Inspection on 15/01/09 for Granby Place

This inspection was carried out on 15th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Granby Place 17/01/08

Granby Place 24/07/07

Granby Place 20/07/06

Granby Place 08/11/05

Granby Place 16/07/05

Granby Place 08/11/04

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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: Granby Place 1-3 High Street Northfleet Gravesend Kent DA11 9EY     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: Helen Martin     Date: 1 5 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Granby Place 1-3 High Street Northfleet Gravesend Kent DA11 9EY 01474326233 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): DGSM Ltd Name of registered manager (if applicable) Mrs Rae Sayers Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 10 The registered person may provide the following category/ies 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 categories: Learning disability - LD Date of last inspection Brief description of the care home Granby Place provides care and accommodation for up to 10 people with learning disabilities. It is located in Northfleet High Street and is within easy reach of public transport. Residents have single bedrooms on the ground and first floor. There are sufficient communal areas for staff, residents and visitors. Currently the weekly fees charged are 626.62. Residents are additionally charged for Care Homes for Adults (18-65 years) Page 4 of 32 care home 10 Over 65 0 10 Brief description of the care home hairdressing, chiropody, personal spending, entry costs to some external amenities, cost of their holidays and the cost of holidays for accompanying carers. Full information about the fees and costs payable, the service provided and the homes Statement of Purpose are available from the Registered Manager. 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 peterchart Concerns, complaints and protection Environment Staffing Conduct and management of the home Poor Adequate Good Excellent How we did our inspection: Granby Place provides care and accommodation for up to ten people with a learning disability. Currently there are eight service users living there. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This Key Unannounced Inspection included a visit to the home in Northfleet on 13th January 2009, where the Registered Manager, one Senior Support Worker, one Support Worker and three Service Users were spoken with. Some judgements about the quality of the service provided were taken from observations and conversation. Some records and documents were looked at together with the premises and facilities of the home. Care Homes for Adults (18-65 years) Page 6 of 32 The last Key Inspection was undertaken on 17th January 2008. A completed Annual Quality Assurance Assessment, AQAA, was received from the home on 14th November 2008. Any other information received by the CSCI since the previous Key Inspection has been reviewed. All of the above have been included within this inspection process and some of the gathered evidence is mentioned in this report where appropriate. What the care home does well: What has improved since the last inspection? What they could do better: People who live in the home, especially those who cant see very well and who have problems moving around, would be safer if staff looked thoroughly at how to stop them getting hurt and if they had more equipment to help them. Some people need help getting up and down the stairs. There are buzzers that residents can press when they need staff in an emergency, but these are not in all the rooms they use. People would be better protected if all staff had up to date training. Not all staff have done training recently in how to help people move around or how to keep them safe. It would be easier to see checks made before new staff start work if they were all kept at the home. The way the manager makes sure that staff are happy and look after residents properly could be improved. The hours and duties of the manager should be looked at to make sure they have enough time to run the home. People might be safer if staff looked at the way they write things down. It would be easier to find out about the help that people need if care plans were clear and up to date. Not all of the things that older people need are written down. Not all of the ways that staff keep residents safe are written down. Not all notes made about how people are given their medication are exact and checked. Not all records about how staff are trained are up to date. Care Homes for Adults (18-65 years) Page 8 of 32 Some people might be better protected if their contract with the home were filled in, so that they could sign it. Residents might be safer if what they agree to pay for when they go on holiday is written down. 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 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. People are given written information about the home and assessed before they decide to move in. This is to make sure that the service provided can meet their needs. Service users are protected by a written contract with the organisation outlining the service they receive, although this could be improved by completing individuals details. Evidence: Granby Place supplies written information about the service they provide. This enables people who are thinking about moving in to the home to decide whether the service is suitable for them. Information is outlined in the Service User Guide and Statement of Purpose. Both contain information that is presented in a way that prospective residents would find easier to understand. Most residents have been living at the home for some years, the latest admission being nearly two years ago. No one has moved in since the last key inspection. The Registered manager said that people who are thinking about moving in would be Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: assessed beforehand to ensure that the home could meet their needs; information would be recorded and care plans for the help that people need would be developed from this. All residents have a contract with the home for the service they receive and these are kept in the office. These consist of a standard format with blank spaces left to be filled in with details specific to the individual person. Some contracts seen were appropriately completed, although two were not. One was not filled in or signed and the other did not detail the room to be occupied. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported to make choices and decisions about their lives. Their needs are reflected in care plans, although this would be improved by a review to ensure increased clarity with all changes being detailed and up to date. Service users would be better protected if all risks associated with their activities were thoroughly assessed and recorded. Evidence: Each person who lives in Granby Place has a written care plan that aims to give staff the information they need to in order to meet their individual needs. These are based on assessments undertaken by the home before people move in. Examples of care plans were seen, which contained information about the person concerned and how they were to be supported. This is holistic and includes details about health and social care, activities, relationships, cultural and spiritual issues, finances, personal goals and Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: achievements. Staff write notes on a daily basis in bound books, specific to each resident. Care plans contain large amounts of detailed information regarding the needs of residents. Although some is recent, some is out of date and not all records are filed consecutively. Notes made on a daily basis are recorded in a bound book, although one had come apart and some pages were out of order; the Registered manager said that this would be sorted out. Details of GP visits used to be recorded in care plans, then in daily notes and are now kept with medication administration records. As a result of the above, information is not always clear or easy to follow. Not all the needs of older people are always recorded in