Inspection on 23/10/09 for Fishermead Boulevard (104)

This inspection was carried out on 23rd October 2009.

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

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

Other inspections for this house

Fishermead Boulevard (104) 06/12/06

Fishermead Boulevard (104) 25/01/06

Fishermead Boulevard (104) 10/12/05

Fishermead Boulevard (104) 24/03/05

Fishermead Boulevard (104) 14/07/04

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Dalewood Respite Care

Orchard,The

REACH Upton Court Road

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Fishermead Boulevard (104) Fishermead Milton Keynes Bucks MK6 2AP     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: Chris Schwarz     Date: 2 3 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Fishermead Boulevard (104) Fishermead Milton Keynes Bucks MK6 2AP 01908670234 01908670234 manager.fishermead@fremantletrust.org www.fremantletrust.org The Fremantle Trust The registered provider is responsible for running the service care home 6 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Date of last inspection Brief description of the care home 104 Fishermead Boulevard is located close to the city centre in Milton Keynes. It was providing care to six male service users with learning disabilities and a range of personal care needs. There are good shopping, leisure and transport facilities close by. The building is a large, detached property with accommodation on two floors. Each person has a single bedroom, one of these is on the ground floor and is next to a bathroom and shower which has been adapted to meet the needs of people with physical disabilities. The service has parking for staff and visitors and there is a large Care Homes for Adults (18-65 years) Page 4 of 33 6 Over 65 0 Brief description of the care home enclosed garden. Fees for the service were £533.82 per week. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over the course of a day from 9.30 am until 4.30 pm and covered all of the key national minimum standards for younger adults. The last key inspection of the service took place on 6 December 2006. Annual Service Reviews were undertaken in December 2007 and 2008. Prior to this inspection, a detailed self-assessment questionnaire, the Annual Quality Assurance Assessment (AQAA), was sent to the manager for completion. It was returned on the day we asked for it to be back and provided a good standard of information about the service although a few sections in the statistical section had not been completed. Surveys were sent to a selection of people living at the service, staff and visiting professionals. Eight replies had been received at the time of visiting the service, two from staff and six from people using the service. Information received by the Care Homes for Adults (18-65 years) Page 6 of 33 Commission since the last inspection was taken into account. The inspection consisted of discussion with the manager and other staff, opportunities to meet with people using the service, examination of some of the required records, such as care plans, medication administration records, staff training records, recruitment files and policies and procedures. Care practice was observed and a tour of the premises undertaken to look at standards of accommodation. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. The manager, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Keys to medication cabinets were readily accessible at the service. Improved security of medication is needed to ensure that only authorised people can access medicines. The service has a complaints procedure in place at the service to listen to the views of people but there were no records to show that a complaint had been handled in Care Homes for Adults (18-65 years) Page 8 of 33 accordance with these procedures. Peoples money, held for safekeeping, was readily accessible at the service. It needs to be kept secure at all times to prevent unauthorised access or theft. Recruitment practice (references and arrangements for starting carers on preliminary clearance) needs some strengthening to make sure that sufficient safeguards are in place to protect vulnerable adults. Some health and safety issues were observed which the manager needs to address: all foods need to being stored in line with safe food handling practice, hoisting equipment needs to be serviced in accordance with the manufacturers or engineers recommendations and hazards such as methods for descaling taps need to be removed. We would also advise that any policies and procedures that refer to the services regulator (such as the safeguarding procedure and emergency procedures) are updated and have the correct contact details so that staff have this information readily to hand when they need it. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures are in place to ensure that the needs of prospective service users are identified before they are offered a placement. There is printed information about the service to help people decide if this is the right place for them although the service would benefit from removing out of date documents to ensure that people are given current information. Evidence: Statistical information submitted by the manager showed that there had not been any admissions to the service in the past year. In the Annual Quality Assurance Assessment we were informed that a statement of purpose and service users guide were in place and that people using the service can have their own copies of these if they wish. The manager told us that a comprehensive assessment would be carried out by the local authority if someone was being considered for a placement and that the service would undertake its own assessment. A series of visits would be undertaken so that the person could try out the service. The manager advised us that the current user group would be involved in any admissions process. We were told that user friendly contracts were in place. Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: People who completed surveys said they had been asked if they wanted to move into this service and that they had received enough information about it to help them with their decision making. The service information file in the office was looked at. There were several versions of service users guides, one which was in pictorial and easy read format but had not been wholly customised for the service and still contained formatting text in several places (such as service user guide for home name and section also needs to cover any specialist services you provide including any strategies for communicating with residents). There was also a statement of purpose which contained all required information but needed minor amendment to show revised contact details for the provider and regulator. The manager advised later in the inspection that information in this file was out of date and that a new statement of purpose had been produced. This version was being kept in the hallway. It was clear in outlining the type of care needs that could be met and included a range of information that people would find useful such as the aims and objectives and how peoples privacy and dignity would be respected, how they can make choices and a charter of rights. It contained the current fees for living at the service. A complaints procedure was contained within the statement of purpose. The manager said that the service users guide was also being revised at headquarters. There were individual files in the office which the manager said were being updated so that each person had a version of the service users guide to keep in their room. Procedures for assessing and admitting people to the service have been looked at during previous inspections and found to be satisfactory. As there had not been any new admissions this process was not repeated. The operations manual in the office contained an admissions procedure for staff to refer to in the event of there being a vacancy. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is good regard for the diverse needs of the people living at the service and their requirements related to their disabilities, lifestyle choices and personal preferences are sought, recorded and met by the staff team, respecting their rights, choices and individuality. Evidence: The Annual Quality Assurance Assessment informed us that person centred care plans were in place for each person and that they are reviewed regularly. People using the service were said to have their own copy of their care plan and could choose which staff were involved in their care plan. The manager advised us that service users had named key workers and that regular residents meetings take place to express views. We were told that where they are able to, people using the service chair their own review meetings. Examples were given of people being involved in decision making such as involvement in staff recruitment and having keys to their room and the front door. We were told that risk assessments were in place. Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: People using the service said in surveys that they sometimes make decisions about what to do each day, during the evenings and at weekends. Three peoples care plan files were read during the visit to the service. These were person centred with use of photographs of the service users throughout. The manager showed that one of the three service users additionally had a talking care plan which he and his key worker had recorded. All care plan files contained essential information such as any aids or equipment people needed, religion, date of birth, preferred name, next of kin and significant people. There were sections on areas such as likes and dislikes, family composition, support with keeping healthy, personal care needs, keeping safe, lifestyle and future plans and social life. Birthdays of friends and family were noted to support people to celebrate these occasions. Care plans showed that people have a named key worker assigned to them. Two of the care plans did not have a date to show when they were compiled and hence how current the information was. The manager was reminded to make sure dates are consistently written. The care plan of a service user with high care needs was particularly detailed around areas such as mobility and using the hoist and slings. It contained photographs and good descriptions of what to do to promote continuity of care and to ensure his safety and the safety of staff when carrying out moving and handling manoeuvres. All of the files had a sheet at the front indicating regular review of care plans and accompanying risk assessments. The member of staff on duty at the time was unable to locate risk assessments when asked to, but offered to contact the manager. As she was due back in a short while this offer was declined. The risk assessments of the same three service users were later looked at and it was observed that three different recording systems were being used. One was the corporate risk assessment format with the sheets of paper loose inside the persons section of the care plan sling files, another was a person centred format with photographs of the service user throughout in a small black folder and the third which related to the person with the highest care needs was person centred and in much more detail because of his needs. His assessments were being kept in the risk assessment file alongside generic risk assessments on the shelves in the office. The manager advised that risk assessments were being updated on the computer (which could not be accessed due to technical difficulties) and that the loose sheets of corporate risk assessment would be replaced in favour of the person centred version. She is advised to give some thought to a consistent filing system for risk assessments. People were seen to make decisions such as choice of food at lunchtime, whether to spend time in their rooms or the communal areas, what they do in their spare time and who they see. No one was managing their own finances; one person was Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: managing his medication. Photographs used to illustrate care plans and risk assessments showed that service users