Inspection on 06/01/09 for Forest Way

This inspection was carried out on 6th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Forest Way 08/01/07

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Forest Way Main Road Minsterworth Gloucestershire GL2 8JQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lynne Bennett     Date: 0 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Forest Way Main Road Minsterworth Gloucestershire GL2 8JQ 01452750686 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): ree.jefferies@brandontrust.org The Brandon Trust Name of registered manager (if applicable) Mrs Kathryn Skinner 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 5. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability (Code LD) Date of last inspection Brief description of the care home Forest Way provides care and support for up to five adults with profound learning and physical disabilities. The home is a detached property with large gardens. The home is owned by a Housing Association. All service users have single rooms and access to a comfortable lounge with dining area. Four of the bedrooms are on the ground floor. The home has a sensory room and the grounds outside are well maintained. The home is situated close to local amenities in the village of Minsterworth and on the main road to Gloucester and the Forest of Dean. The Brandon Trust runs the home, having taken over from the previous service provider in April 2006. Prospective service users and Care Homes for Adults (18-65 years) Page 4 of 32 care home 5 Over 65 0 5 Brief description of the care home others involved in their care are offered information about the home including copies of the Statement of Purpose and Service Users Guide. Copies are kept in peoples rooms. Care Homes for Adults (18-65 years) Page 5 of 32 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 inspection took place in January 2009 by one inspector and involved two visits to the home on 6th and 7th January. The manager was present on the second visit. She has applied to become the registered manager of the home. Time was spent observing the care being provided to all people living in the home and talking to five members of staff. People living in the home have complex needs. Four people have a physical disability and learning disability. They have limited verbal communication and so time was spent observing them and their interactions with staff and others in the home. The manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing some information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). Care Homes for Adults (18-65 years) Page 6 of 32 A selection of records were examined including care plans, medical records, staff files, quality assurance audits and health and safety systems. A walk around the environment was also conducted. Fees for people living in the home at the time of the inspection were 1,280 pounds per week. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 32 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. People have access to the information they need enabling them to make a decision about whether they wish to live at the home. An assessment of the persons wishes and needs are taken into consideration before offering them a place. Evidence: The home has a Statement of Purpose and Service User Guide which have been produced in a format appropriate to the needs of people wishing to use the service. These documents use a mixture of text, photographs and pictures. Although these were reviewed in 2008 both refer to us (The Commission for Social Care Inspection or Care Quality Commission from April 2009) as the Care Standards Commission and the section providing information about the environmental standards had not been completed. These should be amended to provide up to date and current information. A person had been admitted to the home in December 2008 and there was evidence that the placing authority had supplied a copy of their assessment of need and care plan dated July 2008. There was no evidence of the homes assessment of need on the Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: files examined although the home had developed care plans and risk assessments from the documents supplied by the placing authority. Staff confirmed that the person had visited several times prior to moving into the home and that this had been done at their pace. Initial plans for an overnight stay had been abandoned when it was evident the person was ready to move into the home. Their relatives and social worker had been involved throughout this process and there was evidence of continuing frequent contact. Each person had a statement of terms and conditions in place with the home which had been produced using individualised photographs of each person, their room and the activities they wished to participate in. These were excellent examples of the way in which the home attempts to promote total communication within the home and access to information for all people regardless of their disability. The manager also indicated that if necessary an audio record would be produced. Copies of this document and others relevant records were kept in peoples rooms. Each person also had a licence agreement between themselves and the housing association. Care Homes for Adults (18-65 years) Page 11 of 32 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. A person centred approach to care planning focuses on the wishes and needs of people living in the home. Imaginative use of resources enables people to express their wishes and needs. Risks are being managed safeguarding them from possible harm. Evidence: A person centred approach (PCP) to care planning was in place in the home. The manager was a PCP facilitator and said that one PCP review had been held and that others were being arranged. Former Paths were displayed in the home providing a pictorial image of peoples wishes and dreams. These had then been interpreted into care plans. Key workers explained that plans were being reviewed quarterly and any changes or amendments noted. This was seen to be in place for all people except one. The manager said that she was working with the key worker to put this in place. Care plans were in place for a range of emotional, physical, social and intellectual needs. Staff spoken with had a good understanding of how to support people and their likes and dislikes. Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: Communication profiles were in place which provided staff with specific and clear guidance about peoples understanding and expression. Where people were unable to use the spoken word records indicated what any noises they might make meant and how to interpret their non verbal behaviour such as facial expressions and body language. Staff were observed following guidance such as facing a person with a hearing impairment so that they could lip read and making sure one person had access to hand bells through which they communicated how they were feeling. Care plans stated when objects of reference were to be used with people (e.g. a boot to indicate going out) and there was evidence of lots of use of photographs around the home - a staff board and an album with holiday photographs. Staff were observed offering people choice about drinks, meals and activities and enabling people to retain their independence by encouraging them to do things for themselves. One person had an advocate and there was information in the home about advocacy services. Any restrictions such as the locking of the front door and use of mechanical restraints were clearly identified and best interests meetings had been held providing a rationale and consent for these to be in place. Care plans for one person indicated there should be daily opportunity not to have restraints and monitoring forms were in place which indicated this was not being done this frequently. They also indicated that when mechanical restraints had been removed this had been a positive experience for the person. The home needs to review this practice. A range of risk assessments were in place with evidence that they were being reviewed regularly. It was evident that these were being amended and changed as incidents occurred. Accident records were being completed in line with incidents and copies of these sent to Brandon Trust for monitoring. Some incidents had occurred in December which we had not been notified about affecting the well being of people living in the home. Care Homes for Adults (18-65 years) Page 13 of 32 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. People who live at the home are supported to make choices about their lifestyle. They have the opportunity to take part in social, educational and recreational activities and keep in touch with family and friends. People have a nutritional diet and their diverse needs are catered for. Evidence: The AQAA stated,clients are supported to participate in activities they enjoy whether educational or social. They are supported to enjoy an individual holiday and trips out. Each person had an activity schedule in place indicating regular activities at college, day centres, doing rebound/trampolining and using external sensory facilities such as a hot tub and sensory room. People were observed going out to these during the visits and monitoring forms indicated that they did these regularly. Staff said that one session at a sensory facility had been canceled. The manager stated that this was due Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: to the cost and that alternative venues were being resourced. People were also being supported to go out to local garden centres, shopping and access walks in the Forest of Dean. Within the home people were observed having a hand or foot massage, listening to music or watching the television and enjoying the sunshine and views from the conservatory. The home has its own sensory room, called the dream room which staff said was going to be refurbished. Each afternoon people have time in their rooms to relax on their beds. This was indicated in tissue viability care plans as one way in which people could be supported to change their position and reduce the risk of pressure sores. During the visits people spent around 2 hours in bed. Handover records also indicated that on one occasion a person spent 4 hours in bed during the day. This appeared to be rather a long amount of time. People had music or their television on whilst in their rooms. Care plans did not provide staff with guidance on the length of time people should spend in their bed during the day. The length of time people were spending in bed was discussed with the manager. Advice should be sought from health care professionals about their recommendations for bed rest during the day. Records indicated regular contact for some people with family and friends either by visiting the home, visits to them or over the telephone. The person who had recently moved into the home was being supported to attend their former day centre until they were ready to try out local facilities. Three people who live in the home had been fitted with a PEG (Percutaneous Endoscopic Gastrostomy tube). Staff had received the appropriate training from health care professionals although there was no record of this. (See Standard 35) Syringes were being kept in the kitchen which could at times be quite busy, it was advised they were removed to peoples rooms. People were observed being consulted about their lunch. Staff followed guidance in care plans when supporting people to eat their meals, with a degree of sensitivity and patience. Concerns about the diet of one person were being monitored and they were being encouraged to eat and drink. Records showed that they were gradually gaining weight. A dietician had been involved with the home. Meal records were being kept and indicated a nutritional diet was being provided. Fresh vegetables and fresh fruit were available. Care Homes for Adults (18-65 years) Page 15 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care support is offered in a way that responds to peoples needs and preferences promoting peoples dignity. There are some improvements in the administration of medication that need to be implemented to safeguard people from the risk of error or possible harm. Evidence: The way in which people would like to be supported was recorded in their care plans. Peoples likes and dislikes were identified and any allergies clearly highlighted. Personal care plans did not indicate peoples preferences for the gender of staff providing this support. One person had a care plan indicating how staff should support them to express their sexuality with dignity and in privacy. Communication profiles provided staff