Inspection on 27/05/09 for Gracelands

This inspection was carried out on 27th 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gracelands 25/08/09

Gracelands 17/10/07

Gracelands 30/04/07

Gracelands 16/11/06

Gracelands 21/02/06

Gracelands 16/08/05

Gracelands 07/02/05

Gracelands 20/08/04

Gracelands 25/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Gracelands Ellesmere Road Whittington Oswestry Shropshire SY11 4DJ The quality rating for this care home is: zero star poor 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: Sue Woods Date: 2 7 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 31 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 31 Information about the care home Name of care home: Address: Gracelands Ellesmere Road Whittington Oswestry Shropshire SY11 4DJ 01691652153 01691652153 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Loppington House Ltd The registered provider is responsible for running the service care home 7 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 7 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 7 The maximum number of service users who can be accommodated is: 7 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 31 A bit about the care home Gracelands is a large house that is shared by seven people. The home is situated in the village of Whittington which has its own shops and pubs as well as an historic castle. Everyone who lives at the home has his or her own bedroom. Nobody has to share a room. The home has three bathrooms, a kitchen that you can access with staff support as it has a lock on it, and a small patio at the back of the building where people sit and relax or play ball games. The home has two cars available to take people to the shops, to visit family or to access leisure and social activities. The manager and the staff team support people to make decisions about how they live their lives and there is an advocate who visits the home to make sure people are able to make choices and have a say in the running of the home. He is happy to support anyone who lives at the home. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 Care Homes for Adults (18-65 years) Page 6 of 31 How we did our inspection: This is what the inspector did when they were at the care home We visited Gracelands on 27th May 2009 and stayed there for seven and a half hours. The home did not know we were coming. During the time that we were there we looked at what it is like to live at the home. We did this by meeting and speaking with the people who live at Gracelands and talking with the manager, the deputy manager and staff on duty. As some people could not tell us their views of the home we also spent time watching how staff support people to live their lives. We looked in more detail at how the home meets the care and support needs of two people by meeting and observing the people chosen, talking about their care with staff and looking at their care files. This process helps us understand what it is like to live at Gracelands and whether those people receive a good service or not. We looked at staff files to see how the home makes sure that people working at Gracelands are safe and suitable to do so and we also looked at other records to see how the home is run. Before the visit the home sent us the Annual Quality Assurance Assessment (AQAA). The manager completed this. This is a form that tells us how the Care Homes for Adults (18-65 years) Page 7 of 31 manager thinks the home is meeting the needs of the people they support and also tells us other information relating to how the home is run. What the care home does well People who live at Gracelands are supported to make choices and this means that people have control over their lives. People are supported to be as independent as they are able meaning that they develop skills that will help them Care plans show that people attend regular health care appointments and a booklet has been produced for each person living at Gracelands that details their needs and preferences in relation to their health care should they have to go to hospital. The booklet enables health care professionals to know how people prefer their needs to be met and identifies any important information that will enable them to meet that persons needs safely while in their care. Care Homes for Adults (18-65 years) Page 8 of 31 What has got better from the last inspection What the care home could do better As a result of this inspection we found that the home needs to take action to keep people living at Gracelands safe and free from abuse. Staff are not appropriately trained to meet the needs of the people they support during times when their behaviours may cause harm to themselves or others and as a result people, including staff members, are getting hurt. Care Homes for Adults (18-65 years) Page 9 of 31 We found that guidelines in place to tell staff how to safely manage some behaviours did not reflect what staff were able to do meaning that people are getting hurt. There are not always enough staff on duty to meet peoples needs or support people to take part in activities outside of the home. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sue Woods 33 Greycoat Street London SW1P 2QF 02079792000 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. Care Homes for Adults (18-65 years) Page 10 of 31 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 11 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live at Gracelands were supported by appropriate assessments of their care and support needs to ensure as far as is possible their successful admission to the home. Evidence: The manager told us that there have been no new admissions to Gracelands since the time of our last visit when we found that one person had been successfully supported to move to Gracelands and people already living there had been fully consulted and involved in his move. The home Statement of Purpose and Service User Guide were both displayed in the hallway and copies of the Service User Guide were seen on care files reviewed. Both documents reflect current management arrangements and the manager plans to make information easier to read and more user friendly in the future. Care Homes for Adults (18-65 years) Page 13 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Personalised care plans promote independence and ensure that people receive care and support in a way that they prefer however some guidelines do not support staff to keep people safe and as a result everyone is vulnerable. Evidence: We looked at the care plans for two people living at Gracelands to see if they reflected peoples care and support needs. The plans were clearly written and promoted peoples independence in