Inspection on 07/05/09 for Drayton Road (14)

This inspection was carried out on 7th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Drayton Road (14) 24/05/07

Drayton Road (14) 09/02/06

Drayton Road (14) 13/09/04

Drayton Road (14) 13/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: 14 Drayton Road Newton Longville Bucks MK17 0BJ The quality rating for this care home is: One star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Maureen Richards Date: 0 7 0 5 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement They reflect the We review the quality of the service against outcomes from the National Minimum Care Homes for Adults (18-65 years) Page 2 of 30 Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for Adults (18-65) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Drayton Road (14) Drayton Road (14) Newton Longville Bucks MK17 0BJ 01908 649 592 01908649592 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.turnstone.org.uk Turnstone Support Ltd Emma Louise Kilarski Care Home 3 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Learning Disability Physical Disability Number of places (if applicable): Under 65 3 3 Over 65 Additional conditions: The maximum number of service users who can be accommodated is: 3 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 Physical disability - PD Date of last inspection: Brief description of the care home: 14 Drayton Road is a care home providing personal care and accommodation for three younger people with learning and physical disabilities. The home is run by Turnstone Support Ltd and is situated in Newton Longville, which is a small village on the edge of the market town of Bletchley in Buckinghamshire. The home is centrally located within Care Homes for Adults (18-65 years) Page 4 of 30 2 4 0 5 2 0 0 7 the village. Although village amenities are limited, the home is close to them and makes full use of the facilities. Bletchley and the new town of Milton Keynes provide the home with a wider range of amenities. Both towns are within a short journey of the home. 14 Drayton Road is a large, detached bungalow, which has been well designed and refurbished to meet the needs of the three service users who reside there. All bedrooms provide single room accommodation but do not have adjoining en-suite facilities. As the home is a bungalow, there is no passenger lift but aids and adaptations are fitted at key assessed points. The home has a drive that is able to accommodate three vehicles and there is a small garden to the rear and side of the building. Fees for the service are 2145 pounds and eight pence per week. Care Homes for Adults (18-65 years) Page 5 of 30 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 rating How we did our inspection: The last key inspection of this service took place on the 24th May 2007. This unannounced key inspection was conducted over the course of a day and covered all of the key National Minimum Standards for younger adults. Prior to the visit, a questionnaire known as an Annual Quality Assurance Assessment document was sent to the registered manager for completion alongside comment cards for distribution to service users, staff and visiting professionals. Any replies that were received have helped to form judgements about the service and are reported on under the relevant sections of the report. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussions with the service manager, team leader, introduction to the service users, observation of practice, a tour of the environment and examining records required for Regulation. Feedback on the inspection findings and areas needing improvement was given to the service manager during the course of the inspection. The service manager, staff and service users are thanked for their co-operation and hospitality during this unannounced visit. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The key information on the home should be explained to service users on a regular basis and presented in a format suitable to their needs to enable them to understand the information being provided. The organisation should consider using someone who is independent of the home for example relative, friend or advocate to assist service users with surveys to safeguard service users. Service users plans should evidence how service users makes choices and decisions in all aspects of their life with records maintained to evidence this to promote service users self worth, life skills and independence. Care Homes for Adults (18-65 years) Page 7 of 30 Records should be maintained to evidence that service users have access to a range of health professionals and routine health appointments to promote their health and well being. Improvements are required to medication practices to safeguard service users. The registered person must ensure that staff are clear of their responsibility to report potential safeguarding incidences in line with the Organisations and the Local Authority procedures to safeguard service users. Improvements are required to recruitment practices of sessional workers to safeguard service users. All staff including sessional workers must be fully inducted and suitably trained prior to being left in charge of the home on their own to promote service users well being and safety. The conflict and disharmony in the staff team should be addressed to promote a comfortable and safe environment for service users. The registered manager should ensure that other senior staff have access to staff files during her absence from the home with improvements made to filing systems and records to enable the required information to be made more accessible when required to comply with Regulations. Some aspects of health and safety need to improve in relation to safe storage of cleaning products and risk assessments regarding access to latex gloves to promote service users’ safety. 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 websitewww.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Details of our findings Contents Choice of home (standards 1 – 5)........................................................................ 10 Individual needs and choices (standards 6 – 10) ................................................... 