are supported to be as independent as possible, for example by involvement with household chores. The minutes of four service users meetings held this year were read and reflected that people are consulted about their care and asked for their opinions. The services procedures and general ethos promote appropriate handling of sensitive or confidential information and staff were seen to uphold this during the inspection. Care Homes for Adults (18-65 years) Page 15 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met and respecting peoples preferences and religious or cultural requirements. Evidence: A range of activities was described in the Annual Quality Assurance Assessment to show that people using the service have varied and interesting opportunities accessible to them. Day services were also being utilised. People using the service were said to access the community and risk assessments were in place for them to be as independent as possible. We were told that service users take part in planning menus, shopping and meal preparation and that nutritional assessments were in place. Flexible and informal meal times were described. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: Three people were at home on the day of the visit, other service users had left to go to day services. One person was taken out to rebound therapy during the morning and another service user accompanied him. The third person was supported to clean and tidy his room. People returned from day services during the afternoon and were greeted by staff who took an interest in what they had been doing and how they were. One person was getting ready to spend the weekend with his parents. Another person described the activities he takes part in, which include supporting a football team and showed a picture of his girlfriend on his mobile telephone. Records of activities were being maintained in large scrapbooks with photographs and entry tickets to show where people had been. Photographs included the London Eye, Sea World in Birmingham, holidays to Ibiza and Butlins, Cadbury World, the Groovy Gecko Club, a black tie summer ball and Halloween party which people dressed up for. There were tickets to show people had attended events such as football matches and had seen the latest Harry Potter film at the cinema. One person had been enabled to celebrate his 50th birthday recently and staff had put together various photographs of him through the ages. Minutes of service users meetings showed that people are asked what activities they would like to try and where they would like to go for holidays. Nutritional assessments were seen on peoples files. Menus were being maintained and reflected a range of different meals. People were offered a choice at lunchtime and staff ate with them to make the meal time relaxed and chatted to people. One person who requires PEG feeding was not excluded from the social gathering at lunchtime. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living at the service are well met, promoting health, well-being, taking into account their preferences and religious or cultural requirements. Improved security of medication is required to ensure that only authorised people can access medicines. Evidence: In the Annual Quality Assurance Assessment we were informed that all service users were registered with the local doctors surgery and that health passports were in place. We were advised that medication is reviewed regularly and health checks and appointments attended as necessary. Care plans were said to include information on any support people needed with their health and personal care needs and the manager told us that peoples privacy and dignity were respected by the staff team. Any aids and equipment that people needed were said to have been provided. We were told that the service has a medication policy and that all staff have been trained on safe handling of medication. People using the service were said to be assessed and enabled to manage their own medication. Peoples care needs were documented in their care plans with a good level of detail for Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: the person with the highest care needs. Personal care assistance was carried out in private with doors closed to respect peoples privacy and dignity. Moving and handling equipment was in place to assist the person who uses a wheelchair and a new bed was delivered for him during the inspection. Regular assessments were being undertaken for this person to determine the risk of developing pressure damage and a consistent low risk was indicated. An air mattress was being used on his bed and he was supported to come out of his wheelchair and lay down after lunch. Staff made sure his body was supported to keep him comfortable and put on his television, sensory lights and equipment to make the time relaxing and interesting for him. The health passports of three people were looked at. These included information on how the person communicates, any equipment they require, information about people who help them and their contact numbers and records of appointments with professionals such as doctors, chiropodists, dentists and opticians. One persons file showed that the surgery was no longer providing a Well Man service; the manager advised that the community nurse had tried to look into this. The manager could additionally contact the primary care trust for further advice. Records also showed that weights are checked periodically. The service had a medication policy in the operations manual in the office. Individual medicines cabinets had been fitted in peoples bedrooms and there was a main cabinet in the office. One service user was managing his own medicines at the time of the visit. The key to the office medication cabinet was in the lock at the start of the inspection and remained there until around midday. Keys to cabinets in bedrooms were also accessible in the open key cabinet in the office. A requirement is made to ensure that there is better security around access to medicines at the service. Medication administration records were in good order with signatures