Inspection on 19/11/09 for Frinton House

This inspection was carried out on 19th November 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Frinton House 19/05/09

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 13/03/2010.

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:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Caroline Johnson     Date: 1 9 1 1 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 32 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 32 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@consensussupport.com www.consensussupport.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 Support Services 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 32 Over 65 0 8 1 9 0 5 2 0 0 9 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 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: 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 19/11/09 and it lasted from 10.30am until 18.00pm. The appointed manager facilitated the inspection. Over the course of the inspection there was an opportunity to meet with two staff members in private. One care plan was examined. In addition records seen included:- staff rotas, training, medication, menus, health and safety, quality assurance and leisure activities. Since the last inspection the then appointed manager resigned from her position as manager and a new manager was appointed a week and a half prior to this inspection. Following the last inspection of the home in May 2009 a warning letter was sent to the Responsible Individual (RI) detailing the Commissions concerns regarding the rating given as a result of the inspection. No response was received from the RI, however Care Homes for Adults (18-65 years) Page 6 of 32 during a telephone conversation, the RI advised that she had not received the letter. A copy of the letter was then sent to the RI but again no response was received. Following feedback received from the issuing of the draft report, a meeting was held with the provider as part of the local resolution process. As a result of information provided at the time of that meeting it was agreed to rate the management section as adequate. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: As a result of this inspection six requirements have been made. They include three requirements from the last inspection in relation to complaints, staff training and staff levels as they remain unmet and a decision has been made to reword these requirements in acknowledgement of the fact that the manager is so new in post and will need time to address these areas. Whilst it is acknowledged that some progress has been made in recent weeks to improve standards in the home, it is concerning that given that the home had six months to address the areas of the last report so much work was left to such a late stage. It is the Commissions intention to arrange a meeting with the provider to discuss how the home intends to support the manager to improve standards in all areas. Key to addressing all areas is the need to set up a robust quality assurance system with effective monitoring of progress in all areas. Regular auditing in all areas would ensure that record keeping is kept up to date and that staff have the key information they require to meet residents needs. Staffing levels must be reviewed regularly to ensure that individual residents support needs are met but also to ensure that residents are enabled to make full use of their community for activities. All staff must attend mandatory training. It is disappointing that at the time of the last inspection when there were problems with staff dynamics and morale that staff have not had any formal supervision since that time. Care Homes for Adults (18-65 years) Page 8 of 32 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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 10 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. The home ensures that prospective residents are given clear information about the home and the facilities on offer. Evidence: There have been no admissions since the last inspection of the home. There was one placement breakdown. The manager advised that although there is a placement officer who identifies potential residents he would expect to be completely involved in the assessment process for any new residents. He stressed the importance of ensuring that any new resident would need to be compatible with the current client group and that the admission procedure would not be rushed. Information provided in advance of the inspection confirmed that residents have a copy of the statement of purpose and service user guide. Use of the flat on the first floor has yet to be decided. At the time of the last inspection the flat was used to accommodate a resident with complex needs. If the flat is to be used for this purpose again then further work would be required to make it fit Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: for purpose. Care Homes for Adults (18-65 years) Page 12 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. Care plans provide detailed information about the needs of the residents along with the action to be taken to meet them. Evidence: Since the last inspection work has been carried out to improve the quality of the care plans. The manager stated that whilst he is satisfied that care plans have been revised and updated he still feels that there is further room for improvement in this area and he will seek to build upon the work that has been carried out to date. A staff member spoken with confirmed that the they have read three of the five care plans. This was discussed with the manager who stated that work needs to be carried out to ensure that all staff are up to date with the content of the care plans. He stated that it is his intention to review one of the care plans at each of the weekly meetings coming up to ensure that everyone is clear about the action to be carried out to meet residents needs. He also confirmed that a room on the ground floor, currently unused, is to be given over as a staff room. Care plans will be stored there so that staff can Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: refer to as and when needed. A weekly residents meeting is held and the main focus of these meetings appears to be deciding the menus for the following week. There was also evidence that residents are asked if they are happy. There is room to develop this further. There is currently no evidence of how residents are being kept informed about the running of their home for example being informed about maintenance works and staffing arrangements. Care Homes for Adults (18-65 years) Page 14 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. The majority of residents are offered a varied and stimulating programme of activities. Evidence: Each of the residents has a programme of the activities that they participate in. Some of the residents have a very busy week. One resident attends a day centre five days a week. Another two residents attend college two days and one has a work placement two days and the other one day a week. Residents are also beginning to go to clubs and two residents go to the sea cadets one evening a week. Some of the residents like to spend their spare time on the computer or going out to places like bowling or cinema. One resident does not have many activities but recently has started to attend a music gym in Hastings. They also enjoy spending time on a one to one with staff, baking in the kitchen. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: The manager advised that he would like to increase activities particularly for those residents who do not go out much. This will be a mixture of offering more community based activities and organising activities in-house. The home has a seven seater car for transporting residents to day activities. It was confirmed that one resident appears to have difficulty getting into and out of the car. The manager confirmed that an Occupational Therapist (OT) has visited and has made suggestions that they will try. If this fails they will consider other approaches to this. Staff stated that they support residents to maintain contact with their relatives. Records showed that residents decide the plan for each weeks menu at their weekly residents meeting. Some residents are able to make a verbal choice and some choose with the aid of pictures of meals. A second choice is also decided upon. Staff stated that they shop on Monday for that days meal and then an on line shop for the remainder of the week is carried out. Records of meals provided showed that residents are receiving a varied and well balance diet. However, on the day of inspection the food as stated on the menu was not available. Staff stated that they would be going to the shop to purchase the ingredients. There had been a problem with shopping arrangements that week and the weekly shop had not been carried out. The manager confirmed this and stated that this is another area where clearer guidelines need to be put in place regarding how this is to be arranged and in relation to the arrangements for food that is available for staff to eat when on shift. Care Homes for Adults (18-65 years) Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More robust auditing of the systems in place for ensuring that the healthcare needs of residents are being met would assist in raising standards in this area. Evidence: Overall there were good arrangements in place for the management of medication in the home. However, in relation to homely remedies, although there was a list of medications that it was reported that the the gp had approved there was no documentary evidence of this. In addition the home does not have a list of the signatures of the staff that have been delegated responsible for the administration of medication. The manager advised that he would like to review the procedure in place for the management of medication for residents on social leave and he has an appointment made with the local pharmacist where he will discuss this subject. The requirement made at the last inspection of the home is not longer relevant as there has been change to the medication prescribed. Residents are supported to attend a range of healthcare appointments as required to Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: meet residents healthcare needs. However it was noted that on two occasions residents missed appointments in London, at least one of which was due to staffing arrangements. On the day prior to inspection it was noted that a urine sample that was meant to be taken to the local surgery had not been taken and as a result another sample was going to have to be taken. The manager confirmed that he would speak with the staff on duty to find out why the sample had not been taken. Care Homes for Adults (18-65 years) Page 18 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. Systems are in place to ensure that anyone wanting to make a complaint can do so. However there is no robust system in place to ensure that investigations are followed through and resolved. Evidence: There is a detailed procedure in place to ensure that anyone wishing to make a complaint can do so. A simplified version of the procedure is also available. Complaints are stored confidentially. Information provided in advance of the inspection confirmed that there had been three complaints received all of which had been upheld. However on looking through the complaint folder it was apparent that there were numerous concerns in place. A number of statements from staff had been obtained. It was not possible to determine exactly how many complaints there were in the folder as some could have been related or part of a similar issue. Some of the issues may have been staff disciplinary issues rather than complaints. There was no audit trail to clearly see what the complaints were, how they had been dealt with and how they had been concluded. Within the records of the Regulation 26 visits seen, it was noted that there was no reference to any complaints having been received. There is a detailed procedure in place in relation to the protection of vulnerable adults. It was noted that the home has made appropriate referrals when necessary. One investigation was ongoing at the time of this inspection. Staff spoken were clear about the action that should be taken if they were to suspect abuse. Staff training has also Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: been provided on this subject. Care Homes for Adults (18-65 years) Page 20 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. With the exception of the first floor flat where some additional adaptations are required, accommodation provided is comfortable and homely and decorated to a good standard. Evidence: At the time of the last inspection a requirement was made in relation to maintenance issues. Firstly that the masonry on the side of the building be made safe. It was reported that this work has recently been carried out but there was no documentation in the home to confirm this. The manager contacted the property services department during the inspection and they confirmed that the work had been carried out. The second part of the requirement was in relation to the first floor flat and ensuring that it was fit for purpose. The manager confirmed that the flat is not currently in use. Discussions need to take place regarding how this area is to be used in the future. it was agreed that if it were to be used to accommodate anyone with complex needs further environmental adaptations would need to be carried out to ensure that it were fit for purpose and in line with the needs of the potential resident. The manager advised that he has drawn up a list of the areas within the home that he thinks need redecorating. All areas seen during the inspection were clean. Staff spoken with confirmed that they had received training on infection control. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are not always provided in sufficient numbers on all shifts in line with the homes statement of purpose to meet individual residents needs. Not all staff are up to date mandatory training and they have not had the benefit of regular supervision. Evidence: Since the last inspection of the home there has been a high turnover in the staff team. The manager confirmed that one new staff member has started their induction to the home and another is due to start subject of receipt of satisfactory references. Another four staff have been interviewed and appointed subject to appropriate checks being carried out. In the interim the home is using agency staff in order to maintain safe staff levels. They have been successful in having regular agency staff which has helped them to ensure continuity and consistency for the residents. In addition two senior staff from another home within the organisation are temporarily working in the home. The manager confirmed that once a full staff team has been established he would be reviewing each staff members roles and responsibilities and making sure that everyone is clear about what is expected of them. Rotas seen showed that there are three staff on duty throughout the day. At night there are either two waking or one waking/one sleep-in carer on duty. It was not clear why there were differences in the arrangements for some nights. Two of the residents Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: are provided with additional one to one funding for a few hours each week. The rotas do not currently show how these hours are provided. The manager advised that he would be carrying out a review of staff levels at key times to ensure that the home can meet the individual needs and wishes of the residents in relation to activities. The manager confirmed that his aim is to tighten up on induction. He would like all new staff to complete their mandatory training prior to commencing in post. Records showed that a lot of staff training has been provided in the past few weeks. However, in some cases staff, although booked to attend courses, have not attended. The manager was clear that this would not be allowed to continue and he advised that non attendance would be treated as a disciplinary matter. Staff spoken with talked positively of the training that has been provided and both stated that they have completed the Learning Disability Qualification (LDQ) and hope to go on to study for a National Vocational Qualification (NVQ) in the New Year. Records showed that in relation to six staff only one had had supervision since the last inspection. One staff member had no supervision records at all in their folder. Most only had one record of a supervision that had been carried out in April 2009. In addition it was noted in the format used, that the boxes contained yes/no answers but no evidence of any discussion having taken place. The manager advised that he had met informally with a number of staff since commencing in post and he would start formal supervision sessions as a matter of priority. 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. A lack of thorough auditing, a high staff turnover and unsupervised staff places residents at risk of harm. A more robust quality assurance system is required to improve outcomes in all areas. Evidence: Since the last inspection the appointed manager resigned from her position. A new manager has since been appointed and commenced in post a week and a half prior to this inspection. He confirmed that he has completed NVQ level four and the Registered Managers Award. He has a number of years experience in caring and managing services for adults with learning disabilities. The manager confirmed that his expectation is that he is to receive monthly supervision. He has received good support from his line managers since commencing in post and had also had support from another manager of a service run by the company. Since taking up position the manager advised that he has spent time getting to know Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: residents and staff and getting to grips with the organisations procedures and systems. He intends to hold weekly staff meetings to ensure that staff views are being heard and to keep staff up to date with changes in care practises. Staff spoken with during the inspection were cautiously optimistic about the future. As required at the last inspection the home ensures that any notifiable incidents are reported to the Commission. The manager confirmed that a very productive staff meeting had been held a few days prior to the inspection but the minutes were yet to be typed. Staff echoed this statement. Minutes of a meeting held on 5/10/09 were seen. The responsible individual attended this meeting. The systems in place for auditing the quality of care provided were examined. It was noted that surveys for residents, relatives and staff were last carried out in July 2008 but at that time there were only two residents accommodated. A home audit tool was last completed in January 2008 and an external audit was carried out in May 2009. There was no written record of action taken as a result of these audits. The responsible individual or a representative on her behalf visits the home on a monthly basis to report on the conduct of the home. Records were seen in relation to visits carried out from June to September 2009. It was of concern that each month records showed that staff supervision was up to date and that there had been no complaints raised, when in fact it was noted that staff supervisions had not been carried out and there had been a number of concerns raised. In addition a number of requests had been made to ensure that equipment (portable appliances, lift, fire certs, circuit