Inspection on 14/01/10 for Fix Anchor Ltd

This inspection was carried out on 14th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fix Anchor Ltd 17/03/10

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Fix Anchor Ltd 119 Rochdale Road Milnrow Rochdale Lancs OL16 4DU     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: Pat White     Date: 1 4 0 1 2 0 1 0 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 31 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 31 Information about the care home Name of care home: Address: Fix Anchor Ltd 119 Rochdale Road Milnrow Rochdale Lancs OL16 4DU 01706750790 01706750790 anchor-ltd@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Fix Anchor Ltd Name of registered manager (if applicable) Mrs Gail Newell Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the service are within the following category: Mental disorder, excluding learning disability or dementia - Code MD. The maximum number of service users who can be accommodated is: 10 Date of last inspection Brief description of the care home Oaklands House registered as a care home under the company name of Fix Anchor in August 2009. It is registered to provide accommodation, care and support to 10 people with a mental disorder. The home is an older detached property situated on the main road between Rochdale and Milnrow. As such Rochdale and the nearby towns are easily accessible, as are the community facilities. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 10 Brief description of the care home The property is 3 storey with the communal areas being on the ground floor and all the bedrooms on the first and second floor. The bedrooms are all single and ensuite with tea and coffee making facilities, and some have an additional adjoining sitting area. The home has written information about the services and facilties, that is available to people to help them make a decision about whether or not they would like to live there. The fees charged for living in the home are individually assessed according to the support required and the social services financial assessment Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Oaklands House was registered as a care home in August 2009 and in accordance with legal requirements a key inspection had to be undertaken within 6 months of registration. This first main key inspection, that included a visit to the home, was undertaken on the 14th January 2010. In addition to complying with the requirement to undertake an inspection within 6 months of registration, the purpose of this inspection was to assess the quality of the services and care provided by the home, and to determine an overall quality rating. This included checking all the important areas of life in the home that should be checked against the National Minimum Standards For Adults (18 - 65). The inspection included looking round the premises, talking to some residents and a member of staff, looking at residents care records and other documents and discussion with the registered manager and one of the owners who is involved in the running of the home on a day to day basis (referred to in the report as the management). Care Homes for Adults (18-65 years) Page 6 of 31 Survey questionnaires from the commission were sent to the home for residents and staff to complete. At the time of writing this report 4 out of 5 residents and 3 out of 5 members of staff had returned completed questionnaires. Three residents were spoken with at the site visit and gave some views about the home. Some of the views of all the people spoken with, and who completed the questionnaires, are included in the report. In addition before the site visit the home provided the commission with written information about the residents, staff and the services provided and some of this is also included in the report. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: The right kind of support was provided to people in a way that respected the residents rights to dignity and independence. Discussions with people and observation of life in the home indicated that relationships between staff and residents were positive and that staff were supportive towards residents. In the questionnaires one resident said they look after me well and another said that the home did everything well. Another said they were happy in the home and there was nothing they didnt like. In general the written information about the support residents needed was detailed and provided useful information to staff (see below) including the written information about the risks associated with everyday life. Residents were assisted and encouraged to be as independent as possible and to make choices about their routines and lives. Residents could go out either alone or with staff and said in the questionnaires that they had choices in their lives about activities and routines. Residents were encouraged to take part in a good range of activities such as doing voluntary work, going to social centres, shopping, visiting relatives and leisue activities. This helped them to keep occupied and fulfilled and interested in things going on in the community. Residents helped to prepare the food menus which meant that most of the time the meals served suited their tastes and preferences. In addition there was an emphasis on healthy eating, and the food served was varied and appeared nutritious. One resident said the meals were very good and appreciated that they could all put forward a favourite meal each week. The residents had all the necessary medical attention and treatment they needed for both physical illnesses and for mental health support. The residents were linked to the mental health services and had contact with workers in the mental health team. This helped to ensure that they had all the necessary support they needed to keep them well. The home had good procedures for protecting residents from abuse which gave the correct guidance to staff in what to do if they had concerns about abuse taking place. Staff also had taken appropriate training in protecting people from abuse which should further help them to keep people safe. The premises were well furnished and decorated and provided a pleasant place for people to live. The bedrooms were spacious and ensuite, and all who wanted had tea and coffee making facilities, and personal items such as televisions and music players. Some bedrooms had an adjoining seating area. The staff were encouraged to study for the necessary