alongside prescribed dose times. Records were being maintained of medicines returned to the pharmacy. Training records for a sample of staff showed that they receive training on safe handling of medicines. Care Homes for Adults (18-65 years) Page 19 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and safeguarding procedures are in place at the service to listen to the views of people and to reduce risk of harm. There were no records to show that a complaint had been handled in accordance with procedures. Improvement is needed to management of peoples money to ensure it is kept secure. Evidence: We were advised in the Annual Quality Assurance Assessment that the service had an accessible version of the complaints procedure. Consultation meetings were said to take place, giving relatives and friends opportunities to express their views. The manager told us that there were safeguarding policies and procedures in place and that staff receive training to protect service users. One safeguarding referral was identified, which we were informed of before the inspection was being planned. All staff were said to have a Criminal Records Bureau check. People using the service said in surveys that they knew who to speak with if they were unhappy and how to make a complaint. Staff said in surveys that they knew what to do if someone raised any concerns about the service. Feedback from relatives noted at a consultation meeting included that the manager was fantastic and that her team were marvellous. One relative said he had been encouraged to hold out for a place at Fishermead as it was such a good home. Feedback at that meeting also concluded that other relatives were pleased with the support people were receiving. Relatives also indicated to the operations manager that the manager sorts out their concerns Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: but always treated her staff with respect. Positive comments were also made by them about the homely atmosphere and the amount and variety of activities that take place. The operations manual contained the complaints and safeguarding procedures. The safeguarding procedure was detailed and informative but contained out of date contact details for the Commission. It would be advisable to address this to make sure staff have the information they need to hand. A pictorial and easy read version of the complaints procedure was seen and the service had a copy of the local authority inter agency safeguarding procedures to refer to. The complaints and compliments log was looked at. The manager had indicated in the Annual Quality Assurance Assessment that there had been one complaint and the letter from the person dated April this year was contained in the file. There were no documents to show that it been acknowledged and responded to. A requirement is made to maintain records of how complaints are responded to, to show that peoples concerns are appropriately handled by the service. None of the service users were managing their money. Individual wallets were kept in a cash tin in the office. This tin (and the petty cash tin) were on the desk in the office at the start of the inspection with the keys on top and remained there until around midday. A requirement is made to ensure better security of peoples money. The balances and records for three people were checked. Two tallied and one was £1 over; this was explained as likely to be a result of money left in the persons clothing during laundry and put back in the tin. Receipts were being kept to verify expenditure. Recruitment files that were looked at showed that in two out of three files the references were only character references. Two of the three carers started work with preliminary clearance before the full Criminal Records Bureau check had been returned; the manager did not have a formalised system in place to make sure that carers in these circumstances are made aware of limitations to practice. Advice has been given to the manager to tighten up this practice to make sure that people using the service are fully safeguarded. Care Homes for Adults (18-65 years) Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are clean, well decorated and adequately maintained, promoting a positive environment for the people who live there and which are suitable for the range of disabilities that people have. Evidence: In the Annual Quality Assurance Assessment we were told that the premises are kept clean and homely and that rooms are well decorated, modern and meet peoples needs. A maintenance programme was described as being in place. People using the service were said to be encouraged to take part in household chores and to personalise their rooms. People using the service said in surveys that the premises are always kept fresh and clean. The service is located close to the city centre and is a detached two storey building at the end of a row of properties. There is parking in front of the building and in the car park at the side. There is a large enclosed garden with seating areas. Accommodation is on two floors. All bedrooms are single with one of these on the ground floor; those that were seen had been personalised and were in good decorative order. Bathrooms and toilets were close by. The lounge and dining area were attractive, homely and had Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: comfortable furniture. The downstairs bathroom had been adapted to meet the needs of the person who uses a wheelchair and there was a shower which he could also access. The kitchen and laundry were clean and had impermeable flooring. All areas of the building were clean. Toilets were stocked with all the necessary items, including hand wash. Chemical products were kept secure in the cupboard in the laundry. People using the service were being supported to take part in household chores, as noted earlier. In feedback to the manager the inspector mentioned that the strong smell of a well known disinfectant detracted from the homeliness of the building. Care Homes for Adults (18-65 years) Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing is sufficient to meet the needs of people