12 Lifestyle (standards 11 – 17) .............................................................................. 14 Personal and healthcare support (standards 18 – 21) ............................................. 16 Concerns, complaints and protection (standards 22 – 23) ....................................... 19 Care Homes for Adults (18-65 years) Page 8 of 30 Environment (standards 24 – 30) ........................................................................ 21 Staffing (standards 31 – 36)............................................................................... 22 Conduct and management of the home (standards 37 – 43) ................................... 25 Outstanding statutory requirements..................................................................... 27 Requirements and recommendations from this inspection ....................................... 28 Care Homes for Adults (18-65 years) Page 9 of 30 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 who use the 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 are provided with the key information on the service with systems in place to ensure that prospective service users are assessed prior to admission to enable the service to meet their identified needs. Evidence: All service users are provided with a statement of purpose and pictorial license agreement. Records are maintained to evidence when the statement of purpose and license agreement was last explained to service users. In one file viewed the license agreement was explained in March 2009 however the statement of purpose was last explained to that individual in January 2008. The statement of purpose on file was not in a pictorial format as is available within the Organisation. The Annual Quality Assurance document indicates that the home was making the service user guide available in audiotape to meet the needs of one of the service users. This was not available to listen to during the inspection. The home has had no new admissions since it opened. The Annual Quality Assurance document confirms that prospective service users are assessed prior to moving in, they are given the necessary encouragement and opportunity to visit the home and are provided with the necessary information on the home. The Annual Quality Assurance Assessment document confirms that the Organisation has a referrals, assessment, and start of service policy in place which includes the procedure on initial visits, involvement of advocates, visits to the service, transition, appeals, offer of service, Care Homes for Adults (18-65 years) Page 10 of 30 start and review of service. Completed surveys received from service users confirm that they had a choice in the move to the home and was given enough information about the home prior to the move. Care Homes for Adults (18-65 years) Page 11 of 30 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 who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed and specific care plans and risk assessments are in place which ensure that staff offer a consistent plan of care to promote service users well being and safety. Care plans do not evidence that service users are supported to make decisions and choices in their every day life which does not promote their independence. Evidence: All three service user plans were viewed. Each service user has two files. The files viewed included a photograph and a personal details information sheet, which outlined ethnicity, religion, what the individual likes to be known and next of kin details. All of the service user care plans viewed included detailed, informative and very specific details on the support required by individuals in relation to all aspects of their personal care needs in the morning, during the day and at night, health needs, life skills and involvement in household tasks, activities and religious needs, communication and specific behavioral needs. One of the care plans viewed was due for review, the other two care plans were up to date and showed evidence of being reviewed. One service user care plans included a stamp to indicate that the care plan had been explained to them. One of the care plans viewed included a person centred plan in relation to a specific task. However this did not appear to be worked on. None of the service user plans viewed were available in a pictorial format or presented in individuals preferred Care Homes for Adults (18-65 years) Page 12 of 30 way of communication to aid service users understanding. Service users daily record is written in the first person and gives a detailed record of daily care and support given. Alongside this monthly summaries are completed which gives an overview of individuals’ monthly progress or change in most aspects of their lives. Service user plans evidence service users making a choice of linkworker. The Annual Quality Assurance Assessment document indicates that service users are supported to make choices using objects of reference and pictures however service user plans did not evidence this in relation to making choices and decisions with every day tasks, activities or meals. As good practice this should be developed on. The home has an advocate involved who attends service users meetings with minutes maintained to evidence this. However the most recent meetings minutes are not in a pictorial format or presented in individuals preferred way of communication to aid their understanding and involvement. The Annual Quality Assurance Assessment document indicates that this is an area that the home aims to improve over the next 12 months. Service users were assisted by staff from the home to complete the surveys returned to the Commission. As good practice the organisation should consider using relatives, friends or an advocate to assist service users with such surveys to enable service users to feel able to indicate their views. All of the service user plans included a series of individual and generic risk assessments in relation to risks posed to individuals. These were found to be detailed and specific. Two of the files viewed included up to date risk assessments with one of the files viewed indicating that the risk assessments were due for review. None of the service user plans viewed included a moving and handling assessment. All of the service