Inspection on 17/06/09 for Cromer House

This inspection was carried out on 17th June 2009.

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

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

Other inspections for this house

Cromer House 04/05/07

Cromer House 17/05/06

Cromer House 12/09/05

Cromer House 19/05/05

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Coopers Mill Ltd

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Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Cromer House 15 Redan Street Ipswich Suffolk IP1 3PQ     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: Tina Burns     Date: 1 9 0 6 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 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Cromer House 15 Redan Street Ipswich Suffolk IP1 3PQ 01473226399 01473226396 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) : Consensus Support Services Limited care home 10 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 10 Cromer House is owned and operated by Consensus Support Services Ltd, a division of the large private company Caring Homes. It provides 24 hour support for up to ten residents with learning disabilities. All bedrooms are single with en suite facilities. The home is situated near the centre of Ipswich with good access to community facilities and public transport. The Statement of Purpose informs us that fees for the home at the time of inspection start at £1,444.76 per week with additional focused 1-1 support charged at £11 per hour. Care Homes for Adults (18-65 years) Page 4 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection, which focused on the core standards relating to care homes for Adults. The report has been written using accumulated evidence gathered prior to and during the inspection. The inspection process included a tour of the premises and examination of a wide range of documents and records including three staff files and two residents records. We also met and spoke with people who live and work at the home. Information has also been gathered from the homes Annual Quality Assurance assessment (AQAA) and survey forms completed by seven residents and nine care workers. Residents surveys had been completed with the assistance of individuals Care Homes for Adults (18-65 years) Page 5 of 31 keyworkers or relatives. The manager and deputy manager were present throughout our visit and fully contributed to the inspection. What the care home does well: What has improved since the last inspection? What they could do better: 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 7 of 31 Care Homes for Adults (18-65 years) Page 8 of 31 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 9 of 31 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. Prospective residents can expect a thorough assessment of their needs. Further more they and their representatives can expect to have the information they need to make an informed choice about whether the home is suitable. Evidence: The manager provided us with a copy of the homes Statement of Purpose and Service Use Guide. The documents provided key information about the home and the accommodation and services it provides. The Service User Guide was available in an easy read format that had been designed especially with the needs of the service user group in mind. Since the last inspection there has been no new residents admitted to the home and the manager advised us that most people have lived at the home since it first opened. However, they were able to provide us with a copy of the homes admission procedures and a copy of the new assessment tool that would be used to assess the needs of any Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: prospective residents in the future. The assessment tool we looked had clearly been developed to gather detailed information about prospective residents. The document was divided into appropriate sections with relevant headings and appeared to be a thorough and useful tool. Areas covered included; Essential Information such as personal details, ethnic background, next of kin, placing authority, care manager, diagnosis of condition and pen portrait; Benefits and Finances, Mental Capacity, General Health including weight, sensory needs and mobility, Medication, Allergies, Phobias, Likes and Dislikes, Hobbies and Interests, Communication, Personal Care, Daily Living Skills, Eating and Drinking, Accessing the Community, Money Skills, Emotional Support, Safeguarding and Vulnerability. The assessment tool also alerted the assessor to look at the levels of support required in each area and identify any specific areas of risk. In addition it asked if information was available from specialised professionals such as Psychiatrists, Behavioural Support Teams, Occupational Therapists, Speech and Language Therapists, Physiotherapists and Chiropodists. Five out of seven service users that completed surveys said they had been asked if they wanted to move into the home. One said that they had not been asked and one said that they didnt know. Six said that they had enough information about the home and one said that they didnt know. One person told us; I had visited this house to see if I liked it and I got to pick my own room. Care Homes for Adults (18-65 years) Page 11 of 31 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 can expect to have their assessed needs reflected in their individual plans. Further more they can expect to be supported to make decisions about their lives and supported to take risks as part of an independent lifestyle. Evidence: We looked at the care plans of two people that live at Cromer House. Their care plans looked highly individual and detailed the support they required with routines and activities, continence, medication, finances, nutrition, communication, challenging behaviour and interacting with others. Risk assessments had also been completed and covered areas such as fire safety, accessing the community, using vehicles, preparing food & drink, money management, use of public transport, bathing, self harming and protection from abuse. The care plans we examined included evidence of reviews and confirmed that incidents or events that we have been notified about by the home have been appropriately addressed. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: Information provided by the local authority told us that since our last inspection there had been concerns about the quality of support being provided. In particular care plans and risk management strategies in place had not adequately addressed the needs of their clients with autism and very complex needs. At the time of our visit evidence was provided to confirm that action had been taken to address shortfalls and further action was ongoing. Further more the records of one person included a signed statement from a social worker confirming that they were fully satisfied that full protective measures had been put into place and were being practiced to protect the service user concerned throughout their daily routines. Observations we made during our visit and people we spoke with confirmed that residents are supported to make decisions in their day to day lives. The manager also told us that seven of the eight residents benefit from having close relatives that are actively involved in decision making processes. The home had also recently formed links with a local advocacy service and they were hoping that residents would soon have the opportunity to have independent advocates. The staff survey asked if they were given up to date information about the needs of the people they support or give care to. Seven said always and two said usually. The service user survey asked if they made decisions about what they did each day. Two said always and five said sometimes. Care Homes for Adults (18-65 years) Page 13 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of residents day to day lifestyles varies but they all have support to participate in a range of activities and are assisted to maintain contact with their friends and families. People also enjoy a balanced, healthy diet. Evidence: Information provided to us by social care professionals tells us that following some reviews in 2008 they identified shortfalls relating to stimulation and activities. They felt that staffing and management issues at that time had impacted on residents lifestyles and there was an absence of structured activity programmes. However, at the time of our visit it was reported that concerns had been addressed and people were experiencing a better quality of service. Both of the people that we tracked had access to a wide range of activities and one of their care plans included a signed statement by a social worker confirming that they were satisfied that the individual Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: concerned had a full and busy lifestyle with a programme of activities that had been tailored to meet their individual needs. The AQAA tells us that people that live at Cromer House are supported to access the community on a daily basis, this was confirmed by the people we spoke with during the inspection and the observations we made. There was lots of evidence that people had opportunities to get out and about and activities were wide ranging and varied. Comments from staff included; We try to give them the best. We try to get them involved in decisions and we try to do activities we know that they like, Their lifestyles are ok, some are better than others, some have good life styles others are a work in progress!, I feel we look after the service users well but some need more activities and The home could do better on providing activities. It shouldnt matter if you are one or two staff down...there shouldnt be any reasons that activities should be cancelled. Feedback we received and records we examined confirmed that peoples programmes were being developed according to their individual needs and preferences but they were at different stages. Additional funding had been sourced for one resident so that they could be appropriately supported with an active full time programme of activities and the manager was hopeful that similar applications for three other residents would be approved. Records we examined and people we spoke with confirmed that staff support residents to maintain personal relationships with their friends and families. Visitors are welcome at the home and people are given the assistance they need to visit their friends and families too. Information provided in the AQAA and feedback we received confirms that residents are involved in the daily routines of the home. The extent to which people can fully participate in tasks varies and depends on the needs of individuals. However it was evident during our visit that people are encouraged to actively participate in tasks where possible, for example; preparing and cooking food, cleaning the home, doing laundry and welcoming visitors. Meals at the home are prepared and cooked by the care staff and residents participate on a one to one basis to ensure that safety is maintained in the kitchen. The kitchen is homely and domestic in style and on the day of our visit it looked clean and tidy. There was an appropriate food safety policy in place, a record of fridge and freezer temperatures was maintained and staff confirmed that they undertake food hygiene training. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: The lunch time menu on the first day of our visit was tuna risotto followed by fruit or yogurt. The dinner time menu was sausage casserole and jacket potato followed by carrot cake or fruit. Alternatives were available if residents preferred a different option. The menu we looked at was a four week rolling menu. It looked varied, well balanced and nutritious and there was evidence that it accounted for the specific needs and preferences of residents. Food supplies were purchased at the local supermarket by care staff with residents involvement. The menu folder included a recipe for each of the main options and a record of meals taken. Care Homes for Adults (18-65 years) Page 16 of 31 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 can expect their personal and healthcare needs to be met in a way that reflects there preferences and respects their dignity. Evidence: Care plans included the assistance required with personal care and reflected the individuals specific needs and preferences. Records we examined and people we spoke with confirmed that routines, such as getting up or going to bed and bathing are flexible and depend on the needs and choices of residents. Observations we made and people we spoke with also confirmed that residents privacy and dignity is promoted, personal care was provided discreetly and in private. Observations made and records examined confirmed that there were appropriate procedures in place for the safe storage, recording and administration of medication. Staff responsible for handling medication had undertaken medication training and those we spoke with told us that they felt confident that they had the knowledge and skills to undertake medication tasks. There has been one incident of missed medication Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: reported to us since the last inspection which was appropriately addressed by the home at the time of the incident and had not impacted on the well being of the resident concerned. The procedures in place at the time of this visit included daily audits by senior support workers on duty to check that all prescribed medication had been administered. The Medication Administration Records that we looked at were fully complete with no gaps. One resident that we tracked required insulin injections. These were administered by staff at the home. The individuals care plan included a clear protocol for administration that had been agreed by the residents next of kin and two specialist diabetic nurses. Further more there was good evidence that staff responsible for administering the insulin had been suitably trained and assessed as competent to undertake the task. People we spoke with and records we looked at confirmed that people living at the home have their health and well being monitored and are supported to access community healthcare services as appropriate. Records included health care support plans, information about individuals health care needs and outcomes of health care appointments. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be fully assured that they will always be protected by the procedures in place to safeguard them and deal with their concerns or complaints. Evidence: The homes complaints procedure was displayed in the entrance of the home. A text version was also included in the Statement of Purpose and an easy read version was included in the residents Service User Guide. The procedure included contact details for the Commission but it had not been amended to reflect the fact that The Commission for Social Care Inspection had been replaced by The Care Quality Commission. The manager agreed to ensure the details are amended. Information we received tells us that concerns raised by a relative under a previous manager had not been addressed under the complaints procedure and had not been resolved. Further more the individual concerned had not been made aware that they had a right to make a complaint direct to the commissioning authority. This had come to light following a local authority review and their concerns have since been addressed. The complaints procedure we looked at did not specify that people who have their fees paid by their local authority have a right to address their complaints directly to them. This means that they do not benefit from the added protection of the local authority complaints procedure. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: The manager told us that to their knowledge there has been one complaint in the last twelve months. No other complaints were recorded. The complaint was concerning the handling of a serious incident that had not been reported or handled as a safeguarding matter. Due to the nature of the complaint the matter was being investigated by a more senior manager and was ongoing at the time of our visit. The current manager confirmed that they understood that records of complaints must be maintained and showed us a file that they had developed for this purpose. Six out of seven people that completed surveys said that they know who to speak to if they are not happy. Four said carers always listen and act on what they say and three said they sometimes listen and act on what they say. Nine out of nine staff that completed surveys said they know what to do if someone has concerns about the home. The home had a copy of the Suffolk Interagency Safeguarding Procedures in place and accessible to staff. Staff we spoke with were confident that they could recognise signs of abuse and would know the procedures for reporting them. One of them had undertaken the e learning training provided by Suffolk County Council and two others said that they had undertaken training with their previous employers. The homes training records told us that fourteen out of twenty six staff had undertaken Protection of Vulnerable Adults training and the remainder had covered it as part of their induction. The manager assured us that any outstanding safeguarding training would be provided as a matter of priority. Notifications we have received and information provided by the manager confirms that there have been ten safeguarding referrals made concerning residents of the home within the last twelve months. The nature of the referrals varied and included matters of poor staff practice, a matter of theft, a matter of restraint, allegations of abuse by residents and a matter of suspected self harm. The local authority confirm that the manager has demonstrated that they have taken matters seriously, worked