical intervention including details of how to protect the individual from self-harm. Risk assessments were in place to quickly and safely remove a service user, displaying challenging behaviour, in public places. Use of physical intervention was the absolute last resort. The AQAA stated that; staff receive specialist training to deal with challenging behaviours which helps to avert inappropriate handling that might be considered abusive. The focus is always on active strategies and avoidance of problems rather than reactive strategies. Observation on the day the inspection indicated that staff were aware of distraction techniques that prevented the use of physical intervention. There been no safeguarding alerts reported to CSCI in the last 12 months or listed in the homes reports. Care Homes for Adults (18-65 years) Page 21 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. The physical design and layout of the home enabled people who use the service to live in a safe, well maintained environment with access a well-equipped and secure garden area. Evidence: A tour of the premises was made. The accommodation was simply furnished to meet service users preferences of a clutter free home environment. The home was in a relatively fair state of repair giving it a homely feel despite the lack of furniture surplus to requirements. The dining area was equipped with table and chairs that were only available when needed and made available at such times as mealtimes or as needed. Service users bedrooms were decorated to reflect the service users personality and choices which again was a very minimalist requirement that matching their assessed need as featured in their care plan. Pictures available in rooms that depicted service users families and interests were secured to the wall. There was ample storage space in each service users bedroom where service users preferred to keep their belongings. Residents were observed using the house and garden as they wished. The garden area was spacious and offered service users A comfortable alternative to the house with Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: access to a summer house, benches and swings suitable for adult use. Care staff were observed ensuring that the house and gardens were always secure and that access to areas may present a risk to service users such as the kitchen were always locked. The laundry area was clean tidy and provided washing machines with sluice facilities. The service users laundry was well ordered and always washed separately from other service users clothes and care staff had access to hand washing facilities. All harmful chemicals coming under the COSHH categories were appropriate stored in lockable cupboards situated throughout the home as appropriate. Bathrooms and lavatories retain and hand cleaning materials and tissues were kept unobtrusively behind the double glazing ensuring that the home was able to control infection and limit potential damage to the WC and maintain a homely environment. Care Homes for Adults (18-65 years) Page 23 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. The home ensured that care staff received training that was relevant to meeting the needs of the service users who benefited from the staff ratio that enabled them to have the freedom of being able to engage in planned unplanned activities. The homes recruitment procedures were adequate and in need of review. Evidence: The homes AQAA confirmed that 15 care staff were permanent and had attained level 2 National Vocational Qualification (NVQ) or above and three were working towards level 2 NVQ. The home employed one agency/bank care staff who was on duty at the time of the inspection. There was waking staff on duty every night and the service users/staff ratio was one-to-one. During the course of the inspection there were three staff on duty with the service users plus the cook,team leader and registered manager. The AQAA went on to say that; staff have a good understanding of their roles and responsibilities. The company has a professional and continual development programme for all staff. Staff receive regular supervision and are supported by the manager or senior on site throughout the day. This arrangement was confirmed throughout the inspection. Comments received from staff completing the CSCI surveys in the section titled; Do the ways you pass information about people who use services Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: between staff , including the manager, work well; care staff answered; always, usually, sometimes and never. Comments included; the be manager discusses my work only during supervision. The employees come from different nationalities which causes language problems The way of communication between staff and managers is very poor and sometimes there is no answer. In the section of the CSCI survey titled; What could the service do better; comments included; shifts should be better staffed, more NVQ trained staff, better support from the managers. And. Better food, more shopping service users who dont use their pocket money at all, more equipment and better co-operation between managers and support workers. In section titled; What does the service do well, Care staff replied; everyone is doing their best to meet service users needs. Meets basic needs of service users. In the session the CSCI survey relating to equality and diversity, e.g. this relates to disability, age, gender, race and ethnicity, sexual orientation and faith; Care staff indicated that the the home; always, usually provided the right support, experience and knowledge to meet the different needs of people who use the services. The homes AQAA stated that; we are trained staff to work with all service users and team members through shadowing and mentoring, in a way that embraces and promote equality and diversity. We are planning to have cultural days, to be reflected in activities and dressing, for both service users and staff where appropriate. The homes AQAA stated in the section titled; How we have improved in the last 12 months; staff had been supported to work on their, Learning Disability Qualification,LDQ and a good success rate has been achieved. Care workers confirmed that this was the case and that they received training that was relevant to their role but felt they needed more support from the company Liaise regarding being kept upto-date with new ways of working, commenting; I have done in the past, LDAF induction folders and I have a certificate for LDAF level 2, I want to do the NVQ3 but the company told me it is not available. Another care worker commented; we would like to do some more training i.e. epilepsy or NVQs which seems to be too expensive for the company. These comments indicated that care staff required more information about their training needs and other comments indicated that communication of the homes management and care staff were in need of improvement. Staff personnel files of four care staff on duty were sampled for proof of relevant training and recruitment practices. There was evident in place to show that care staff had all received training that was relevant to their role as stated in the CSCI surveys. Evidence of training included; PROACT SCRIPrUK which according to the homes Statement of Purpose; places an emphasis on a proactive to care and supports individuals through times of behavioural crisis in a sensitive and caring manner so that the needs of the whole person are met. Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: Other areas of training included in the induction programme included health and safety-related aspects of care such as; manual handling, fire training, infection control and food hygiene. Client focused training also included; autism, safeguarding, medication administration and makaton. This represented a rounded approach to staff training received by care staff on duty however the comments of care staff indicated a need for further training opportunities to made available. The homes care staff were mainly from overseas. When asked about their ability to communicate clearly with service users the manager advised that the company recognised the need for support in this area and as a consequence English language courses were being explored at the local technical college. It is recommended that the home reviews access to staff training to ensure that it is equitable and encompasses equality and diversity. Four personnel folders were sampled to confirm at the home practice robust recruitment procedures. All personal and received a Criminal Records Bureau, CRB clearance prior to starting work at home and the home had ensured that references, passport ID, employment history and visas were in place. One personnel folder did not hold all the required documentation however the Director of Care confirmed that the documentation was held at head office due to reapplication for a new visa. It was recommended that any personnel documentation relating to care staff ID that is in the process of being renewed should retain a copy for the personnel folder and retained at the home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The consistency of management was in need of review as care staff did not feel supported. The home was committed to ensuring that service users and their representatives were involved in the running of the home and health and safety measures were in place and reviewed on a regular basis to ensure the safety of service users and care staff. Evidence: The registered manage, Mr Kefasi Mamhungu, was studying for his Registered Managers Award, RMA and he advised that this will be completed later this year. Mr Mamhungu has been in post since 2007 and have attained a BSc (Honours) in Social Work. The Statement Purpose mentions the Director of Care was responsible for starting up the first two homes for Liaise Loddon Ltd. A relative completing the CSCI survey commented in the section titled;Do you know how to make complaint about the care provided by the home;we did have a newsletter about it, but couldnt remember. Would ring up the Director of Care and speak to her. Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: Evidence presented in the CSCI surveys, indicated that there was some conflict and confusion of roles and responsibilities of the area/regional management off site, the registered manager and the staff at the home. The lack of complete recruitment documentation due to there not being copies made and kept at the office also illustrated some shortfalls in communication. Failures in the recording and storage of medication shows that there was a need of improved reporting processes. We would like to emphasise that there was a lot of positive comments such as;seem to do well with everything. People are always polite. On the day of the inspection the home was hosting a review of the care planning, risk assessment processes,activitie and objectives. The meeting involved some of the organisations therapeutic practitioners and would of involved the manager had he not been involved in the inspection process. Care staff completing CSCI survey completing the section titled; do the ways you pass information about people who use services between staff including the manager work well agreed that this happened sometimes comments included; the manager discusses my work at supervision only, and, the way of communication between staff and managers is very poor and sometimes there is no answer. Care staff felt that shifts should the better staffed, nor NVQ trained staff. In section titled; What does the service do well. Care staff replied; everyone is doing their best to meet service users needs. This meet basic needs of service users. Care staff said that the home always/usually receive the right support, experience and knowledge to meet the different needs of people who use the services. The homes assessment and service user focused care planning ensured that service users received care that met their needs. They have access to a range of social and healthcare practitioners and their home environment was safe and secure. The home needs to improve its medication practice and ensure that medication is kept at the appropriate temperature. It is accepted that the storage place is secure and respects service users home environment, however, the storage quality of this arrangement was in doubt. Personnel files inspected showed a wide range of expertise and training available at the home but care staff did not feel supported by the management structure in place or believed that they had access to a full range of training. Comments received suggest that work needs to be done to ensure that communication between the care staff and management teams are improved. The views of relative and service users were sought following the six monthly care plan reviews and managers from other homes conduct regular, regulation 26 visits to ensure that the home is run in the best interests of the service users. When service users go home they take a communication book with them. Service users have a parent advocate form whereby details of communication with parents is recorded Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: including when parents rang the home. One of the service users used a video phone on a regular basis to contact their parents but have since lost his phone. The manager advised that the home was be searching the possibility of obtaining a video touch screen device was being considered for the use of the service users. Health and safety aspects of the home were all in good order. Home insurance was in place, fire safety measures such as the fire risk assessment completed in October 2008 and a health and safety report was completed on the ninth of May 2008 and staff had attended health and safety training events. The home was very fire safety conscious and recently notified CSCI of the need to turn off the fire alarm system while a fault was being repaired. Care staff were aware of assembly points in case of fire . All chemicals that could be dangerous to service users were kept locked and sensitive measures had been taken ensuring that soap and paper towels were kept safely within toilets and bathrooms to ensure reasonable measures were taken to promote hygiene. Care Homes for Adults (18-65 years) Page 29 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 30 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 20 13 An accurate record must be kept of all medication administered to service users. The significant number of entries left blank on the medication administration record chart is not acceptable. In the interests of safe medication handling all medication must be recorded as prescribed and an accurate audit of medication at the home must be kept at all times and be available for inspection. 18/04/2009 2 20 13 A thermometer must be 18/04/2009 kept in a medication cabinet. The medication cabinet used must be capable of maintaining the medication at the correct temperature levels as directed by the prescription. Daily records of the temperature must be made to ensure that the Care Homes for Adults (18-65 years) Page 31 of 33 cabinet is keeping the medication at the recommended temperature to so that the quality of the medication held within it can be assured. In the interest of safe medication handling all medication must be stored in a secure place and at the correct temperature. 3 37 9 The home must ensure that the managers skills and experience are adequate to meet care needs of service users and care staff. The management of the homes care staff was inconsistent and poor communication may put the service users at unnecessary risk. 18/04/2009 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 34 It was recommended that any personnel documentation relating to care staff ID that is in the process of being renewed should retain a copy for the personnal file. Care Homes for Adults (18-65 years) Page 32 of 33 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. 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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