Inspection on 22/05/09 for Good Neighbours House

This inspection was carried out on 22nd May 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Good Neighbours House 12/06/08

Good Neighbours House 26/11/07

Good Neighbours House 14/11/06

Good Neighbours House 01/12/05

Good Neighbours House 18/08/05

Good Neighbours House 30/12/04

Good Neighbours House 17/05/04

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Good Neighbours House 38, Mary Datchelor Close London SE5 7AX     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: Sonia McKay     Date: 2 2 0 5 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 33 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 33 Information about the care home Name of care home: Address: Good Neighbours House 38, Mary Datchelor Close London SE5 7AX 02077037451 02072527105 good.neighbours@scope.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : SCOPE care home 16 Number of places (if applicable): Under 65 Over 65 0 physical disability Additional conditions: 16 The maximum number of service users who can be accommodated is: 16 The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD Date of last inspection Brief description of the care home Good Neighbours House is a purpose built care home which provides care and accommodation for up to sixteen adults who have a physical disability. The home is fully accessible to people who use wheel chairs. Each resident has his or her own room. The home has three floors, access to the upper floors is by stairs or the two passenger lifts. None of the bedrooms on the top floor of the home are currently in use. Three residents live in accommodation which is used to develop independent living skills and, as appropriate, to facilitate a move to independent living in the community. The home is located close to the centre of Camberwell where there is a busy shopping centre, banks, restaurants and pubs. Public transport routes are close by. Care Homes for Adults (18-65 years) Page 4 of 33 Brief description of the care home The charges for the current residents are between 2,000 pounds and 6,000 pounds per month. There have not been changes in the ownership, management or service registration details in the last 12 months. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service was completed on 13th June 2008. This inspection was carried out in two days by two inspectors and a regulation manager. To do the inspection we looked at records and talked with residents and staff. There was a tour of the premises and a meeting with current home managers. We also looked at the information that the home sent to us in their annual quality assurance audit. Care Homes for Adults (18-65 years) Page 6 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The home is in need of major refurbishment and redecoration. The preferred personal care routine of one resident cannot be done until a new bathroom is fitted. The statement of purpose and service users guide must be further review to ensure that there is adequate information about the home and the services provided. Cultural needs must be developed into plans so that identified needs can be met. Care Homes for Adults (18-65 years) Page 7 of 33 More should be done to review and improve the quality of care provided. This can be done by developing a quality assurance plan. Some areas of medication administration must be improved. 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 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. The written information about the home and the services provided is adequate. Additional information must be added to ensure that current and prospective residents have all of the information required by current legislation. The needs and aspirations of prospective residents are assessed properly and they are offered visits to the home before they make a decision to move in. Evidence: There are two documents about the home. The statement of purpose and a service users guide. Rules about restrictions on visitors at night must also be stipulated as the guide currently says that visitors are welcome at any time, and this is not the case as overnight or night time visitors are not allowed. A copy of the most recent Commission inspection report is available in the reception area. The statement of purpose provides adequate information about the home but there are some areas that require the addition of more information, for example, the complaints procedure, the arrangements for respecting the privacy and dignity of Care Homes for Adults (18-65 years) Page 10 of 33 Evidence: residents, bedroom sizes and rules about visitors. The service users guide needs more information about placement fees and how they are spent. One new resident has moved into the home since the last inspection. Records show that the acting manager obtained the local authority community care assessment of need and also conducted her own assessment by talking with the prospective resident and nursing staff at the hospital. The resident visited the home twice before he decided to move in and he currently awaits his first placement review. The resident did not receive written confirmation that his care needs had been assessed as able to be met by the service, although a letter was sent to the placing authority confirming this. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning and risk assessment have improved, although further work is needed to ensure that all areas of care and support are reviewed regularly. Residents are consulted about their care and about how things are going for them in the home. Evidence: Each resident has a file of written information about their care. This confidential information is stored in a staff office which is locked when not in use. These files are maintained by key workers. Care plans and review dates are monitored by the management team. Plans and written information about three of the current residents were examined. Care plans are in place for all three and all had been reviewed regularly. A requirement made in this regard is therefore met. The records are better organised and stored than they were at the last inspection. Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: Information is easier to locate. A new format for care planning is in place and two of the three plans seen had been signed by the resident. Plans cover a range of appropriate areas, including healthcare, as required in the previous inspection report. During the last inspection a requirement was made is regards to recording and planning for peoples cultural needs. A manager completed an assessment of the cultural needs of each resident. Unfortunately these assessments have not been reviewed and developed into specific pans that can be reviewed along with other areas of care and support planning. This must be done to ensure that peoples cultural needs are addressed. Each resident has a set of risk assessments that look at a range of standard environmental risks and any additional risks identified during assessment. Risk assessments are also reviewed regularly and monitored by managers, as required in the previous inspection report. Each resident has a key worker. The key worker meets with the resident each month to discuss how things are going for them. There are also regular residents group meetings. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Better staff co-ordination and resident consultation has helped to improve the range of activities available. Staffing is better organised so that residents who need extra help with engagement now receive it. Residents are part of their local community and more is being done to find out about communiy links for residents who need support. Evidence: Residents engage in a variety of day time activities, either at home or in the community. Some are able to organise their own lives, meeting friends and accessing local shops and resources independently and others need more support from staff. A member of staff is employed to assist with activities. Some residents have additional one to one support time from staff and this is now better co-ordinated so that staff are aware of who needs the extra support and when. Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: Some residents attend day centres and college classes and there is a wheelchair accessible house vehicle and driver to assist with transport. The communal lounge now has a large television, big enough for people to see properly. residents were observed to spend time together in the lounge or in the privacy of their bedrooms. There is also a room that is used for arts and crafts and other activities. There is a large noticeboard with the weekly plan of activities available. A resident also organises a regular bingo night with prizes. There is progress in developing better activities for people and the service aims to further improve this area by regular consultation with residents and maintaining a suitable in house programme of things they wish to do. Meals are served at reasonably set times although residents can request snacks at other times also. Some residents live more independently and have their own kitchenettes, but most have meals made by staff in the catering style kitchen, which is not wheelchair accessible. Some of the residents need assistance to eat specially prepared meals (soft textured for example). Staff were observed to be providing this assistance on a one to one basis with patience. Records are kept of the meals served and the kitchen is clean and tidy. Food stocks are good and stored correctly. There is a hot and cold drinks machine in the dining areas so that residents can make their own drinks. Comments from residents indicate that the food is alright and they are generally satisfied with most meals. Menus are discussed in house meetings. Residents can have visitors although late night or overnight visits are not allowed. This house rule is not written down. The provider must look at this rule carefully and make sure that people moving to the home are made aware of it, as this may prevent people from starting or maintaining an intimate relationship. Residents are not routinely issued with a key for the front door although some do lock their bedrooms. A requirement was issued about this and the manager said that all residents had been asked if they wanted a key but only one resident wanted one. The key was provided. It is recommended that key issuing be considered as part of the process of moving into the home. 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. Personal care arrangements are good for most people although restricted facilities at this time mean that some residents may not be able to maintain their personal care in ways that they prefer, for example having a bath rather than a shower. Staff have got better at recording important information about health care and health care needs are generally well met. Medication is handled well by trained staff although further improvement is necessary in some areas such as ensuring that doses are not missed, recording, and storage. Evidence: Many residents require staff assistance to bathe and some need help to use the toilet. Some residents have continence needs. The nature of the support required is recorded in written care plans that are reviewed regularly. During the last inspection it was noted that some residents were using the bathing facilities on the third floor. The third floor is no longer used and is declared out of bounds to residents and staff. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: We looked at the personal care and health care records for three people. One person used to enjoy the jacuzzi bath on the third floor and, as there is a low ceiling in the first floor bathroom, the hoist cannot be used there. This means that the resident is unable to use the bath. Staff are reported to be providing a bed wash instead. The acting manager said that only one or two members of staff are confident enough to provide personal care assistance using a shower trolley. A risk assessment is in place for the moving and handling involved. However, the persons personal care plan does not record this change in personal care arrangement and the current arrangements are not adequate as this is not the preferred personal care routine of the resident. The acting manager said that bathroom refurbishment to address this is planned. Records relating to the two other residents were in accordance with their current needs and were up to date. Staff have also received training in some of the specific health needs of some of the residents, for example, diabetes and epilepsy.There has also been some input and team support around understanding challenging behaviours. Residents choose when to get up and when to go to bed. Residents are all registered with a local GP, dentist and optician. Some residents also attend hospital clinics to monitor their individual health matters. Each resident has a key worker to help them to organise and plan. Key workers and staff on duty maintain records of the health advice and care given and records relating to health care and appointments seen during this inspection were much better organised than at the last inspection. There is an individual record of each persons weight and these records are kept up to date. We inspected medication records, medication storage areas and training. Medicines are handled well, storage facilities are adequate, medicines are held securely, and the manager and staff in charge of medication on the day of the inspection were knowledgeable on medication issues. There has been a noticeable improvement in medication handling since the last inspection in June 2008. All staff who give medicines have had appropriate training, including competency assessments. Observation of administration of medication and inspection of records showed that staff are following the homes procedures, ensuring medicines are given safely and as prescribed. All prescribed medicines were available at the home, and records of administration together with stock check showed that residents are receiving their medicines on time and as prescribed. Records are kept of the receipt, administration and return of medicines, and inspection of these showed that the home can account for all medicines held on behalf of residents. Two residents are supported to keep and take their own medicines. Risk assessment are in place to ensure their safety, these are reviewed regularly and lockable storage is Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: provided in their rooms. One resident goes on social leave regularly, and the home ensures that medicines are supplied so that doses are not missed. Records are kept of which medicines have been supplied and returned to ensure that all medicines can be accounted for. Another resident goes to a day centre regularly, and has missed five lunchtime doses of a prescribed medicine. The home should make arrangements to either send the medicines with the resident, or alter the timing so that medicines can be given before leaving or after returning to the home. One resident is on prescribed oxygen. He uses it himself, however staff are also trained on how to use it, and there are written guidelines in his care plan from the hospital physiotherapy unit. An area for improvement is the process for the use and recording of food supplements, creams and other external medicines such as scalp lotions. Staff are not recording when they are used. One prescribed medicine, a food replacement drink, is being given three times a day as prescribed, however staff are only signing once a day. The home must ensure that staff record when all prescribed medicines are used, and it would be good practice to add frequency of use an area of application of creams to the medication record. Some creams and external products are also kept in residents rooms, in unlocked cupboards. It is recommended that the home carries out a risk assessment to ensure that it is safe to do this, and also that these are checked and replaced regularly. Two other areas for improvement in recording are when medicines are handwritten onto a medication chart; they should be a robust check for accuracy, which is usually a second check by staff. Also it would be good practice to write the quantities of medicines carried forward from one month to the next to help in carrying out stock checks, for example, painkillers, creams and other medicines used on out when required basis which dont need to be ordered every month. No controlled drugs are held at the home, however the home must obtain a controlled drugs cupboard as this is now a legal requirement for all care homes. Care Homes for Adults (18-65 years) Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that they are concerns in complaints will be listened to and acted upon and procedures are in place to ensure that they are protected from abuse. Evidence: Procedure in place and the registered provider publishes a leaflet called complaining isnt wrong it is right. The leaflet details the actions that residents or others should take if they wish to make a complaint. The leaflet is available in a variety of formats, including audio tape and large print, and it is available in poster format in communal areas of the home. There is a record of all the complaints made. The record was examine during this inspection and there is evidence that appropriate action is taken when residents or and others complain. Residents are also encouraged to raise concerns during one-to-one meetings and house meetings. There are procedures to protect vulnerable adults from abuse and staff have a clear understanding of when to contact the local authority, and/or the police, to assist in any investigation should abuse be suspected. Staff all receive training about what to do if they suspect abuse and local authority procedures to safeguard vulnerable adults are Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: available for reference. Scope, who run the home, also have a safeguarding manager to provide advice and to monitor safeguarding procedures. The home has