every day living tasks. The home works closely with an independent advocate who visits the home to support people to make decisions. The manager said that on the day after our inspection he was chairing a meeting for people living at Gracelands and there were to be no staff or management representatives present. This gives people the opportunity to independantly share their opinions and discuss issues that matter to them. The home has introduced ways to help people to be involved with the running of the home and to make choices. For example there is a pictorial rota on the wall in the Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: kitchen showing people when it is their turn to help with meal preparation and a large picture book containing all different types of food to help people decide what they would like to eat. There are plans in place to support people when they are anxious or displaying behaviours that place themselves and others at risk of harm and for the majority of people living at the home staff said that they are effective however, one man is currently challenging the service and staff can not use the guidelines written down to help keep people safe. We found that the home ensures that daily activities are as safe as possible for people to enjoy. Risk assessments were seen in place for community and home based activities and they had been reviewed to ensure they were still appropriate by the deputy manager. Care Homes for Adults (18-65 years) Page 15 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Potentially people living at Gracelands can take part in a variety of identified leisure and social opportunities that they enjoy however the current situation within the home is stopping this from happening and impacting on peoples quality of life. People benefit from supported family contact and involvement meaning that they are able to stay close to the people that matter to them. Evidence: People living at Gracelands have opportunities to develop and practice independent living skills. We saw people attending to their laundry and assisting to prepare the evening meal, however opportunities to enjoy leisure and social activities outside of the home are currently limited due to staffing levels and the increased support needs of one of the people living at the home. This is now impacting on peoples quality of Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: life according to the staff team. On the day of our inspection people were in the lounge for most of the day although at the managers request one staff member organised a craft session and one person did some personal shopping when staffing levels increased in the afternoon. One person needs to be support by two staff when he goes out from the house and given current staffing levels (and his current behaviours) this is limiting his opportunities. See requirement standard 33. Care plans showed that one person enjoyed doing craft work while at home and some people attend a local business venture in Ellesmere where they enjoy art and craft work with people from the area with similar interests. Family support is encouraged and contact is recorded to show that people stay in touch with the people that matter to them. People enjoy varied and balanced meals and the menu is flexible to accommodate changes. For example on a nice day recently everyone enjoyed a BBQ rather that having the planned casserole. People are reminded and encouraged to eat five fruit and vegetables a day to keep them healthy and people take part in menu planning and meal preparation. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are generally safeguarded by the homes system for handling, storing and administering medication and planned changes to storage arrangements will offer better protection. The personal and health care needs of the people who live at Gracelands are generally well met enabling them to enjoy good health and receive support in a way that they prefer. The personal and health care needs of the people who live at Gracelands are generally well met enabling them to remain fit and well. Evidence: Care plans showed us that people attend regular health care appointments in order to keep them well and on the day we visited one person was seeing a psychologist at home. Health care needs are recorded to enable staff to know how peoples personal and health care needs are to be met. A booklet has been produced for people to take to hospital if treatment is required as an in patient. The book enables health care professionals to know how people prefer their needs to be met and identifies any important information that will enable them to meet that persons needs safely while in their care. These booklets were seen on all files reviewed. People choose what they Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: wear each day and one person told me that she like to put on her beads. Care plans are very detailed to enable staff to know how people prefer to have their personal care needs met and people are encouraged to be as self managing as possible. Key workers who spoke with us were knowledgeable of peoples care and support needs and are involved in reviewing plans enabling consistency and continuity of support. Arrangements in place for the recording and storage of medication were satisfactory with protocols in place to enable staff to be consistent when administering medications as and when required. The manager carries out regular audits of medication arrangements to ensure that systems are working and people are getting the medication prescribed when they need it. Staff do not administer medication unless they have been trained to do so in order to protect people from mistakes being made. People are safeguarded by these arrangements and effective monitoring means that any errors can be picked up quickly and actions can be taken to improve processes when required. The manager is currently waiting for safe storage for a named medication that, she has just been made aware, is a controlled drug. She has a book in use to identify how much of this medication is on the premises and was aware of the guidelines for storage facilities required, although the insert currently on order may not meet these requirements. The manager said she will make sure that the cabinet is suitable to keep this medication safely stored. A medication, identified in one persons care plan, to be taken as required was not recorded on the record provided by the chemist, suggesting it is not being currently prescribed for this use. When questioned staff said that they would not give this medication as it would not be effective at the time when needed. Arrangements need to be clear to ensure that no one living at the home receives medication that they should not. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People can be confident that processes are in place to ensure their views will be listened to meaning that they have a say in how they live their lives. However the current situation at the home is meaning that the majority of people are being intimidated by the actions of another person thus affecting everyones quality of life. People living at Gracelands are at risk of harm or abuse because not everyone who is employed to look after them is appropriately trained or confident to manage their challenging or unpredictable behaviours and care plans do not support staff to follow clear protocols that would protect them Evidence: People living at Gracelands have access to an independent advocate who will be speaking with them soon in a private meeting enabling them to have the opportunity to share their thoughts and feelings about the running of the home. The manager stated that she will share with him current concerns that people have about the situation within the home. Following our visit we referred six of the seven people living at Gracelands to the safeguarding adults team as we feel that they are experiencing verbal and physical abuse on a regular basis. The manager is aware of the safeguarding process and has used it in the past in relation to isolated incidents. She is seeking support from health and social care professionals in order to get help for one person living at the home and Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: is aware that until support and training is delivered people living at the home are vulnerable. (See requirement in outcome area 35). Staff told us that they think that the situation within the home is currently unsafe. The deputy manager said that the home is safe if guidance is followed to the letter (although we have found that not all information is appropriate). Staff have concerns about the guidelines in place in relation to physical intervention as they do not reflect current training and individual needs. Attempts to carry out such actions have caused staff to be injured. Staff were not confident with the current level of training and there has been a delay in some staff receiving any training at all despite the challenges they face to keep people safe. The home has received three complaints within the last twelve months. One was from a man who lives at the home. All were upheld and the home took action to make improvements as a result. The manager also showed us a compliment letter received from the family of two of the people living at Gracelands in relation to the way staff supported them to attend a family wedding. The home has a pictorial complaints procedure although no one has used it recently to show their dis satisfaction following incidents within the home suggesting they are not familiar with it. We looked at arrangements in place for protecting peoples money that is held by the home. The policy seen was very general and did not support the home to enable people to retain any independence over managing their finances. However they system has a number of safeguards built into it to ensure that all money is accounted for and people are active in going to the bank and collecting their cash (which is then kept in one large cash tin in the homes safe). The deputy manager was unsure as to weather the procedure covered the use of CHIP and PIN cards and said he would look into this to ensure peoples financial protection. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live at Gracelands are provided with a safe place to live however redecoration and refurbishment will make the house more homely and changing one of the bathrooms into a walk in shower room will offer people a choice of bathing facilities. Evidence: At the time of our visit we looked around the home to see if the environment was safe and well maintained. The home was clean and tidy although communal areas require redecoration to make Gracelands a nicer place to live. Bathrooms in particular were in need of refurbishment and the manager stated that plans have been approved for one of the bathrooms to be turned into a walk in shower. When asked how the home could be improved staff said that having a shower facility would give people a choice of bathing. It is recommended that this task be made a priority. Staff have received training in infection control and staff and people living at the home use disposable gloves and aprons for meal preparation to ensure that good standards of hygiene are maintained. Care Homes for Adults (18-65 years) Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at Gracelands are supported by a staff team who are focused on supporting them as and how they prefer however people cannot be sure that staff can keep them safe and as a result they are at risk of harm. Appropriate pre employment checks on staff who work at Gracelands ensure that the home only appoints people who are suitable to work with vulnerable people. Evidence: Staff told us that they feel well supported by the new manager and given the challenges they had had to face over the last twelve months this is very positive for the future development of the home. Opportunities for staff to get together and discuss the running of the home have improved and the deputy manager felt that having team meetings scheduled for the next twelve months will enable people to be flexible to attend. He also stated that his supervision plan, although not been very regular over the last 12 months, is now back on track and this is essential to support staff through the current difficulties. In relation to training, staff have received the majority of training required in order for them to carry out their roles safely and competently however we were concerned that Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: staff have either not been trained or have received ineffective training in relation to managing violence and aggression. Staff felt that the current one day training course did not give them the level of knowledge and practical support to enable them to safely meet the needs of one person currently living at the home. Accident and incident records show that named staff have been injured as a result. This lack of training also means that staff cannot effectively protect vulnerable people living at the home. The majority of staff have received Adult Protection training and those who have not are to do it in the near future. All staff who spoke with us were aware of the procedures for reporting and recording incidents of abuse and would be happy to raise concerns immediately. The staff files of two care staff who joined the team within the last twelve months were reviewed