qualifications for people working in a care service, and all the staff working in Oaklands House had either gained these qualifications or were studying for them. The management supported staff in their every day work and also to personally progress and develop. Staff told us in the questionnaires that they felt encouraged and supported at work. Care Homes for Adults (18-65 years) Page 8 of 31 The management and some of the staff had been working in the home for a number of years when Oaklands House was a supported living scheme, and this meant that residents could benefit from continuity of care, and were looked after by people who they knew and were used to. The owner and manager provided stable mangement and support and continuity of care. They were well qualified and had the necessary experienced to run a care home for people with a mental illness. The views of the residents were listened to, and used to develop the service. Residents told us in the questionnaires that overall staff listened to them and acted on what they said. The health and safety of residents and staff was promoted and the home was a safe place in which to live and work. What has improved since the last inspection? What they could do better: The way people are admitted to the home could be improved and emergency admissions should be avoided, so that staff and the person concerned have time to get to know one another and so there is useful written information about the support people need from the start. This written information also needs to be reviewed and updated so that staff have accurate information from which to develop the plan of support needed. This is necessary to ensure that peoples needs are understood and that staff have instructions on how to support people. Also in the care (support) plan there could be more written information about the support needed in personal care and personal hygiene which includes what people can and cant do for themselves and how this is affected by illness. The written information about the risks associated with some aspects of every day life could be further improved, such as developing the risk assessments associated with hot radiators. The medication systems in the home must be improved so that there are recording systems and adminsitration systems that comply with the regulations and guidance, and that ensure medicines are admisnistered correctly and safely. Some action was taken immediately after the site visit and this will be monitored by the commission to ensure the necessary improvements are made and maintained. We are confident that the mangement are committed to improving this aspect of the service. The way staff were recruited to work in the home should be improved. All the necessary checks should be obtained before staff start work in the home such as the protection of vulnerable adults and criminal records bureau checks. Also full employment hsitories should be recorded and gaps in employment explained in writing. All these measures are necessary to help ensure that only suitable people are employed in the home. Also the induction training that new members of staff undertake should be improved so that it is in accordance with government guidance (Skills for Care) to help ensure that they receive the right training, and gain the skills, to work confidently with people in the home. Care Homes for Adults (18-65 years) Page 9 of 31 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 10 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes admission procedures should help people to decide whether or not the home was a suitable place for them to live, but up to date written information about these needs should be available for everyone living in the home to help assist staff provide the right support. Evidence: There was written information available to all the people living in Oaklands House which told them of the main aspects of the home, such as about the staff, routines, meals and care plans. Though this was not fully assessed, we were satisfied that people had enough information to help them make decisions. Oaklands House is a newly registered care home and most of the residents living there were former tenants of a supported living scheme. The management (one of the owners and the registered manager) told us that admissions to the home would be planned if possible, and that this would involve a gradual introduction of the person to the home. People could stay for meals, and stay overnight if they wished, to see what the home was like. However one person had come to live at Oaklands House, a few Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: days before the site visit, as an emergency admission, though they had visited the home some months previously. We were told that an assessment of need had been undertaken on the day of the admission. However no records of this were available in the home at the site visit, and four days after admission. There was also no written information from the Social Services, who had been involved in the admission. This meant that there was no written information available to instruct staff on this persons needs and the support required, and from which to develop a support plan. Whilst there was no evidence that this person was not getting the support required in this first week, written information is necessary to help staff understand peoples needs and to help ensure people get the right support. The management subsequently provided evidence that the assessment had been undertaken on the day of admission and was now being used as the basis of developing the support plan. Other residents had assessments that had been undertaken some time ago and when they were tenants under the supported living scheme. These assessments were comprehensive at the time they were written and covered all the main matters of health, personal and social care. The management had also undertaken training in legislation and government guidance about assessing peoples mental capacity to make their own decisions and about protecting their rights. We were assured that this will be included in the homes assessment process. However the assessments viewed would benefit from being reviewed and updated to provide an up to date basis from which to develop new support plans. Whilst there was no evidence through observation and talking to people that their needs were not being met, up to date and accurate information is necessary to help ensure that people get the right