users living at the home are mobile with some individuals needing support on occasions with mobility. After the inspection the Registered Provider provided evidence that moving and handling risk assessments were in place. Care Homes for Adults (18-65 years) Page 13 of 30 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 who use the 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 are supported to maintain family involvement, be involved in a range of activities and provided with nourishing meals which promotes their well being however records do not evidence that service users are actively involved in decisions and choices which makes individuals feel valued. Evidence: None of the current service users are involved in work placements. All of the service users attend Gateway club and a local day centre weekly. The local college has set up a weekly cookery session at the home with this being provided at the college from September 2009 to further promote involvement in the local community. Service user plans included a weekly outline of activities that individuals take part in with a record maintained on individual files of activities that individuals have actually participated in. Service user plans do not evidence how service users made the choice of a specific activity and this should be addressed as outlined under standard 7. The records indicate that service users are offered a range of activities, which include shopping, horse riding, line dancing, hydrotherapy pool, drives and meals out. During the morning of the inspection one service user was out with their relative, one service user was at a hospital appointment and the other service user was at home. In the Care Homes for Adults (18-65 years) Page 14 of 30 evening of the inspection all three service users went out for a meal. The Annual Quality Assurance Assessment document indicates that service users are being supported to try new experiences with film nights being introduced and service users being supported to access the local library. Information on forthcoming activities is discussed at service user meetings and displayed on the activity board. At the time of the inspection staff confirmed that a holiday to Blackpool was booked for June with all three service users being supported to go. Written feedback received from some staff include comments such as more in house activities should be provided with one staff member commenting that higher staffing levels were required for trips out and holidays. Service users are supported to maintain contact with families and service users plans outline important people in service users lives and the support required by individuals in maintaining those links. During the inspection the inspector spoke with a relative who confirmed this and confirmed that they were happy with the care provided. Staff do not enter service users bedrooms without their permission and this was evident during the inspection. Service users are supported to open the front door to visitors and they are made aware of who is visiting the home. A risk assessment is in place to indicate the risks associated with individuals having a key to the front door. Service user plans outline service users preferred form of address and the support required by individuals in managing their post. Service users can choose when to be alone or in company and when not to join an activity. The daily records support this. Service users have access to all areas of the home. Service users are provided with three meals a day with snacks and drinks available throughout the day. Individual records are maintained of meals eaten. Service users have a choice of cereals, toast and juices for breakfast with a choice of an individual meal for lunch. There are no records maintained to indicate how individuals made those choices. The home has recently introduced a four week rolling menu plan for the evening meal. This outlines the main ingredient for example meat or fish. Staff confirmed that each morning service users make a choice of how they want the meat or fish prepared and use pictures to assist those choices. The Annual Quality Assurance Assessment document confirms that service users are supported to make meal choices by the use of pictures and objects of reference. However individual records are not maintained to evidence this and the introduction of the four week rolling menu plan seems to limit that choice. Some service user plans outline the support required by individuals at mealtimes with risk assessments in place for individuals as required. The Annual Quality Assurance Assessment document confirms that with the support of the dietician they are offering continual support to one service user to develop a more active healthier lifestyle and is safely losing weight. This individuals care plan included a weight chart but did not include a support plan or the dieticians guidance to indicate how this was being managed and whether it was in line with the dieticians guidance.This should be addressed. Care Homes for Adults (18-65 years) Page 15 of 30 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. Service users personal care needs are met with records in place to evidence this which promotes service users well being. Health needs are met however accurate records are not being maintained to evidence this which potentially puts service users at risk. Improvements are required to medication practices to safeguard service users. Evidence: Service users plans clearly and specifically outline the support required by individuals in meeting their personal care needs. Times for getting up and going to bed are flexible and individual daily records evidence this. Service users were involved in choosing their linkworkers with records on file to evidence this. Service user plans outline their communication profile, daily routines and likes and dislikes in relation to food, which is available in a pictorial format. All of the service users are registered with a local General Practitioner. The Annual Quality Assurance Assessment document confirms that service users have access to specialist health professionals when required. The Annual Quality Assurance Assessment document indicates that service user annual plans have been implemented to