also got better at ensuring that all the necessary authorities are notified of any significant events in the home, for example, incidents. Care Homes for Adults (18-65 years) Page 20 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home environment is poor and in need of major refurbishment and redecoration. Evidence: The premises allows access for people who are wheelchair users. There is adequate communal space, although the main kitchen is not accessible to people who use wheelchairs. The ground floor reception area has a new carpet and there are displays relating to the activities available in the home. There is a large dining room with an adjoining television lounge. A new large screen television has been purchased and this makes it easier for a wider group of people to see it properly. There are also more private sitting spaces available in the hallway and lobby area of the home, one of which has a pay phone. There is a room specifically for activities such as arts and crafts. This room is reported to be used more often now and there are many arts and crafts materials and games available. Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: The dining area has doors that open onto a grassed area where residents can sit out in warm weather. All of the bedrooms are single occupancy. There is also accommodation for people who are working towards greater independence. These people have use of small kitchenettes. During the last inspection we noted that the third floor of the home was unsafe and we required a risk assessment be undertaken. As a result of this, the third floor of the building is no longer in use as it is risk assessed as being unsafe. This area is out of bounds to residents and staff and is roped off at the stairwell. Residents currently have use of the ground and first floor of the building only. Staffed offices are now all on the ground floor. Offices on the first floor are being used by an area manager. During a tour of the premises it was noted that some of the bedrooms are personalised and others are less so. The area manager said that residents can choose what they want to do with their bedrooms and some prefer a less cluttered room. Lighting is poor in the first floor communal hallways and the paintwork is dark in colour making the hallways dim. En suite fittings in some of the bedrooms are in a poor state of repair, with chipped and damaged worktops and poor decor. Carpets in some of the areas of the home are worn thin and in some cases had to be repaired during the inspection because of trip hazards. Overall the home environment does not meet the modern expectations of residents and the home has an institutional appearance. One bedroom has a strong smell of urine. This is unacceptable and a requirement made in this regard during the last inspection is not met. Action must be taken swiftly to ensure that bad odours are removed. The lounge carpet is stained and the furniture is old and in need of replacement. There are two passenger lifts available. Breakdowns are reported to be frequent and on the two days of the inspection either one lift or the other or was not working. The lift repair team are reported to be responsive and repairs carried out quickly and one or other lift is generally working. During the last inspection it was noted that the central heating was not working Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: properly in some areas of the home and alternative heating, electric radiators, were in place in some bedrooms as an interim measure. The problems with the central heating are now resolved. The registered provider have acknowledged that the maintenance of the home needs improvement and the existing arrangements of a part-time maintenance worker are insufficient to address the many areas that need improvement in the home environment. There are plans to develop one ground floor room into a sensory room. Care Homes for Adults (18-65 years) Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well trained and they have more opportunity to meet with a line manager to discuss their work and performance. Shift planning has improved and this ensures that sufficient staff on duty to meet the needs of the current residents. Evidence: During the last inspection we issued a requirement for the home to ensure that a sufficient number of staff on duty to meet the needs of the residents. They are now five staff on duty during the morning, there are four staff on duty during the afternoon and two staff on duty at night. Shift planning is used to ensure that residents requiring additional one-to-one time get it. There is an administrator and a cleaner. There are plans to replace the current arrangements for cooking and maintenance. Care staff will be preparing the meals and a central maintenance team will cover home maintenance. There is progress in developing a qualified staff team. The acting manager said that over 75 per cent of the care team have a vocational qualification in care. There has also been training in some of the specific health needs of the current residents. Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: The acting manager has organised individual staff records so that she is better able to maintain a matrix of staff training required for each year. Training is provided by the registered provider as part of a rolling programme. Examination of the recruitment records relating to a new member of staff provide evidence of satisfactory recruitment checks before staff are allowed to work in the home. Each new member of staff is inducted in the home to familiarise themselves with the home and the procedures and there is also mandatory training. Staff are supervised by their line manager. The frequency of supervision was a low last year and a requirement was issued. The acting manager has developed a supervision make checks to ensure that meetings are conducted with the required frequency. A record is kept of each meeting. Staff appraisal meetings take place annually. Many of the staff have worked in the home for