testing and microbiological) was serviced/tested. These had been repeated on each form with no reference to the fact that they had been outstanding from the previous report. The latest report in October showed that the majority were still outstanding but there were some certificates in the home showing that some of these matters had been attended to. Records for the October visit were forwarded on to the Commission the day after the inspection. This visit was conducted on 30/10/09 and stated that all staff were to be supervised the following week. This was not achieved. Information is not included on the form about the number of staff vacancies and how these hours are being covered. Therefore the provider is not being given clear information about the running of the home. It was reported that in addition to the monthly visits conducted by the organisation, the manager would also have responsibility for submitting detailed information to the provider. Records seen showed that the last report submitted was sent in July 2009. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: As the manager is was so new in post he confirmed that he has yet to be provided with details of the breakdown of the various budgets available to him. Discussion was had about the management of the budget for food. He confirmed that the budget appears to be generous but the system for utilising the budget needs reorganising to ensure that there is always a plentiful supply of food available. Procedures for the management of residents finances were briefly examined and it was agreed that the manager would assess the measures in place further to ensure that they are in the best interests of residents. In advance of the inspection a range of satisfaction surveys were sent to the home for them to distribute to residents, staff, relatives and any visiting professionals. Three resident surveys were returned. In each case staff had supported residents to complete them. In response to a questions about what the home does well the three responses were (1)make everyone welcome, (2) the staff listen to me, (3) everything. In relation to what they could do better the responses were (1) have regular staff, (2)we need more staff but not too many so its not too busy, (3) No. Three health professionals returned surveys. In one case the respondent wrote very positively about their experience of working with the service who they said were proactive in promoting a clients needs. In the second case the respondent highlighted a number of concerns too much use of agency staff, care plans and risk assessments not updated, client information (reports) archived even though it is still relevant, management attending training but not putting it into practise, what appears to be a lack of robust support from within their own organisation. The third respondent stated that improvements could be made to the way in which activities are planned so that individuals could have needs met rather than having group activities. They also stated that there is poor communication between staff and with other services and a delay in decision making. Four staff surveys were received. In each case there were differing views. One staff member felt the management were to blame for the recent turnover in staff and they were full of praise for the senior management. A second felt that the high staff turnover was a problem and they felt that the staff team was unappreciated. They were full of praise for the senior management. The third respondent felt that the staff team were good and needed to be supported by the senior management. They also stated that when the whistle blowing policy was followed senior management did not follow the companys policy. They stated that support from senior management had improved in recent weeks. The fourth staff member valued the increased training Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: opportunities but felt that the home could be better managed with better communication and more staff. Three relatives surveys were were received. One comment included I give all my gratitude to the staff for the way they are caring for my relative. A second comment included concern about big turnover of staff and agency help. The third respondent felt that the home could do better in washing and ironing and keeping carpets clean in bedrooms. In addition they said that they are concerned about the turnover of staff. Care Homes for Adults (18-65 years) Page 27 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 28 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 22 17 Regulation 17(2) Schedule 4 30/01/2010 para 11 The Registered provider must ensure that all complaints received are investigated and there is a clear audit trail of the investigation and outcome. Residents views must be listened to and acted upon. 2 33 18 Regulation 18(1a) 15/01/2010 The registered person must have regard to the assessed needs of service users and to the homes Statement of Purpose to ensure that at all times suitably qualified, competent and experienced persons are working at the care home in sufficient numbers to provide effective care and meet residents individual preferences. Residents must be supported by an effective staff team. Care Homes for Adults (18-65 years) Page 29 of 32 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 3 35 18 Regulation 18(1) The registered manager must ensure that all staff receive training suitable to the work they have to perform. Residents must be supported by qualified and competent staff. 15/01/2010 4 36 18 Regulation 18(2) The registered person must ensure that all staff receive regular supervision. Residents benefit from well supported and supervised staff. 15/01/2010 5 39 26 The registered provider 15/01/2010 must ensure that visits carried out on a monthly basis accurately reflect waht is happeningin the home and there must be evidence to show how action points have been addressed. A copy of these reports must be sent to the Commission. So that the service is regularly audited. 6 39 24 The Registered Person must 15/01/2010 introduce more robust quality assurance systems. The views of service users, professionals, relatives where appropriate and other Care Homes for Adults (18-65 years) Page 30 of 32 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 interested parties should all be sought and the information collated, published and findings actioned. So that the home is run in the best interests of service users. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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