within a spirit of openness and shown a commitment to address shortfalls and ensure robust measures are in place to safeguard people. Following an incident of theft procedures in place for holding cash on behalf of residents have become more robust by introducing a numbered tag system that identifies any discrepancies immediately. Further more all transactions carried out on behalf of residents are recorded and audits and checks are regularly undertaken to ensure that records and cash floats balance. Residents records viewed included details of actions the home had taken to protect them from potentially abusive situations and plans for supporting them in managing Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: their behaviour. We could also see that issues reported to us through regulation 37 notifications had been appropriately addressed. The manager had made one Deprivation of Liberty Safeguards referral and confirmed that all support plans and risk assessments are in the process of being reviewed to ensure that they are meeting the requirements of the Mental Capacity Act and the Deprivation of Liberty Safeguards. Care Homes for Adults (18-65 years) Page 21 of 31 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. Residents can expect to live in a clean, comfortable and safe environment. Evidence: The AQAA tells us that the home has a five year maintenance, decoration and renewal plan in place and in addition to the routine maintenance, repairs and servicing that has taken place during the past twelve months dining room furniture has been replaced, some flooring has been replaced and communal areas have been redecorated. At the time of inspection all areas seen were tidy, safe and clean. The exception was the shaft lift that had a stained carpet and smelled of urine. We were told that this had gone unnoticed because it hadnt been used for sometime. The lift was cleaned while we were there and we were advised that the carpet would be replaced soon. Of the seven surveys returned by service users six said that the home was always clean and one said sometimes. The furniture, decor and facilities were practical but comfortable and had been provided with the needs and preferences of the residents in mind. Furniture and fittings in the communal areas seemed a little sparse but staff explained that this was due to the behaviour traits of one of the residents. In contrast peoples bedrooms were Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: highly individual and reflected their personalities and interests. All of the bedrooms were single and included en-suite bath or shower rooms and WCs. The laundry room was clean, tidy and appropriately equipped. There were suitable hand wash facilities and disposable gloves provided and clear infection control procedures were in place. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected by robust recruitment procedures but they cannot be sure that they will always receive the support they need from appropriately trained and competent staff. Evidence: Records examined and discussion with the manager confirmed that current recruitment procedures include Enhanced Criminal Record Bureau Checks (CRBs), verification of ID, written references and health checks. People are also required to complete an application form and attend a face to face interview as part of the staff selection process. The three staff files we looked at did not include a photograph of the individual concerned but the manager assured us that they would address this as a matter of priority. Feedback from staff confirmed that new staff initially work under supervision and undertake induction programmes that meet the Skills for Care induction standards and Learning Disability Award Framework. The AQAA tells us that approximately fifty percent of care workers employed hold or are working towards NVQ level two in care or above. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: Staff spoken with and records seen confirmed that care workers undertake training in areas such as Fire Safety, Moving and Handling, Safeguarding Adults, First Aid, Infection Control, Food Hygiene, Customer Service, Report Writing, Conflict Management, Medication and Health and Safety. There was also evidence of Mental Capacity and Deprivation of Liberty Safeguards training and training about residents specific needs, for example autism, epilepsy, makaton sign language, diabetes and insulin administration. However, the staff training matrix evidenced that training was not always provided within appropriate timescales and we could see that for some people training in areas such as fire safety, moving and handling, protection of vulnerable adults, first aid, infection control, food hygiene and health and safety was still outstanding. All nine staff that completed surveys confirmed that the home had undertaken appropriate recruitment checks such as CRBs and references before they started work. Two said that their induction had covered everything they needed to know very well, five said it had mostly covered everything and two said it had partly covered everything. Nine said that they are provided with training relevant to their work, eight said they are provided with training to help them understand peoples specific needs, nine said they receive training that keeps them up to date and seven said they have training that gives them the knowledge and skills they need. The manager and deputy manager had recently undertaken specialist communication training that was recommended following some local authority reviews. We were advised that training for the remaining staff was being planned although local authority representatives tell us that they feel the company has been slow to authorise the training. Feedback from social care professionals and discussion with the staff and manager confirms that the home experienced a high turnover of staff in 2008. When the current manager joined the home in November 2008 there was a significant number