monitor and maintain service users’ paperwork and health needs/ appointments. In two out of the three service users plans viewed this annual plan was blank for the period from January to May. Service user plans outlined the support required by individuals in meeting their health needs and to attend appointments. However they did not outline the frequency or evidence that service users are supported to attend routine health appointments with Care Homes for Adults (18-65 years) Page 16 of 30 few records maintained of the outcome of actual appointments that service users have attended. Therefore it was not assessed if service users have access to a range of healthcare facilities and attend routine follow up appointments. Following the inspection the Registered Provider provided evidence to confirm that service users have access to health professionals and agreed for the recording of health appointments to be improved. None of the service users are self-medicating. However service users medication is kept in their bedrooms in individualized locked cabinets and their medication is administered from there. The key to the medication cupboard is kept insecure in each bedroom. This was addressed as a temporary measure during the inspection with the Registered Provider confirming after the inspection that individual key safes had been provided. Each service user has an individual medication file which include an agreement for staff to administer their medication. Service users plans include specific guidelines on the support required by individuals in relation to their medication with medication risk assessments in place to address potential risks. Service users medication file included a description of individual seizures and outlined the protocol on the use of as required emergency medication and the emergency procedure in response to seizures, which was agreed and signed by the General Practitioner. Records are maintained of the date of seizure, seizure type and indicates whether as required emergency medication was administered and required. One service users medication administration record indicates that on one occasion that month as required emergency medication was administered but not signed for. Another service users medication administration record indicate that a medication was prescribed but only administered once on the 10th April and not administered in May up to the date of the inspection. The team leader advised this was not administered as the guidelines on administration were not clear as to whether it was to be administered as required or regularly. She advised they had been liaising with the General Practitioner to get it resolved. There was no records maintained to evidence that the staff at the home had liaised with the General Practitioner and subsequently this medication was not been administered as prescribed. During the inspection the service manager contacted the General Practitioner who advised this medication was to be administered twice a day as prescribed. This must be addressed so that medication is administered as prescribed and any discrepancies are dealt with in a timely manner to prevent a delay in prescribed medication being administered. All of the medication administration records viewed showed gaps in the administration of creams, shampoos and for one service user in the administration of their prescribed liquid gel. The team leader advised that the liquid gel was discontinued but this was not recorded on the medication administration records to indicate date and who had discontinued it. The service manager had competed a detailed medication audit but all recommendations from that audit were not being followed in relation to day to day practices of medication administration. Service users medication files include detailed protocols on the administration of all as required medication, which is signed by the General Practitioner. The home do not use any homely remedies. All medication received into the home was not signed for with one service user having duplicate copies of a medication administration record in place for the same time period which was confusing and potentially could lead to an error. Records of stock checks of medication and disposal of medication were maintained. All staff involved in medication administration are assessed and deemed competent Care Homes for Adults (18-65 years) Page 17 of 30 prior to being expected to administer medication with annual reassessments of competency carried out to promote good practice. Two staff are involved in the administration of medication. Specific staff are also trained in the administration of emergency medication with updates in this training overdue for three staff. Training records confirm that staff have training in safe handling of medication with a new medication policy in place to support practice. However improvements are required to medication practices to safeguard service users. The Registered Provider confirmed after the inspection that the current shortfalls in medication practices were considered out of the norm and had been addressed with the individual staff concerned with amendments made to the medication policy and staff medication assessments to support practice. Care Homes for Adults (18-65 years) Page 18 of 30 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 who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to ensure that complaints are managed appropriately to safeguard service users. Staff have the required policies and training to ensure that service users are safeguarded from potential abuse however staff practice indicates these policies are not being followed which potentially put service users at risk of abuse. Evidence: Service users have an individual copy of the complaints procedure, which is in a pictorial format with evidence of it being explained to them. The last record of explanation of the complaints procedure in one of the files viewed was in 2006, which is not annually. The Organisation has recently reviewed the complaints, concerns and compliments policy with a copy of this policy in the home. The Annual Quality Assurance Assessment document confirms that the home has received no complaints in the previous twelve months. A complaints log is in place