with a guide to interpret how people were feeling and how to recognise distress or pain. One person suffered from flatulence and records indicated that staff had tried several ways to help them alleviate this. A listening device was in place to safeguard one person during the night from possible harm. A care plan and risk assessment were in place although there was no evidence Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: of consent for the use of this or guidance about when it should be switched off. During the first visit the monitor was switched on during the day. Each person had a health action plan in place and other records containing evidence of appointments with a range of health care professionals. Outcomes of appointments were recorded. Support had been provided by staff to people needing to stay in hospital overnight and for long stays. Staff and the manager confirmed close working with the local Community Learning Disability Team. Care plans, risk assessments and protocols were in place for people with epilepsy. Staff had received training in the use of as necessary medication. Medication systems were mostly satisfactory. Staff were completing training in the safe handling of medication and stock checks were being done each week. There was no evidence that competency checks were being carried out with staff. There had been three medication errors of which we were informed. The manager described action which had been taken as a result of this to prevent further errors. Staff described the way in which medication was administered to people. They must make sure that the administration record is not signed until medication had been given to the person. They were given guidance on the way in which the record could be marked to indicate medication was being given to the person. Liquids must be labeled with the date of opening so that they can be disposed of after three months. One administration record had handwritten entries on it, these needed to be signed and if possible countersigned by the author and another member of staff. The home had a homely remedies protocol in place dated 2006 which needs to be reviewed. An End of Life book was being put in place with representatives of people living in the home about how they wish to be supported through terminal illness or after death. These documents like others had been developed using personalised photographs representing a very individualised record of their end of life wishes. This is excellent practice. Care Homes for Adults (18-65 years) Page 17 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People or their representatives may not be able to express concerns or complaints because the complaints procedure is not accessible within the home. Systems are in place which should safeguard people from possible abuse. Evidence: The home has a complaints policy and procedure. The manager stated that the complaints procedure had been produced in a format appropriate to the needs of people living in the home using text and picture. A working copy of this document was not accessible to people living in the home and the complaints file could not be found. The manager stated that each person had a personal copy of the Service User Guide in their room but this only made reference to the complaints procedure and did not contain a copy of it. A feedback form with questions about the service, for visitors and relatives was provided in the entrance hall. Staff said they had attended training in the protection of vulnerable adults but that this was some time ago. Records confirmed most staff had completed training in 2006 and 2007. New staff were completing training as part of their induction. The manager confirmed that one member of staff was booked to do this training in 2009. Information was given about training with the local Adult Protection Team. The home had a copy of local procedures. The manager confirmed her understanding of these and had sought advice about an issue with them and was informed that the incident Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: reported did not amount to abuse. We had not been informed about this and although the correct procedures, investigations and outcomes were recorded we should have been notified. Training for all staff was put in place as a result of this incident. Staff spoken with had a lack of confidence in the whistle blowing procedure and although some had used this process, they were not always satisfied with the outcomes. The manager said that a team building event in 2008 had attempted to tackle this by assuring staff that any concerns they had would be listened to and acted upon within the terms of the whistle blowing procedure. The home had recently had a financial audit of its systems by Brandon Trust. Records were being checked at each handover by staff and an audit trail was in place. Receipts were being numbered and could be cross referenced with entries on records. There was an agreement in place that any purchases over a set limit needed to be discussed and authorised by management. A rationale for this expenditure was then recorded. Care Homes for Adults (18-65 years) Page 19 of 32 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. People live in a home that is clean and well maintained which recognises their diverse needs creating an environment that matches their personal requirements. Specialist equipment is provided to those people who need it. Further improvements could be made to equipment provided for moving and handling of people to make sure they are safe from possible injury. Evidence: Since the last inspection considerable work has been completed within the home including redecoration of peoples rooms and installing overhead tracking in the bathroom. An assisted bath was operational with the additional option of a shower if people preferred. Communal areas were pleasantly decorated and all parts of the home were clean and tidy at the time of the visits. At the last inspection in 2007 Brandon Trust had identified the home in their Estates and Services Strategy to relocate the home to more suitable premises. The AQAA confirmed that this was still part of the long term plans for the home. The manager also said that they were planning to refurbish the sensory room. Access for people who use wheelchairs was by ramp through a door to the side of the house and a door to the rear. Not all parts of the home were accessible to people using wheelchairs. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: Concerns were expressed by staff about the systems provided for moving and handling of people in the home. Each person had an overhead track to which a portable hoist was attached. Staff were observed having to stretch to attach this. As noted previously, on most occasions one member of staff was also completing moving and handling tasks putting themselves and people they support at risk of possible harm. Other adaptations and equipment had been provided around the home with input from the appropriate health care professionals. Infection control measures were in place and personal protective equipment had been provided for staff. Hazardous products were stored correctly and data sheets were in place. Care Homes for Adults (18-65 years) Page 21 of 32 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. Peoples needs are met by a competent staff team, who have access to a satisfactory training programme that provides staff with knowledge about the diverse needs of people living at the home. Recruitment and selection procedures should safeguard people from possible harm. Evidence: The staff team were almost at full strength at the time of this inspection. Some long term sickness and maternity leave was being covered by the use of bank staff employed by Brandon Trust. Three staff supported people on each shift and there was one waking night staff. New staff were completing a corporate induction programme with Brandon Trust and copies of completed booklets were seen. The manager confirmed that staff were also completing the Learning Disability Qualification. New staff said they completed mandatory training during their induction. There was evidence that they were also having supervision during their probationary period to assess their knowledge, skills and competencies. At the time of the first visit the National Vocational Qualification (NVQ) Assessor was visiting the home working with a member of staff to complete their NVQ Award. The DataSet provided with the AQAA indicated that nearly three quarters of the staff team Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: have a NVQ Award. This exceeds the National Minimum Standards. Staff spoken with had mixed feelings about the dynamics of the staff team and the manager acknowledged that a team building day had been held away from the home to explore these issues. A communication protocol had been put in place as a result. Staff were observed treating people with dignity, respect and sensitivity during the visits. Recruitment and selection information was inspected for three new members of staff. One member of staff was appointed in early December 2008 and no information was on their file. The manager explained that she was waiting for the Human Resources Department to return this to her to put on the file. Information for the other two members of staff was eventually found and was satisfactory. It was evident that staff were not being employed until two satisfactory references and a Criminal Records Bureau (CRB) check had been obtained. Full employment histories were supplied on application forms. One file contained evidence that proof of identity and a current photograph had been obtained but the other two files did not have this information. A CRB dated 2006 was observed on another file and the manager was informed that all CRB certificates could now be destroyed. A training matrix was in place but had not been updated since 2007. The manager explained that a new electronic database had been set up to monitor training for staff and that she was waiting for training to be able to access this. Copies of certificates on staff files confirmed that staff had completed training in Oral Hygiene and Fire in 2008. Staff said they had also completed training in PEG care although there were no records to confirm this. Bank staff said they have access to training and one was completing an open learning course in food hygiene. Staff need refresher training in safeguarding of adults. Care Homes for Adults (18-65 years) Page 23 of 32 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. People benefit from living in a home which embraces a person centred approach to care. There are some risks to their health and safety which need addressing to make sure they live in a safe environment. Systems for the moving and handling of people need to be reviewed to make sure that people are not put at risk of injury.Quality assurance systems are in place which would be enhanced by including feedback from people living in the home and their representatives. Evidence: The manager was appointed in mid 2008 and her application to become registered manager of the home is being processed by us. She was an experienced manager with Brandon Trust and had NVQ qualifications at Level 3 and 4 and the Registered Managers Award. As part of her continuing professional development she had completed training in Health and Safety for Managers, Leadership and Oral Health care in 2008. She was a Person Centred Planning facilitator and there were some excellent examples of total communication within the home and endeavors to make information accessible. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: The manager completed the AQAA and returned it to us before the deadline. This contained some information about the service and long term plans for the home. As noted in the report there were some shortfalls in relation to moving and handling concerns and accessibility of the complaints system to people and their representatives. Brandon Trust have a Quality Assurance System in place which produces an annual report of the service with an action plan for the following year. The have a total of 20 quality standards from which the manager will produce a self assessment. Reports for last year and for this year were examined and it was evident that a report was being produced indicating whether actions from the previous year had been met. The home had a number of actions outstanding which were carried across to the forthcoming year. The manager stated that she and the team were working to address these. Brandon Trust have a Quality Network Approach which looks in detail at what is happening in the lives of a small number of people they support. The manager