Inspection on 19/05/09 for Frinton House

This inspection was carried out on 19th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Frinton House 19/11/09

Frinton House 21/05/08

Frinton House 15/08/06

Frinton House 13/12/05

Frinton House 01/02/05

Frinton House 21/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Frinton House 22 Buckhurst Road Bexhill on Sea East Sussex TN40 1QE     The quality rating for this care home is:   zero star poor 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: Caroline Johnson     Date: 1 9 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Frinton House 22 Buckhurst Road Bexhill on Sea East Sussex TN40 1QE 01424214430 01424214431 frinton@consensushealthcare.org www.concensusupport.com Consensus Support Services Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 8 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: 8 The registered person may provide the following category of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning disability - LD Date of last inspection Brief description of the care home Frinton House is a detached property situated a short walk from Bexhill town centre and railway station. Bedroom accommodation is provided in five single rooms situated on the ground and first floors. In addition there is a one bedroom flat on the first floor. A shaft lift is fitted to assist access to first floor accommodation. The home is registered to accommodate eight adults with a learning disability; the registered owners are Consensus Community Support Ltd. The fees charged start from 1,350 pounds per week and include all day care provision and 250 pounds towards the cost Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 8 Brief description of the care home of a fully supported annual holiday. If residents require one-to-one support these costs would be negotiated separately. The cost of basic toiletries and chiropody are also included in the fees but residents pay themselves for hairdressing. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor 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: For the purpose of this report the people living at Frinton House will be referred to as residents. As part of the inspection process a site visit was carried out on 19/05/09 and it lasted from 9.45am until 4.50pm. The deputy manager facilitated the inspection as the manager was on leave. Over the course of the inspection five residents were seen. In addition time was spent with a senior manager from within the company, with the area manager and with three care staff in private. A detailed examination was carried out of two care plans. In addition records seen included; staff recruitment and training, menus, health and safety, quality assurance and leisure activities. The manager was appointed to manage the home in January 2008. The Commission is currently processing her application for registration. Care Homes for Adults (18-65 years) Page 6 of 33 Senior managers recognised that there is a lot of work required to improve standards in all areas. They confirmed their commitment to raising standards and agreed that the current system would need to change as a matter of urgency. It was agreed that an experienced manager from within the organisation would take over the management of the home for a short period whilst the manager is on leave. Additional support would also be provided to ensure that care plans are brought up to standard. Consideration would also be given to bringing in additional experienced staff to support staff in meeting the needs of the residents. Arrangements would also be made to attend to the outstanding works in the flat to ensure that it meets the needs of the individual accommodated. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are provided with clear information about the home to enable them to make a choice about admission. The current practice of admitting residents prior to ensuring that all staff are trained to meet their needs leaves residents and staff at risk of harm. Evidence: The statement of purpose was reviewed and updated in May 2009. The service user guide was also updated but the deputy manager advised that it will be amended further and a version in makaton will be prepared. She also advised that although they have been through the documents with residents it has not been recorded that this has been done. Four residents have been admitted to the home since the last inspection. Records were examined in relation to one of these residents and it was noted that the home had obtained a very detailed assessment from Social Services in respect of the needs and abilities of the resident. In addition there was detailed information provided by the residents family and the home had also carried out a very detailed assessment. Care Homes for Adults (18-65 years) Page 10 of 33 Evidence: It was noted in the assessment that in the previous placements there were times when the resident required restraining and on these occasions there were three to four staff present. A risk assessment carried out as part of the assessment process stated that there should be at least one staff member on every shift trained in scip manoeuvres. Staff spoken with were in the process of having strategies for crisis intervention and prevention (scip) training but stated that the manoeuvres they had learned were not appropriate for dealing with this residents behaviour. It was also recommended in the assessment that staff should receive training in mental health and that information should be available about bi-polar disorder. Records seen showed that the manager had training in mental health but there was no reference to staff having received training on this subject. Where areas are identified as part of the assessment process arrangements to meet assessed needs should be in place prior to a resident moving in. Each of the residents had a contract/terms and conditions of residence in place. Care Homes for Adults (18-65 years) Page 