to record complaints made and action taken. The Commission have not received any complaints in respect of this service. Completed surveys received from service users confirm that they know how to make a complaint. The Annual Quality Assurance Assessment document confirms that the home has had no safeguarding of vulnerable adults referrals or investigations. The organisation has recently updated the safeguarding of vulnerable adults policy, which is line with Local Authority safeguarding procedures. This revised policy was available at the home waiting to be filed. Alongside this the home has a copy of the Bucks interagency adult protection procedures. The training records viewed indicate that the majority of permanent staff have up to date safeguarding training with this training booked for two staff members. Training records were not completed for sessional workers so it was not established if those individuals had up to date safeguarding of vulnerable Care Homes for Adults (18-65 years) Page 19 of 30 adults training. During the inspection it was noted that one service user had three injury body chart forms completed within 6 days, with one service user having one injury body chart form completed which indicated unexplained bruising was noted on those individuals. The daily records made no reference to it, the seizure record did not indicate that those individuals had recently had a seizure, no accident forms were completed and they were not reported on the monthly return to the service manager. An entry was made on three occasions in the communication book to make staff aware that those individuals had bruising. This entry was initialed as being read by all staff including the registered manager who did not act to address the unexplained bruising in line with Turnstones policies and procedures and the Local Authority safeguarding procedures. This practice is unsafe and potentially puts service users at risk and must be addressed by the Organisation to safeguard service users. The service manager agreed to make a referral to the local Authority safeguarding team in retrospect of the incidences. The service manager confirmed after the inspection that reporting incidents of unexplained bruising was discussed in a recent team meeting and the safeguarding of vulnerable adults trainer will do training specifically aimed at the team. The unexplained bruising have been reported to the Care Manager. Some staff have training in positive communication. Service users plans include guidance on the support required by individuals when things go wrong which outlines how staff manage behaviours that may challenge. Service user plans include guidance on the support required with finances and a money risk assessment to manage potential risks. Permanent staff files were inaccessible in the home. Sessional workers files were accessible but incomplete as outlined under standard 34 and this practice potentially put service users at risk. Care Homes for Adults (18-65 years) Page 20 of 30 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 who use the 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 is homely and personalised and staff support service users to live in a clean and maintained property, to promote their safety. Evidence: The home is located on one of the main routes into Newton Longville and is a detached bungalow. There is ramped access with grab rails from the car park to the front door and once inside all accommodation is on level ground. There is a lounge with combined dining room overlooking the front garden and a good sized kitchen leading off it with access to the garden area. Each service user has their own good sized bedroom, which had been decorated and personalised to individual taste. There is a large bathroom with shower and toilet and a separate toilet next to it. The home does not have a bath and this was being pursued by the advocate on behalf of service users whose needs had now changed from when they moved in. The team leader confirmed that the whole house had recently been decorated and it appeared to be well maintained, homely, airy and bright. The office doubles as a staff sleeping in room and is centrally located in the building. The home has a separate laundry, which was sufficient for the size and needs of the home. One of the cleaning cupboards was not locked properly or the lock is damaged as it opened under minimal pressure. This should be addressed to protect service users. Outside, there is parking for a small number of cars with a small enclosed garden to the rear of the property. The Annual Quality Assurance Assessment document indicates that the aim is for the garden to be developed into a sensory area and involve service users more in the care and maintenance of their garden. Staff are responsible for the cleaning of the home and on the day of the inspection it appeared clean and tidy although there was an unpleasant odour in the shower room. Care Homes for Adults (18-65 years) Page 21 of 30 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. Some staff have access to mandatory and specialist training to enable them to meet service user needs however some recruitment practices and sessional staff inductions must be improved on to safeguard service users. Evidence: Some staff have specialist training in positive communication, epilepsy, diversity awareness and autism awareness training. The Annual Quality Assurance Assessment document confirms that over 50 of staff have an National Vocational Qualification with 2 new staff being nominated to commence this training. The Annual Quality Assurance Assessment document confirms that staff have good relationships with other professionals. No feedback was received from health or social care professionals involved with the home to support this. Feedback was received from the advocate who visits the home who commented, that sometimes initiatives take a while to get going. However the home constantly review and improve staff practice to respond to the changing needs of their service users with service users needs kept central. The rota indicates that there is two staff per shift with the registered manager rostered to work part admin and part support hours during the week. The home has separate night staff