support. At the time of the site visit contracts/terms and conditions for the (new) care home had not been finalised. A draft copy was submitted to the commission before this report was completed and we were confident that they would be used in the near future. Care Homes for Adults (18-65 years) Page 13 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans included sufficient details about most areas of support that people needed. Residents were supported in making decisions about their lives and they were supported to take risks associated with independence. Evidence: All the residents, apart from the resident referred to above, had care plans that detailed what staff needed to do to support them. These plans were detailed, and included useful information and guidance to staff, in most important matters, and we were assured that a care plan was being developed for the person who had recently gone to live in the home. There was evidence that these care plans were being reviewed and updated with the residents. The care plans were being developed in a person centred way which indicated what people could do for themselves and how individuals needed to be supported to increase independence and choices. However there was no care plan that indicated what assistance people needed, if any, with personal hygiene and what they could do for themselves. Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: There was evidence in the records and through talking to people that residents were involved in making decisions in their lives, such as spending money and drinking alcohol, and how these decisions were made and who was involved. This showed that residents rights were upheld. Residents who completed the questionnaire surveys for the commission were satisfied with the level of choice they had. The risk associated with some activities and some aspects of daily living and behaviour were assessed. These risk assessments were specific to the individual residents and were generally completed satisfactorily, though more written guidance could have been available to staff on how to manage the risk associated with some aspects of peoples lives, for example the restriction of alcohol consumption. Also there was no assessment of any risk associated with uncovered radiators in peoples bedrooms (see Environment). Residents were assisted to make choices regarding their routines and activities. There were risk assessments that indicated why there were restrictions for some people in such matters as alcohol consumption, and as stated above these indicated why some decisions had been made. There were residents meetings and residents had one to one meetings with staff to give them the opportunity to discuss choices and preferences. In discussion with the residents and the management it was evident that residents had made choices, for example, about where to go on holiday, and about the meals served. Care Homes for Adults (18-65 years) Page 15 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were encouraged to take part in a range of suitable and fulfilling activities and were encouraged to maintain links with their families and the community. Independence was promoted. The meals served were in accordance with residents preferences and principles of healthy eating. Evidence: Residents were encouraged to take part in fulfilling activities that included visiting social centres and doing voluntary work. Residents had a plan of weekly activities that showed they were encouraged to attend outside support programmes, excercise, shop and to help in the running of the home. All residents were encouraged to take part in preferred leisure activities, including church interests if appropriate. Some were members of a gym and all enjoyed trips to pubs and restaurants and other places of entertainment in the community. Residents Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: were given the opportunity of going on trips together or with a member of staff, though one resident said in the survey questionnaire that there should be more trips out with staff. A few days holiday was included in the fees, and last year residents had chosen a hotel break in Blackpool. People were supported to maintain existing relationships and to form new ones. They were encouraged to have contact with families and friends, and several residents had regular contact with their families. There was an emphasis on maintaining peoples choices and independence. Routines were flexible enough to suit peoples preferences and people could do what they wished during the week in accordance with their wishes and agreed aims and objectives. Residents were encouraged to take part in activities but could choose not to if they wished. They had keys to their bedrooms and front door keys were available to people if needed and if appropriate. Residents spoken with and those who completed questionnaires confirmed that they had these choices in their daily lives. The food served appeared healthy and appeared to suit the residents preferences. Residents helped to plan the menus and were encouraged to help prepare the meals. All had the chance of having a main meal of their choice each week. Breakfast and lunch meals were flexible around the residents routines and they could make their own snacks and make drinks at any time throughout the day. Residents spoken with confirmed that they chose the menus on a weekly basis. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate personal support is provided to residents and in such a way as to promote independence. Residents physical and mental health care needs were monitored and addressed but medication practices were unsatisfactory. Evidence: Residents were provided with the level of support required in personal care and hygiene. They were expected to take some responsibilty for some personal and domestic tasks, in order to promote independence and maintain life skills. However as stated above there was insufficient information on the care plans about the support required in this aspect so staff did not have written guidance about what assistance people needed if any. Looking at records and talking to the management and the residents showed that the residents physical and mental health needs were promoted and that they had the health care they needed. It was evident that one resident had had all the medical treatment and care required for a physical illness they had gone through, and that residents had contact and support from the mental health services. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: We checked the medication systems and found that they were not in accordance with the Care Homes Regulations and good practice guidance, and were unsatisfactory for the recording and administration of medicines. There was not a clear audit trail of medicines received and being adminsitered, and it was not clear whether or not medication that was not in the monitored dosage blister packs was being handled, or given, correctly. Two medicines for one resident were seen with no records of them either being received or administered. The courses of these had not been finished. We were told that these were no longer being taken by the resident, but there was no written information/instructions to indicate why this was the case, and if this was on the instruction of the General Practitioner (GP). One was a course of antibiotics; and not completing a course of antibiotics, unless advised by the GP, can mean the medicine is not effective and can therefore impair a persons recovery. Staff had received inhouse training for the system that was in use, but were not undertaking training in the systems currently required in care homes. The management agreed to take immediate steps with the community pharmacist to revise and update the systems, and a referral has been made to a pharmacist inspector at the commission for a follow up visit to monitor progress and ensure safe systems. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents had channels to air any concerns and complaints. The procedures for safeguarding people from abuse available in the home were suitable and provided the correct guidance to staff on how to protect.people Evidence: There was a suitable complaints procedure that was on display on the homes notice board, and in the written information given to people. We were informed that no complaints had been made to the home, and none had been made directly to the commission. Residents spoken with, and all but one who completed the commission survey questionnaire, said they knew what to do if they were not happy about anything and knew how to make a complaint. There were no issues that the residents wished to discuss with us at the time of the site visit. The management told us that only minor concerns and grumbles had arisen and these had been dealt with immediately. Frequent discussions with the staff gave residents a chance to air any worries or concerns on a daily basis. There had been no recent reported allegations or suspicions of abuse. The procedures available in the home at the time of the site visit were suitable and gave step by step instructions to staff on what action should be taken in the event of an incident or allegation of abuse. All staff had undertaken training in safeguarding adults from abuse to help them understand how to protect people, and the member of staff spoken with confirmed that she had recently undertaken this training and that she Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: knew what to do if she had any concerns or suspicions of abuse. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Oaklands House provides homely, comfortable, well maintained and furnished accommodation for the residents, and their bedrooms met their needs and promoted independence. Evidence: A tour of the premises confirmed that as stated in the AQAA the premises had been recently improved in some areas. There was a modern kitchen and dining room with relatively new appliances, and the ground floor lounge had been refurbished and decorated in contemporary style. Plans have been passed for a conservatory to be built at the back of the house and we were told that building was due to start in the near future. We were told that this will also be a ventilated room for smoking. At the time of the site visit residents had the use of a small room on the first floor as a designated smoking area. The bedrooms were spacious and personalised and some had adjoining seating areas. Residents could have televisions in their rooms if they wished and music facilities. All bedrooms were single and ensuite and there were tea and coffee making facilities if wanted. There was sufficient communal and private space for the residents. The residents were encouraged to assist in keeping their rooms at an acceptable standard of cleanliness and this was seen as a way of promoting independence. All areas of the Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: home viewed were clean. Residents who completed the questionnaires said that the home was usually fresh and clean. We were told that all the hot water outlets had regulatory devices that should prevent the water flowing too hot. However the bedroom radiators were uncovered and any risk to the individual occupants of the rooms had not been assessed. The management agreed to address this and we were subsequently informed that risk assessments had been developed and action taken to protect those who needed it. Some windows on the first and second floors could be opened wide enough to pose a risk to some residents. The management agreed to fit window restrictors and we were subsequently informed that this work was in progress. There was a basement which had several rooms for staff use and included a meeting room. There was also a staff sleep in room on the first floor. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team had the right qualifications and the right experience to meet the needs of the residents. However staff recruitment procedures need to be improved to help protect residents from unsuitable staff. Evidence: The management told us that staff training was a priority and that all staff (5 in total at the time of the site visit) had achieved the relevant qualifications for people working in a care service. Some staff had completed training in mental health and the management were in the process of trying to resource training in this for other members of staff. Other information provided by the home showed that staff had undertaken recent training in protection of vulnerable adults (see above), fire training, manual handling, and food hygiene. All staff had undertaken training in first aid, but this needed renewing. We were told that this would be completed in 2010 so that staff could respond appropriately in a medical emergency. However the induction training undertaken by new members of staff was not in accordance with the Skills for Care guidance and may not be in