11 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improved care planning and record keeping is essential to ensuring that residents identified needs are met. Evidence: Two care plans were examined in detail. In relation to one resident it was noted that whist there was a wealth of assessment notes in place there was no actual care plan in place. There were no guidelines in place for meeting this individuals needs however there were a range of risk assessments in place and within each risk assessment there was guidance for staff. One risk assessment refers to dealing with an individual when they are presenting with challenging behaviour. It refers to the need to press the alarm/panic button to call for assistance. Staff stated that when they have done this the alarm has not worked. They then have to unlock a box to get to a phone but there is no time to do this in an emergency leaving both the resident and the staff vulnerable. Some staff have refused to work in this flat. All staff spoken with stated that the procedures in place are inadequate and they do Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: not feel safe working in the area. When incidents occur there is a detailed report written by staff stating how they have dealt with the situation. Three staff spoken about a particular incident that they had concerns, this incident involved attempts made by a resident to cause serious selfharm. Although one of the staff had confirmed that they had written a report, the report was not contained within the file. It was suggested that this might be in a pile waiting to be filed. An incident of this nature should have been reported to the Commission. In relation to a second care plan it was noted that there was some information provided about how the individual needs were to be met. However, the activity programme chart was not completed and there was only one risk assessment seen and this related to preparing food for others. This was dated February 2009 and it stated that it should be reviewed monthly. There was no evidence that this had been done. It was acknowledged that a lot of work is required to improve the standard of care planning. The company has recently introduced a new format for this purpose and records showed that the home was working towards a deadline of completing the new process by the end of July 2009. It was also reported that specialist support would be provided to the home to assist in this area. Notes were seen in relation to residents meetings held in January and March 2009. Minutes generally state that residents make no comments. Within one they state that residents went on to work together to choose a menu for the following week. There was no evidence that there was any planning in advance of the meeting to try to make them more productive and record keeping did not include reference to the choices given to and decisions made by residents. The home needs to find a way of demonstrating more clearly the choices and decisions made by residents. Care Homes for Adults (18-65 years) Page 13 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels and/or lack of permanent staff who know the residents well means that not all residents are currently able to make good use of their community for activities. Revised menus would ensure that residents could be offered a more balanced and varied diet. Evidence: In relation to one of the residents case tracked an activity plan for one week period was examined and it was noted that there were very limited activities in place. The resident had been unwell the previous week so this might have accounted for this. Activities for the week included time in the park on two occasions, listening to music, trip to a cafe, a walk on three occasions and the cinema. There was also a chart showing what activities the resident did at home including Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: making drinks, lunch, snack, washing up and putting dishes away. In relation to the second resident it was noted that they attend college two days a week and that they also do voluntary work in a charity shop. This resident was observed using the kitchen independently to make a jam sandwich for lunch. Staff reported that as a result of inadequate staffing they are unable to take the residents out as often as they would like. There was a menu on display in the kitchen. The menus show which residents chose each meal but not what choices were presented to them so that they could make the choice. There is a choice of meal provided but the choice is rather limiting. For example if the main meal is toad in the hole the alternative is sausage and mash. Another example was that the main meal was roast lamb with roast potatoes and vegetables. The alternative was the same other than, mashed potatoes were offered. A staff member reported that one resident has no input into the menus. However staff tell them what is on the menu and they can choose a different meal. The day prior to the inspection they chose a completely different alternative and staff went out to buy the ingredients. It was reported by staff that they often run out of food and that on occasions there is no money available to buy food. It was noted that cupboards contained the food that was on the menu for the day. The home had run out of sugar and there was very little tea and coffee available. Staff stated that there was no butter at breakfast. This was discussed with the senior management of the home who stated that there is a good budget for food and there is no reason why money should run out. They agreed to implement a system as a matter of urgency to ensure that food is available in sufficient amounts at all times. Care Homes for Adults (18-65 years) Page 15 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lack of appropriate staff training and unclear guidance for staff in relation to the management of some residents healthcare needs could place residents at risk. Evidence: The home is in the process of getting health action plans in place for all the residents. The deputy manager advised that they are being supported with this by the community learning disability service (CLDS). Staff observed in the course of their duties treated residents with respect and dignity. In relation to one resident it was noted that there was a very detailed risk assessment in place in relation to their epilepsy and advice for staff about when an ambulance should be called. In a care plan seen there was also very detailed advice and guidance in relation to the management of epilepsy. There was also evidence that external professionals were involved in the management plans. However, on reading through further documentation it became obvious that further changes had been made to the management plans and it was very unclear as to what was the actual current plan. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: Issues relating to the prescription of invasive medication need to be clarified as a matter of urgency. It was noted that another resident receives ongoing support from a psychologist at the CLDS. A staff member spoken with felt that too many staff have been trained to administer medication. This has caused confusion and care staff are scared of making mistakes. It was also reported that the training in medication is provided in-house by the manager and there is no formal training on the subject. Care Homes for Adults (18-65 years) Page 17 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to enable anyone wishing to make a complaint to do so. However, record keeping in relation to the management of complaints remains inadequate. Evidence: There is a detailed complaint procedure in place. In addition there is a simplified version of the complaint procedure in the service user guide. The procedure has changed in that records are now held securely in the office. A comments box has also recently been introduced for residents to assist them in raising any concerns that they might have. This has yet to be used. It was reported that there had been no complaints reported to the home. However, it was then discovered that a relative had recently raised a concern. The deputy manager advised that the matter has been referred to her line manager for them to deal with as the concerns relate to issues beyond the control of the manager of the home. On looking through another complaint folder another complaint was found dated April 2009. The complainant had failed to sign the complaint but the author was known to the home. The deputy manager advised that the manager had dealt with the complaint but there was no record on the file of the investigation or the outcome. The deputy advised that she would track down the details of the investigation and outcome. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: Within this complaint there was reference to a resident having possibly sustained an injury. It was not clear how this had happened. This matter has not been reported to the Commission and no safe guarding alert has been made. There is a folder in place containing all safe guarding alerts that have been made by the home and the outcome. It was noted that training has been booked for staff on the protection of vulnerable adults at the end of May 2009. Care Homes for Adults (18-65 years) Page 19 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a clean and comfortable environment. Not all parts of the building are safe and fit for the purpose intended. Evidence: Since the last inspection three of the bedrooms have been turned into a one bedroom flat. It was reported that the flat has been designed to cater for someone with challenging behaviour. There is a keypad lock at the entrance to this flat from the home and a separate entrance to the flat from the rear of the property. At the time of inspection the flat was occupied but the resident only had access to their bedroom. The lounge/dining room had been locked and a chair was used to prevent access to a radiator in the corridor, as due to a problem with the heating system the guard had been taken off the radiator. It was reported that the problem had been fixed and the guard would be replaced. It was also noted that the door guard to the front door was broken, that a wardrobe was also broken and the sofa had been damaged by workmen working in the home. There was a risk assessment in relation to the environment but this had not been updated in relation to the recent changes. The risk assessment did not take into account the fact that there are several windows in the flat none of which have safety Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: glass. In addition there were a number of areas/objects observed within the flat that could potentially present a risk to the safety of both the resident and the staff. With the creation of the new flat this means that although registered to accommodate eight people the home can now only effectively accommodate six. The deputy manager advised that they would write to the Commission to seek a reduction in the registered numbers. Apart from the flat area the only areas seen within the home were the main lounge, quiet room, dining room and kitchen. These areas are well maintained and decorated to a good standard. The exception to this is the quiet room which has been closed off to residents as it is currently being redecorated. The future use of this room is currently under review. It was noted in monthly reports that there is a problem with masonry falling of one side of the property. This problem has been identified monthly since December 2008. It was reported that a quote has been obtained in respect of this work but no timescale has been provided for this work to be carried out. At the time of the last monthly report this was marked as urgent but there was no reference to how or who was dealing with the problem. Care Homes for Adults (18-65 years) Page 21 