with a waking night staff member and a sleep in person on duty at night with back up management support available as required. At the time of the inspection the home has no vacancies with one new staff member awaiting clearance prior to commencing work. The rota indicated that there was some staff on annual leave and some sickness. Those gaps in the rota were being covered by the Organisations sessional workers. On the day of the inspection there was two staff on duty, a team leader and a new sessional worker to the home. The permanent staff member had taken a service user to the hospital, which left the new sessional worker in the home Care Homes for Adults (18-65 years) Page 22 of 30 on their own with two service users for part of the morning. As will be outlined under standard 34 and 35 this individual was not properly recruited, inducted and trained to be left in charge of the home with service users on their own and this practice potentially put service users at risk. This individual was unaware of the inspection process, inspectors role and the requirement to access records required for Regulation. The home has regular team meetings with records maintained to evidence this. Written feedback received from one staff member commented that the home needed to improve upon team meetings. No indication was given of what improvement was required. The registered manager was not on duty and had been on annual leave for two weeks. The team leader and service manager did not have access to staff recruitment files including information on agency staff. This should be addressed to ensure that records required for regulation are made available to senior staff for inspection purposes during the managers absence. The Annual Quality Assurance document confirms that two references, Criminal Records Bureau checks and POVA first checks are taken before appointment. Evidence of recruitment checks for sessional workers is maintained on a central database, which is accessible from the home. The service manager accessed the information for three sessional workers who were currently working at the home. This confirmed that all sessional workers used at the home had a Criminal Records Bureau check, which was obtained whilst employed as a permanent staff member. None of the individual records viewed confirmed that two references had been obtained for any of those staff. The human resources department confirmed in a telephone call to the service manager that those individuals were previously employed as permanent staff and new references were not obtained when they transferred to a sessional contract. However the Organisation is required to confirm that two references have been obtained for individuals as outlined in schedule 2 and this must be addressed. The information on the sessional worker on duty during the inspection indicates that their work permit had expired since December 2008.The human resources department confirmed in a telephone call with the service manager that this had not being followed up with the individual concerned as she had not worked for the Organisation since December 2008. As this individual had not worked for the Organisation for 5 months there was no evidence that it had been established what they were doing during this time and a POVA first check or a new Criminal Records bureau check was not applied for when they recommenced work with the Organisation. This same individual was left in charge of the home on the day of the inspection in an unsupervised capacity. This practice is unsafe and potentially put service users at risk. During the inspection the service manager made the decision that this individual would not be used until such time as the required information had been obtained. The Registered Provider confirmed after the inspection that the human resources department carry out audits of sessional workers records and as part of that audit address where a sessional worker has not worked for three months. Prior to the inspection there had been changes in the human resources department staff which resulted in those audits not taking place which was felt to be specific to this staff member that has since being addressed. The rota indicates that the home has recently used agency staff. The team leader on duty thought the information on agency staff was kept by the registered manager. A folder was found which contained some information on agency staff with the majority of it for agency staff that had not being used for some time. This file contained confirmation of recruitment checks for one of the agency staff recently used but this Care Homes for Adults (18-65 years) Page 23 of 30 information was not available for the other two agency staff. This must be addressed. The training records viewed indicate that permanent staff have the majority of the required mandatory training with moving and handling practical and fire safety video training overdue for a number of staff. Staff have had some specialist training as outlined under standard 32. The electronic training records for all of sessional workers viewed was not completed to indicate if they had the required mandatory training. This information was available at the home for one of those individuals but not for the staff member on duty during the inspection. The Annual Quality Assurance document indicates that the common induction standard process is in place and that all new staff receive structured induction training. Written feedback received from staff confirm this however one person highlighted that there was no induction for sessional workers. The team leader had commenced on the previous shift an induction for the sessional worker on duty during the inspection. The induction records were incomplete and confirmed that this individual was not inducted into key health and safety areas and service users risk assessments but was left to work with service users in an unsupervised role in charge of the home. This practice is unsafe and potentially puts service users at risk. The team leader confirmed that she supervises a number of care staff and the registered manager supervises her and the remaining care staff. Supervision records were viewed which confirm that those individuals being supervised by the team leader receive monthly supervision. Written feedback received from staff confirm that they receive regular supervision. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being regularly monitored but is not being effectively managed to safeguard service users. Evidence: The home has a registered manager who has completed the registered managers award and she is currently completing a National Vocational Qualification level 4 in health and social care. The Annual Quality Assurance Assessment document outlines current practice, let us know the changes they have made and the improvements required to develop the service. However it was assessed at this inspection that some areas of practice are not as outlined in the Annual Quality Assurance Assessment document. This inspection has resulted in a change of rating of the service and a number of requirements to improve practice to safeguard service users. Written feedback received from staff indicate that some staff felt more leadership training was required for the lead members of the team, with conflict resolution skills required for the team. Some staff felt there should be better use of the communication book and better communication through the communication book. One person commented that staff at the home should be involved in decision making as staff from the office make decisions regarding service users that they know nothing about. This feedback would indicate that there is some conflict and disharmony in the team, which should be addressed to promote a comfortable and safe environment for service users. The organisation carry out monthly Regulation 26 visits with detailed and thorough Care Homes for Adults (18-65 years) Page 25 of 30 reports including an action plan available to evidence this. A medication audit was completed in April 2009 with improvements to practice required from that audit. A health and safety audit was due on the day of the inspection but it did take place. The service manager confirmed that feedback is sought from staff, service users, relatives and other stakeholders. The last audit was carried out in 2007/2008 and was due to be done again this year. During the inspection it was noted that some records required for Regulation were inaccessible with some unable to be located. There was a pile of loose paperwork for filing and further paperwork to be dealt with by the manager on her return. This should be addressed so that records required for Regulation are well maintained and are accessible to staff in the course of their work. As outlined under standard 23 accident reporting is not in line with the Organisations and Local Authority procedures. During the inspection the staff on duty could not initially find the accident book with this eventually being located in one of the filing cabinets. This should be addressed so it is accessible to all staff. As outlined under standard 35 the majority of permanent staff have up to date mandatory training with moving and handling practical and fire safety training due for some staff. It was not assessed if all sessional workers have the required training, as records were not available to evidence this. The Annual Quality Assurance Assessment document confirms that there are policies in place, which comply with the health and safety act. It indicates that a fire risk assessment is in place and that the fire equipment is serviced with regular fire drills taking place. It confirms that the portable appliance testing is carried out annually A sample of health and safety files were viewed. An up to fire risk assessment was in place. Fire records indicate that weekly fire point tests, fire blanket, door guards and emergency lighting checks take place. A fire drill was carried out on the 30th April 2009. Service user plans include risk assessments in relation to fire. The home has records in place to confirm up to date servicing of gas appliances, portable appliances and fire equipment. Records are in place to evidence health and safety checks of bedrooms as well as water temperature checks, fridge and freezer temps and food probe checks. These were well maintained. During the tour of the home it was noted that latex gloves were accessible. The registered manager must consider whether this poses any risks to service users. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes No √ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 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 Prescribed creams and shampoos must be administered as prescribed with the medication records signed to indicate if applied or not. To safeguard service users. 30/06/2009 2 20 13 The medication administration record must outline if a medication is discontinued, date it was discontinued and by whom with this being cross referenced in the service users file or health record. To safeguard service users. All medication administered must be signed for and all medication must be administered as prescribed with any discrepancies dealt with in a timely manner to prevent a delay in prescribed medication being administered. 15/06/2009 3 20 13 15/06/2009 Care Homes for Adults (18-65 years) Page 28 of 30 4 23 13 To safeguard service users. The registered person must ensure that staff are clear of their responsibility to report potential safeguarding incidences in line with the organisations and the Local Authority procedures. To safeguard service users. The registered manager must ensure that all staff, including sessional workers and agency staff are properly recruited with the required records and checks in place and available as outlined in schedule 2 and Schedule 4. To safeguard service users. All staff including sessional workers must be fully inducted and suitably trained prior to being left in charge of the home on their own. To safeguard service users. All staff must have up to date moving and handling practical and fire safety training. 15/06/2009 5 34 19 30/06/2009 6 35 18 15/06/2009 7 35 18 30/06/2009 8 42 13 To safeguard service users. The registered manager must 31/07/09 consider if access to latex gloves poses any risks to service users with risk assessments in place to address potential risks. 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 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!