of vacant hours and we were told that this was as a consequence of several established and experienced workers leaving the home at the same time to take up work at another home owned by the same company. This had a huge impact on the residents of Cromer House, many of whom need structure and routine from people they know and trust. People we spoke with and records we examined confirmed that at least ten out of twenty six staff had started working at the home in the last six months. This means that almost half of the workforce are new to the job and several have not yet completed their induction training. Although this is being addressed through individual training and development plans it does mean that residents are supported by a high Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: ratio of inexperienced staff that have not been fully trained. Of the nine staff that completed surveys five said that they usually have the right support, experience and knowledge to meet the different needs of residents, two said that they usually have and two said that they sometimes have. The staff we spoke with during our visit seemed to have a good understanding of residents needs. They talked confidently about peoples support plans and programmes and were committed to providing a good service. Throughout our visit staff interacted with residents positively and with confidence and respect. At the time of our visit there were eight residents living at the home. The staffing ratio was five or six staff during the day time and evening and two waking night staff at night. The manager was supernumerary. They advised us that there were some funding issues since it had been identified that some people need higher levels of support, particularly in the community. They said that they were working to resolve this with the commissioning authorities. At the time of inspection we observed that people were provided with appropriate assistance and support and there was a high level of staff presence and activity. Of the nine staff completing surveys two said there are always enough staff, three said there are usually enough, three said there are sometimes enough and one said there are never enough. Comments we received indicated that staff felt that people would particularly benefit from more staff to support them with activities and to access the community safely. Five of the nine staff completing surveys told us that they receive regular supervision. The three staff we spoke with also told us that they have supervision regularly. Comments also confirmed that the manager and senior staff are approachable and staff feel appropriately supported. Care Homes for Adults (18-65 years) Page 26 of 31 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. Residents cannot be sure that they will benefit from a consistently well managed service. Evidence: At the previous inspection in June 2007 we found that the registered manager had left and although they remained working for the company they no longer managed the home on a day to day basis. The acting manager at the time was an experienced staff member who was undertaking the daily management responsibilities in the home until the time that a permanent registered manager was in position. A manager was appointed in September 2007 but we were not notified and did not find out until we received a completed AQAA from them in April 2008. That manager left before submitting a completed registered managers application. The current manager started in November 2008 and has not submitted an application to register as Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: manager. Feedback we received during the inspection and from the local authority tells us that the manager is approachable and their leadership style is having a positive impact on the service. However, following the inspection they confirmed that they had resigned and alternative management arrangements are not yet confirmed. At the time of our visit quality assurance systems included regulation 26 visits. Each visit is recorded together with any action points; the manager is then responsible for ensuring matters are addressed. The manager also completes a monthly managers report. The report we looked at was thorough and evidenced that the manager is clear about what the service does well and where and how they need to improve. This was also reflected in the AQAA submitted to us by the manager and the information provided to us by the local authority. Information provided to us about the high staff turnover in 2008 (see staffing section) tells us that the movement of staff from Cromer House to another of the companys homes was poorly managed and left a high number of vacant hours. This had a negative impact on residents. There were routine maintenance and health and safety checks in place that related to fire prevention, water temperatures and food hygiene. Accidents and incident records were analysed by the manager on a monthly basis and the importance of completing accident reports had recently been raised at a team meeting. All cleaning materials and substances were stored securely when not in use and the AQAA tells us that all required safety certificates, such as gas, electric and fire equipment, are in place and in date. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 31 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 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 22 The homes complaints procedure should make it clear that people have the right to address their complaints to the commissioning authority and contact details should be provided. Strategies should be developed to ensure that any future staff vacancies do not impact on residents. Residents need to be supported by a consistent team of staff that are sufficient in numbers, knowledge and skills. 2 32 Care Homes for Adults (18-65 years) Page 30 of 31 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. 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