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Insufficient staff levels, a high use of agency staff and inadequate training could compromise the safety of residents and the quality of the care that is provided. Evidence: Following the last inspection it was reported that additional staff were recruited to work in the home. However, within the past few months there has been a high turnover in the staff team. At the time of this inspection there were some staff on leave and it was reported that there was approximately three senior posts vacant and two-three support worker posts vacant. Vacant hours are currently being covered by a mixture of permanent staff covering extra shifts and a high use of agency staff. The deputy manager advised that as far as possible they try to use regular agency staff. A staff member stated that they have worked a shift in recent weeks when they were the only permanent worker and they were on duty with three agency staff. The rota seen showed that there are four staff on duty for the early shift and four for the late shift. There are two waking night staff but in the days prior to the inspection this had been raised to three waking night staff as a temporary measure and the need for the third carer was to be kept under review. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: A number of the residents are funded to receive one to one support for parts of the day and one resident is funded for two to one support for four hours daily to make use of the community. The current rota does not show all the vacant hours and does not show the one to one funded hours and how they are being covered. Staff stated that not all residents are getting their one to one support. It was reported that a team leader has been appointed subject to obtaining a CRB (criminal records bureau) check. A staff member stated that although they have had a changed role within the home for a month they only received their job description the day prior to the inspection. Records were seen in relation to one staff member recently appointed to work in the home. Recruitment procedures had been followed thoroughly. It was noted that a supervision session had been provided on 17/5/09. An in-house induction had been completed but there was no reference to CIS (common induction standards). There was no training matrix in place. A general staff training folder was examined and it showed that there were significant gaps in mandatory and specialist training. Some of the statistics included staff that no longer work for the home. It was acknowledged by the deputy manager that this might not be the most up to date information. From the records available this showed that five staff had completed training on epilepsy awareness in January 2009, four staff on understanding epilepsy and the administration of rectal diazepam, five staff completed first aid training in December 2008, four staff have completed moving and handling in December 2007, four staff have completed the LDQ (learning disability qualification) in July 2008 and four staff completed fire marshal training in February 2008. These numbers do not include any of the staff spoken with during the inspection. Monthly reports seen indicate that all staff receive regular formal supervision. In addition staff spoken with confirmed that they receive formal supervision. All staff spoken with stated that they do not find the process helpful and there is no constructive advice or support. Staff also said that most of the problems have only occurred in recent weeks and that prior to this the home was a pleasant place to work. Care Homes for Adults (18-65 years) Page 23 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The operation of this home does not fully safeguard residents and staff and urgent additional support is needed to ensure the health, safety and welfare of the residents and staff. Evidence: The appointed manager has submitted her application for registration with the Commission. She was on leave at the time of inspection. The appointed manager has completed the Registered Managers Award and is currently studying for a degree in psychology. During the inspection two senior managers came to the home to attend a staff meeting that had been planned for the afternoon. Some of the findings of the inspection were shared with them. Following the staff meeting they acknowledged that there was a lot of work to be done to improve standards in the home. They confirmed their commitment to raising standards and agreed that the current system would need to change as a matter of urgency. It was agreed that an experienced manager from within the organisation would take over the management of the home for a short Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: period whilst the manager is on leave. Additional support would also be provided to ensure that care plans are brought up to standard. Consideration would also be given to bringing in additional experienced staff to support staff in meeting the needs of the residents. Arrangements would also be made to attend to the outstanding works in the flat to make it safe. All staff spoken with stated that the morale in the home was low and that there is a tense atmosphere. Staff do not feel protected by the systems in place and feel that management do not understand the problems that they face. This was discussed at the time of inspection and senior managers stated that they would review the systems in place and look to building up a more positive staff team that have confidence in the systems set up to support them. Following the staff meeting they arranged a further staff meeting to be held two weeks later. A staff member spoken with stated that they had been able to share their views in the staff meeting and had been told that the issues raised would be addressed. As stated previously, although there appears to be a good budget in place for food and other requirements the management of this budget would indicate that money is not