using the service and carers are inducted and trained to a good standard to be able to meet peoples care needs. Some improvements to recruitment practice are advised to provide better safeguards for service users. Evidence: In the Annual Quality Assurance Assessment we were told that mandatory training was up to date and that specialist training could also be accessed. We were told that all staff receive regular supervision and have annual appraisals. All staff were said to have undertaken an induction programme and to have been provided with a job description. Regular staff meetings were said to take place. In statistical information we saw that there were eleven part time carers, five of whom had achieved National Vocational Qualification at level 2 or above. Two staff had left working at the service in the past year. Seven staff were said to have received training on safe food handling. People using the service said in surveys that staff usually treat them well and usually listen and act on what they say. Staff said in surveys that they are given up to date information about peoples needs and their induction had covered the areas they needed to know about. They said they receive training which is relevant to their role, helps them to understand and meet individual needs and keeps them up to date Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: with new ways of working. They considered their training equipped them with enough knowledge about health care and medication. They said they receive regular support from their manager to meet and discuss how they are working and considered the ways in which information is shared usually worked well. They said there are usually enough staff to meet peoples individual needs and that they had enough support, experience and knowledge to meet different needs such as those arising from equality and diversity. Comments in response to what does the home do well? included: meet the individual needs, have a professional but homely, comfortable environment, work well as a team and the home provides a friendly and lively environment for all residents. One person said the service could improve through acquiring a better computer system. On the day of this visit there were two staff on duty plus the manager in the morning. Two staff were scheduled to work during the afternoon and evening and one person sleeping in overnight. Rotas were being maintained and the manager advised that no agency staff were needed as there were enough relief staff to cover any gaps. A staff photograph rota was also being used to show people using the service who was on duty. Minutes of staff meetings showed that these take place regularly and a range of issues are covered such as updating on each service users needs, an update on safeguarding training and reminders to book medical appointments and to support people to buy presents for their family, such as for Mothers Day. The recruitment files of three staff were looked at. All contained an application form, Criminal Records Bureau clearance, references and health clearance. Two people only had character references, verified by the referees saying they were work colleague, family friend, neighbour and friend and one stating that although he had worked with the person in a retail position the information supplied was a personal reference. The manager was advised to make sure that at least one reference is from an employer, where possible, this helps to provide a more impartial and balanced view of peoples suitability. In two files peoples start dates were prior to receiving Criminal Records Bureau clearance. The manager was unable to produce any documentation to show that new starters in these circumstances had been formally made aware of the limitations to practice until full clearance is received, including not being able to take service users out alone, and that other staff have also been informed of these limitations. She is advised to put tighter safeguards in place to fully protect people using the service. New staff undertake an induction which meets the common induction standards and this takes place over five days. Mandatory training is covered in this time including Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: infection control, safeguarding, the Mental Capacity Act 2005 and input on equal opportunities. Probationary assessments were seen on peoples files and records of supervision and annual appraisals were noted but not read. Training records of three staff were looked at. These were up to date apart from one persons moving and handling which was last attended in July 2008. The manager was made aware that this needed to be looked into. Records of one of these staff, who had worked at the service longer, showed she had also attended specialist training on areas such as PEG feeding, epilepsy awareness, skin care, sex and sexuality for people with learning disabilities and understanding and responding to challenging behaviour. Care Homes for Adults (18-65 years) Page 26 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has an experienced manager and there is regular monitoring by the provider to ensure standards are being met. Health and safety practice needs some attention to make sure that people using the service are not put at risk of harm. Evidence: We were informed in the Annual Quality Assurance Assessment that the manager keeps her training up to date and ensures service users are fully involved in their care. The Annual Quality Assurance Assessment was received on the day it was due to be returned to us. Some sections had not been completed in the statistical section such as questions about controlled medicines, infection control and nutritional screening. Other sections had been completed satisfactorily. The manager told us that an annual quality audit takes place and that the provider visits on a regular basis to assess quality of care. We were informed that regular health and safety checks are carried out and statistical information showed that equipment was being serviced as recommended, such as gas appliances, the heating system, portable electrical appliances, electrical hard wiring and hoists. Fire fighting and emergency lighting equipment was also being maintained from information provided. Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: The certificate of registration was displayed in the hallway as was the certificate of current employers liability insurance. The manager of the service is registered, experienced in working with people with learning disabilities and holds a National Vocational Qualification level 4 in care. She was seen to be approachable throughout the day by staff, service users and relatives. The report has highlighted some areas of management weakness that need to be improved to ensure better safeguards for people and these (as well as the positive areas) were fedback to the manager at the end of the visit. The manager confirmed that she has attended training on deprivation of liberty safeguards and described a current situation where a best interests meeting was being called to look at the issue of resuscitation. There were reports available in the office to show that the provider undertakes regular monitoring visits to assess quality of care. The manager said there had been a quality audit at the end of last year/beginning of this year but no report had been forwarded. Another audit was planned to take place a fortnight after this inspection. There was an emergency procedures file in the office covering issues such as sudden death, missing persons, gas leaks, loss of water supply, power failure and accident and incident reporting. Home and mobile telephone numbers of senior Fremantle Trust managers were included in it. Three of the procedures looked at referred to the Commission for Social Care Inspection as the regulator and gave contact details for the Oxford office, which is out of date information. The manager was advised to ensure staff have the correct details to hand when they need to respond to emergency situations. Accident records showed that only one accident had occurred in the past eighteen months and measures had been put in place to prevent a recurrence. The fire officers report dated June 2009 was looked at. It showed satisfactory standards for fire safety and advised regular review of the fire based risk assessment. An environmental health food hygiene report was seen, dated October 2008. A 4 star/good award was given plus some advice. Some issues were brought to the managers attention regarding storage of food during this inspection. In the fridge there were two packets of open meat that had not been sufficiently covered over and had no dates of opening. Dates of opening had not been identified for a jar of mayonnaise (to be used within 4 weeks of opening) and a jar of salad cream (use Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: within 6 weeks of opening). There were two cucumbers past their best in the salad tray alongside other vegetables. Two fairy cakes had been put back in a cupboard without any covering on them. Service users are actively involved in food preparation at the service, which may have contributed to this. A requirement is made to ensure foods are stored in accordance with good hygiene practice to ensure the health and well being of people using the service. We would also advise that the manager amend or prepare risk assessments to support the practice of service users involvement to make sure that food is handled safely. Records showed that servicing of hoisting equipment had been carried out in January this year and a recommended re-test date of July 2009 was given. There was no certification to show that the equipment had been re-tested and the manager advised that it had only recently been done, three months overdue. The manager needs to ensure that equipment is serviced in line with the manufacturers or engineers recommendations, in order that it is safe to use and to prevent accidental injury. We would expect measures to be put in place to prevent a lapse in the future. Records showed that there was a current gas safety certificate for the service and that portable electrical appliances had been serviced this year. The electrical hard wiring certificate in the file expired in April this year; the manager advised that an electrician had visited the service since then to carry out a new check although there was no evidence to verify this. The manager was asked to obtain a certificate to verify this work has been undertaken and to provide a copy with the response to the draft inspection report; this was addressed. A couple of hazards were seen around the building and pointed out to the manager. On arrival at the service, staff were cleaning and the manager had put strips of tissue soaked in descaling liquid on taps to remove lime scale. There were four service users in the building when this was noticed, three of whom could have gone to the toilet unaided and come into contact with this liquid when they washed their hands. The other was the clinical waste bin in the downstairs bathroom. It had been fitted with a non-return lid to prevent anyone coming into contact with the contents but the lid was not put on properly and there were used items just inside the lid which would present a risk if handled. Care Homes for Adults (18-65 years) Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Keys to medication cabinets are to be kept secure. This is to ensure that only authorised people can access medicines. 01/12/2009 2 22 22 Records are to be maintained at the service to show how complaints have been responded to. This is to ensure that the service can demonstrate that it listens to peoples views and acts appropriately in response to their concerns. 01/12/2009 3 23 16 Peoples money is be kept secure at the service at all times. This is to prevent unauthorised access or theft. 01/12/2009 Care Homes for Adults (18-65 years) Page 31 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 42 16 Food is to be stored in line with good food hygiene practice. This is to ensure the health and well being of people using the service. 01/12/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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