said that there were no similar systems in the home to obtain formal feedback on an annual basis from people living in the home, their representatives and other health care professionals involved in their care. Regulation 26 visits by representatives of Brandon Trust take place each month and a copy of the reports produced were available for inspection. The manager said that although different people complete these visits they monitor actions outstanding from previous visits. Systems for the monitoring of health and safety were in place. The fire risk assessment was produced in 2007 and was due for review. Each person had an individual fire risk assessment in place. Although regular drills were taking place there did not appear to be a drill during the night. Given the complexity of peoples needs and that one waking night staff was employed it is important that staff feel confident with night time fire drills. Other fire records were satisfactory. Records confirmed regular servicing of equipment and utilities. Water temperatures were being taken each time the bath was used and on a three monthly basis for other outlets around the home. Fridge and freezer temperatures were being recorded regularly. Items in fridges which had been opened had not been labeled with the date of opening. Concerns were raised by us during the visits about the moving and handling of people. Staff were observed using hoists (with overhead tracking) on their own. Staff also said that one member of staff would roll people in their beds. Care plans and moving and Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: handling risk assessments referred to staff but not how many should be used for these tasks. The manager stated that the care plan and risk assessment for one person stated that two members of staff must be used but others were not specific about numbers. Advise should be sought from the appropriate health care professionals and moving and handling trainers. Some staff said they had recently completed moving and handling training and that the trainer was surprised that only one member of staff was involved in these tasks. Care Homes for Adults (18-65 years) Page 26 of 32 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 27 of 32 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 6 12 The registered person must 08/02/2009 make sure that people have access to the appropriate care and treatment as identified in their care plans. This is to make sure that where needs are identified in care plans staff enable people to have these needs met. 2 9 37 The registered person must notify us of any incidents affecting the wellbeing of people living in the home such as assault on other people or staff. This is to make sure that people are safeguarded from possible harm. 08/02/2009 3 20 13 The registered person must make sure that medication is administered and handled safely. This is in relation to labeling of liquids with the date of opening, signing handwritten entries, 06/03/2009 Care Homes for Adults (18-65 years) Page 28 of 32 reviewing homely remedy records regularly. This is to safeguard people from harm or possible error when administering medication. 4 22 22 The registered person must 08/02/2009 make sure that all people have access to a copy of the complaints procedure. This is so that people or their representatives can express concerns or complaints. 5 29 23 The registered person must make sure that suitable adaptations, equipment and facilities are provided for people who are physically disabled. This is to make sure that when people are transferred this is done safely and without fear of injury. 6 39 24 The registered person must make sure that feedback is obtained from people living in the home and their representatives about the quality of care being provided. This is to make sure that the quality assurance system takes into account the views of people using the service. 06/03/2009 06/03/2009 Care Homes for Adults (18-65 years) Page 29 of 32 7 42 13 The registered person must 31/08/2009 make sure that a safe system for moving and handling people is in place in the home. The registered person must make sure that a safe system for moving and handling people is in place in the home. 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 1 The Statement of Purpose and Service User Guide should be reviewed as indicated in the text to make sure information is up to date. When admitting new people the home should also complete the organisations assessment of need. The practice of putting people to bed for long stretches of time (over 1 hour) during the day should be reviewed, with advice from health care professionals. Syringes should be kept in peoples rooms to prevent contamination from being in a communal area. Consent should be in place for the use of the listening device. Guidance should also be drawn up indicating when the device should be switched off. A signature list should be put in place for staff administering medication. Handwritten entries should be countersigned. Competency checks should be carried out on staff administering medication. The complaints file should be accessible for day to day use. Revisit the whistle blowing procedure with all staff. Staff need to have a refresher in the safeguarding of adults, this should be provided at least every two years. Where there are concerns about poor practice or possible abuse of people living in the home we should be notified. Page 30 of 32 2 3 2 16 4 5 17 18 6 20 7 8 9 10 22 23 23 23 Care Homes for Adults (18-65 years) 11 12 13 34 34 35 Evidence should be provided that proof of identity and a current photograph have been obtained. Copies of recruitment and selection records for new members of staff should be kept in the home. Evidence that staff have completed training in PEG care, use of PRN medication and any other cascaded training from health care professionals should be provided. Items in fridges and freezers should be labeled with the date of opening. Advice should be sought from health care professionals/trainers about the correct level of staffing needed for the transfer of people to chairs, their bed or the bath. Staff should have the opportunity to explore and practice how to evacuate people from the home during the night. 14 15 42 42 16 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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