always available when needed. In relation to quality assurance, records showed that surveys were completed in June 08 when there were only two residents. Views expressed were positive and they have been included in the service user guide. It was not clear if the surveys had been sent to relatives for their views. The deputy manager advised that they would be sending surveys again soon and that they would also be sent to relatives and staff. The operations manager visits the home once a month unannounced to check on the running of the home and to report to the owners on the findings. It was noted that some common themes reoccur from one month to the next with no definite plan of when or how they are to be completed. This was evident in relation to maintenance issues and in relation to the updating of care plans. It was also not clear if the views of the staff team were being expressed or if the views expressed were those of the management of the home about the staff team. In several reports seen it stated that the residents were out at the time of the visit so there were no views recorded. One member of staff had been dismissed for gross misconduct and it was not clear if they had been referred to the protection of vulnerable adults (pova) list. The most recent monthly report provided more detailed information, the views of two residents were provided and it was noted that some of the timescales for outstanding items had changed. Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: There were numerous general house risk assessments in place that were drawn up in 2008. There was no evidence that they had been reviewed and this is more relevant because the home has changed dramatically from only having two residents to having six. In one risk assessment it stated that all staff must be trained if necessary in behaviour and physical intervention. Information provided in advance of the inspection showed that the majority of the policies and procedures were reviewed in 2008. The home is not currently reporting all incidents that affect the wellbeing of residents to the Commission. Care Homes for Adults (18-65 years) Page 26 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 14(1d) The registered person must ensure that prior to admitting a new service user arrangements must be put in place to ensure that needs identified as part of the assessment process are met. Prospective service users must know that the home will be able to meet their needs. 31/07/2009 2 6 15 15 [1] [2] The Registered Person must ensure that meaningful, person centred care plans are developed and completed for all service users that clearly set out their aspirations and life goals. Service users must know that their assessed and 15/08/2009 Care Homes for Adults (18-65 years) Page 28 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action changing needs and personal goals are reflected in their individual plan. 3 17 16 16 [2] [i] The Registered Person must devise menus that reflect the dietary needs, choices and preferences of service users living in the home. To ensure service users receive a balanced, healthy and nutritious diet. 13(1b)(2) The registered person must ensure that they seek specialist advice regarding the use of invasive medication for one resident and that all information in the care plan is updated to reflect the advice obtained. Service users must be protected by the homes policies and procedures for dealing with medicines. 5 22 17 17 (2) Schedule 4 para 11 The registered person must ensure that when a complaint is received, detailed records are kept of the investigation and the outcome. 15/07/2009 30/06/2009 4 20 13 30/06/2009 Care Homes for Adults (18-65 years) Page 29 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Service users and their relatives/representatives must be confident that their complaints will be listened to, taken seriously and acted upon. 6 24 23 23 [2] [b] [c] [d] The 15/07/2009 Registered Person shall having regard to the number and needs of the service users ensure that- The premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. (a)that masonry is made safe on the side of the building. (b)That the newly constructed flat is made safe and the facilities within it are accessible to the person living in it. The Registered Person must produce a written action plan showing timescales for ensuring that the flat is fit for purpose and that the masonry problem is to be addressed. 7 32 18 18 [1] [c] [i] The registered person must ensure that all staff are up to date with 31/07/2009 Care Homes for Adults (18-65 years) Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action mandatory training and specialist courses that have been identified as essential for working in the home. Service users needs must be met by appropriately trained staff. 8 33 18 18 The registered person must ensure that a review is carried out of the staff levels to ensure that residents individual needs can be met. 15/07/2009 Residents must be supported by an effective staff team. 9 42 37 37(1e) The registered person must ensure that any event in the home that affects the well being of a service user must be reported to the Commission without delay. Service users must benefit from competent and accountable management of the home. 10 43 25 25(1) 30/06/2009 30/06/2009 Care Homes for Adults (18-65 years) Page 31 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action The registered provider must ensure that the home has sufficient money available to provide for the service users accommodated. Service users benefit from competent and accountable management of 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 2 35 38 All staff should received induction that is in line with the Common Induction Standards. Work should be undertaken in an attempt to improve relationships between management and the staff team. Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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