a number of years and now the residents well. Care Homes for Adults (18-65 years) Page 25 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Interim management arrangements are in place and they are adequate. There is some improvement in the way that the home is organised and the registered provider is working to improve. More must be done to assess the quality of the service provided and this will better inform future improvements to the service. Evidence: The registered manager is experienced and qualified but he is on a period of extended leave at this time. Interim management arrangements have been in place for almost a year. The area manager is based in the home a few days each week and one of the care coordinators is acting up as a manager. The registered provider sends a representative to inspect the service once in each month in accordance with regulation 26. A report of the findings of these inspections is available in the home. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: Overall management of the home has improved since the last inspection. Recordkeeping has improved. The home manager is notifying the relevant authorities if any incidents are allegations occur. There is an annual fire risk assessment in place and there is an environmental risk assessment in place, as required in the previous inspection report. The third floor of the home is no longer in use as a result of the environmental risk assessment. Managers must do more to ensure the safety of the building. Badly worn carpets and exposed wiring present current risks that should have been picked up before this inspection. During the last inspection a requirement was issued as there was evidence that mobility aids such as wheelchairs were not being checked for faults of an enough. There is now an individual record of the checks made on each wheel chair in use and staff are advised to check all aids before using them. Recorded checks are conducted each week. This makes it safer for residents and staff. There is insufficient working regard to quality assurance. There is no quality assurance plan in place. A requirement made in this regard is not met. Care Homes for Adults (18-65 years) Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 1 5 The Registered Person must ensure that the service user guide is reviewed and amended so that it includes all of the information required by Regulation and the National Minimum Standards. The timescale of 01/09/07 for meeting this previous requirement is not met. A copy of the revised guide must be supplied to the Commission by 28/09/2009 2 6 12(4)(b) The Registered Person must ensure that the care plans include details of the residents cultural needs and how they will be addressed by the home. The timescale of 01/04/07 for meeting this previous requirement is not met. 28/09/2009 3 30 16 The registered person must 28/08/2009 ensure that all parts of the home are free from offensive odours. Care Homes for Adults (18-65 years) Page 28 of 33 4 39 24 (1) The registered person must 28/10/2009 establish and maintain a system for reviewing and improving the quality of care. Care Homes for Adults (18-65 years) Page 29 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 1 4 The statement of purpose must be reviewed and additional information about how complaints will be handled, bedroom sizes and arrangements and restrictions in regards to visitors must be added. To ensure adequate information is available. 28/10/2009 2 20 13 Controlled drug storage must be provided. Care homes are required to have correct storage available. 30/09/2009 3 20 17 Staff must keep a record of 31/07/2009 when prescribed medications are administered Staff are not currently recording the administration of each administration of topical creams and food supplements 4 23 23 The registered person must ensure that electrical wiring 17/07/2009 Care Homes for Adults (18-65 years) Page 30 of 33 is safe throughout the building and exposed wiring hanging from the walls is removed and made safe. To ensure safety. 5 23 23 Stained and damaged floor coverings must be repaired, replaced or cleaned To prevent trip hazards. To prevent bad odour and to improve the environment. 11/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 16 Prospective residents should be informed of the outcome of the pre-admission assessment. Residents should be offered a keys to the front door and to their bedroom door during the process of admission to the home. If a key is not issued a record should be kept of why. Residents visitors should have access subject to individual and collective consent. Residents should be consulted, both individually and as a group, about rules relating to visitors. Staff should conduct an assessment of the risks relating to storing prescribed creams and other topical medications in residents bedrooms. Staff shpuld maintain regular checks on these items to ensure they are replaced regularly. Quantities of medicines should be carried forward from one month to the next on medication administration records to better enable justified stock checking. This is aprticularly useful for medicines that are only used as required. Staff should make arrangements for residents to take their medication with them when they go out for the day, or if this cannot be done for the timing of the administration to be altered so that prescribed doses are not missed. When medications are handwritten onto medication administration records there should be a more robust 3 16 4 20 5 20 6 20 7 20 Care Homes for Adults (18-65 years) Page 31 of 33 accuracy check. This is usually done by a second member of staff examining the record and signing as well. 8 9 23 23 The registered provider should develop a schedule of works and a programme of refurbishment for the home. The advice of an occupational therapist should be sought in regard to planned refurbishment and lighting. Care Homes for Adults (18-65 years) Page 32 of 33 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. 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