and found to contain the essential information required for the home to demonstrate that people are recruited safely to ensure the protection of vulnerable people. Records showed, and staff confirmed, that all required checks are carried out before people work within the home. Staffing levels on the day of the inspection reflected the rota although staff felt more staff available to offer one to one support would improve the service offered at Gracelands by improving peoples opportunities to do the things that they like to do. The manager reported that one to one support has been identified for one person. On two occasions in the last three weeks staff reported, and the Rota reflected, that only two staff were on duty and this level is considered unsafe. The manager was required to carry out a review of staffing levels and increase them accordingly dependant on the outcomes. She planned to discuss staffing levels with the responsible individual for the organisation when she met with her the following day. When we asked staff how the service could improve staff said they would like to see more staff on duty and perhaps more group outings as this would improve peoples quality of life. Two staff commented on long working hours as an area where they would like to see changes. People living at Gracelands said yes that they liked the staff and from observations of people sitting with the staff in the lounge, people were encouraged to join in conversations and staff responded promptly to requests. Care Homes for Adults (18-65 years) Page 24 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The acting manager of Gracelands is offering stability and support to a home that has experienced a number of challenges over the last twelve months that have potentially impacted on the quality of the service provided. The health and safety of people living at the home and the staff team is being compromised by the home not being able to safely protect people from the impact of the behaviours of one person and this is affecting peoples quality of life. Evidence: The acting manager for Gracelands is now going to apply to us to be the registered manager. This arrangement will offer much needed stability to the staff team and the manager is experienced in management and will ensure that the views of people living at Graceland are heard. She has support from a senior management team and the resources of a trainer in relation to managing challenging behaviours. The organisation currently uses paperwork that was developed to support services for older people. The manager and the deputy manager are using this paperwork selectively and continue to develop a person centred approach to care planning. A senior manager within the organisation is currently looking to redevelop paperwork in Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: line with current best practice for younger adults. The manager ensures that the environment is safe with regular safety checks carried out to monitor this. However at the time of our visit heath and safety of the people living at Gracelands and the staff team who support them is not being maintained and action needs to be taken to address this issue. Accident and incident forms show staff are regularly being injured by one person and without exception staff fear for the safety of everyone living at the home. The training is insufficient. Guidelines are inappropriate and peoples quality of life is being affected as a result. Following our inspection the manager arranged to increase staffing levels with immediate effect and contacted health and social care professionals to address the increased support needs of one person living at the home. She has also arranged additional training and support for staff. It is felt that these actions will make peoples lives better and safer. On 2nd June we spoke informally with the responsible individual for Gracelands who was knowledgeable of the strengths and needs of the service and felt confident that the organisation could support the home to make changes to improve outcomes for people living at the home. Care Homes for Adults (18-65 years) Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes  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 Care Homes for Adults (18-65 years) Page 27 of 31 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description 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 Description Timescale for action 1 6 12 People must be provided with 26/06/2009 the care, support and supervision they need in order to be kept safe and well. Care plans must contain necessary guidance for staff in order to do this. This is to keep people safe and well supported within their homes. 2 32 18 The home must ensure that 01/07/2009 staff have the skills and experience necessary for the tasks that they are expected to do. This is to ensure that they can carry out their roles safely and effectively 3 33 18 The home must ensure that 26/06/2009 there are sufficient staff on duty at all times to meet the care and support needs of Page 28 of 31 Care Homes for Adults (18-65 years) the people living at the home and maintain peoples safety. This is to ensure that peoples identified care and support needs can be met to enable them to live full, safe and active lives. 4 35 18 Staff must receive training to 01/07/2009 ensure that they can carry out their roles safely and effectively. This should include any specialist training, at an appropriate level, identified to meet the assessed needs of the people they are to support. This is to ensure that staff have the knowledge and skills needed in order to meet peoples assessed needs and to keep both themselves and the people they support safe. 5 42 13 01/07/2009 The manager must ensure safe-working practices within the home at all times. To include training and direction in all aspects of health and safety. This is to keep staff safe from harm or injury that could be avoided. 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 29 of 31 1 20 It is recommended that the home keeps a copy of each persons prescription with the administration records to evidence what medication is prescribed regularly and what is to be given as and when required. It is recommended that the homes policy and procedure in relation to managing peoples money be reviewed to reflect peoples involvement in the process and to cover the use of bank cards from cash machines. It is recommended that the organisation ensure that they provide Gracelands with policies, procedures and paperwork that reflects that people who live there are younger adults and not older people. 2 23 3 40 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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