sufficient depth and detail to ensure that staff who have not previously worked in care are fully equipped for their roles. At the time of the site visit there was evidence that there appeared to be enough staff on duty during the day to meet the needs of the residents and including management Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: hours and daily support from the owner. However there was only one member of staff on duty in the evening and overnight and staff indicated in the commissions survey questionnaires that there were not always enough staff on duty. One resident also stated tht there should be more staff on duty to enable more trips out to take place. Two additional members of staff were being recruited at the time of the inspection, because the number of residents in the home was expected to increase, and we were informed that this should rectify any shortfalls in staffing levels for residents and staff. The member of staff spoken with confirmed that the management was supportive and encouraging in training, and that the owner and manager were approachable and accessible. This was also confirmed by the 3 staff who completed the commissions survey questionnaires. The member of staff spoken with also confirmed the training that she had undertaken, and this was in accordance with information provided by the management. However this could not be supported by staff who completed the survey questionnaires as two out of 3 respondents did not provide this information. The records of two relatively recently recruited members of staff were viewed and showed that for one person the procedures followed for staff recruitment were not fully in accordance with the Care Homes Regulations. This person had commenced work prior to the criminal records bureau (CRB) and protection of vulnerable adult checks being obtained, and some months before the full CRB check was returned . Also a full employment history had not been given. Whilst there was no evidence that unsuitable people were employed in the home, rigorous staff recruitment procedures for all applicants according to the Care Homes Regulations and guidance are necessary to help protect people from unsuitable staff. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well managed by experienced and qualified people and the health and safety of the residents and staff was promoted. Evidence: The registered manager was experienced and qualified. She had considerable experience working in the field of mental health, and in addition to having the management qualification required by people managing a care home she had other relevant qualifications, including one in mental health. The owner also had relevant experience and qualifications and worked on a daily basis in the home, supporting the manager and staff. The home had developed internal quality monitoring systems appropriate to the home, and that involved seeking the views of the residents and visitors, including relatives. There were questionnaire surveys, and residents could give their views in residents meetings and one to one discussions with staff. The views of social workers were recorded at reviews etc. All this information was being used to develop this relatively new service, and we were assured by the management that they were committed to making the developments necessary and also to address the matters arising from this inspection. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: In general the home was a safe place for residents and staff, and staff had undertaken some health and safety related training, such as moving and handling, fire training, first aid and food hygiene. Some safety aspects regarding the premises were discussed with the management (see Environment) and we we were assured that these were being addressed. The information provided by the management prior to the site visit and the viewing of some of the maintenance records showed that all the necessary checks and servicing of the installations and equipment were being carried out. A new central heating and water system had been installed in February 2009. The fire precautions were satisfactory and should help protect people in the event of a fire. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 All medication must be given 19/02/2010 as prescribed unless directed not to do so by the General Practitioner. So that residents take the medicines they need to promote their health and well being. 2 20 13 Suitable systems must be in place for the accurate recording of, medication received into the home, being administered and medication disposed of. So that there is a clear audit trail of medicines that helps to prevent mishandling of medicines, and helps to ensure all medicines are given properly. 19/02/2010 3 34 19 Staff recruitment must be in accordance with the Care Homes Regulations, and staff must not commence work in the home without a 19/02/2010 Care Homes for Adults (18-65 years) Page 29 of 31 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 criminal records bureau check being obtained. Also full employment histories must be recorded and gaps in employment explored and documented. To ensure that only suitable staff are employed, and that residents are protected. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 Up to date and accurate assessments of residents needs should be available in the home for all residents, including those who are admitted as an unplanned emergency. The draft contract should be made available for use as soon as possible. The care plans should contain sufficient details to guide staff in all matters of personal, social and health care, and indicate what people can and cannot do for themselves, and their preferences. This should include the support people need with personal hygiene. Staff should undertake training in medication that is up to date and relevant to the new systems put in place. Residents should be protected from the hazards of hot surface radiators and from windows that open too wide. The staffing levels should be kept under review in the light of comments made, and increasing numbers of residents, to ensure there are sufficient numbers of staff on duty. The homes induction programme for new members of staff should be in accordance with government guidance and Skills for Care. 2 3 5 6 4 5 6 20 24 33 7 35 Care Homes for Adults (18-65 years) Page 30 of 31 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. 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