detail. Although some reviews of peoples care had been undertaken by Social Services, in two care plans seen, there was no record found of any reviews undertaken by the home. Residents are supported to make their own individual decisions and choices. They are encouraged to live as independent lifestyle as is possible. Residents are involved in decisions about the running of the home and have regular meetings. They are involved in cooking and menu planning. The home aims to support residents in taking risks as part of maximising their independence, whilst at the same time keeping them as safe as possible. This is done by making an assessment and recording the findings; examples seen included travel to a day centre, uneven surfaces, using the kitchen and going on a day trip and holiday. Records are kept in peoples care plans, although not all risks assessed have been written down. In particular, one resident has no detailed recorded risk assessment about mobility problems and poor eyesight, specifically including tripping over objects, mobility aids, use of the bath hoist, staff emergency call equipment or falls. Because this is not written down comprehensively, it is difficult for the home to show how these significant risks have been reduced or avoided. 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. Service users enjoy individual lifestyles and are supported to choose from different opportunities for leisure and personal development. They are able to maintain relationships with their family and friends if they wish. Service users enjoy a choice of meals. Evidence: Residents are treated as individuals who have different interests and aspirations. Activities and development opportunities are provided accordingly. Residents enjoy a lifestyle with a variety of options to choose from. Routines of the home aim to be flexible to accommodate this. Residents participate in the local community. They enjoy attending various day centres, taking part in social events and activities that Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: personally interest them or to further develop their life skills. Activities include art and craft, woodwork, cooking, shopping, & healthy eating; residents go for day trips, to the theatre and to the leisure centre, including bowling and a Jacuzzi. One resident particularly enjoys visits to steam trains. Residents are able to relax in their home watching television or DVDs, cooking or playing games. One resident has enjoyed regular employment for some years and travels independently using public transport. People have the opportunity to go on holiday if they want to, either individually, with other residents in the home or with a day centre. Residents are able to see their family and friends as often as they wish, either by visiting them or receiving them in their home; there is a separate visitors room if they wish to use it. Most people have actively supportive families and are able to maintain friendships outside of the home. Residents are supported towards independent living skills. They are encouraged and supported with domestic tasks wherever possible such as shopping and cooking. Laundry and kitchen facilities are domestic in nature. People can choose what they want to eat and are supported in cooking tasks and menu planning. The Senior Support Worker demonstrated a good understanding of individual residents food choices and preferences and indicated that special diets can be catered for if necessary. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from support which aims to meet their individual needs and wishes. Service users are protected by the systems in place for the administration of medication, although this would be enhanced by improvements to record keeping. Evidence: Residents are given the personal support they need to maximise their independence, while respecting their dignity and privacy. The staff demonstrated a good understanding of the preferred routines of each individual. Staff demonstrated a good understanding of residents health and social care needs. Care plans contain information regarding this. Residents have access to social and health care professionals, such as GP, chiropody, optician and any more specialist appointments. Residents weight is monitored and their nutrition assessed. The Registered Manager said that they were in the process of arranging an assessment from an Occupational Therapist regarding any equipment or adaptations needed for individuals and the premises generally. The risks involved in the care of one individual have been Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: mentioned previously under the Individual Needs and Choices section of this report. Arrangements are in place for the storage and administration of medication by staff. An easily monitored dosage system is used. Currently the home does not administer any controlled drugs or medication that needs refrigeration. Medication records seen were generally completed appropriately, with the exception of handwritten entries. These were not signed as double checked by two members of staff. Three entries for drugs required on an if and when basis, whilst indicating the number of tablets taken, did not detail the specific dosage; one did not show the time given. The Registered Manager stated that they would request pre-printed administration records from the pharmacy. The Registered Manager stated that all staff had received medication training and this is discussed under the Staffing section of this report. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users views and concerns are listened to. Systems are in place to protect them from potential abuse, although this may be improved by recording holiday cost agreements. Evidence: Residents are at ease and confident talking with the Registered Manager and staff who listen to their views and concerns. The home has a written complaints procedure. There have been no complaints regarding the care provided to residents since the last inspection; although there is the facility to record these should this be the case. Written policies regarding the protection of vulnerable adults are available, which provide guidelines for staff. The Registered Manager demonstrated a good understanding of these and stated that all staff had received training in the protection of vulnerable adults. The home has a system in place, which aims to protect the financial interests of residents. Small amounts of cash are held on their behalf, which is kept securely. All money is stored individually with transaction records and receipts. Cash checked tallied with accounts seen. Staff make regular checks and the organisation audits the system. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: The Senior Support Worker said that when residents go on holiday, they are happy to pay for their accommodation, travel and staff costs. There was nothing seen in writing confirming this from residents, their representatives or their care manager. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from living in a homely and comfortable environment with sufficient communal rooms and areas. They enjoy choosing the style and arrangement of their own rooms together with their personal belongings. The environment is generally suitable for current service users, although those with poor mobility and eyesight are put at some risk. They would be better protected by a professional review and the provision of the adaptations and specialist equipment that they need. Evidence: The building fits in with the local community and has a style and atmosphere that is broadly suitable for residents. They benefit from living in homely and comfortable accommodation. The premises are clean and hygienic, although the Registered Manager assured the inspector that the downstairs corridor carpet would be cleaned soon. Adequate recreational, dining, toilet, bathing and individual accommodation are Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: available for residents. The home provides a through lounge.dining room, second television lounge, conservatory and visitors room. There are gardens to the front and rear with a car park secured by a gate. Residents clearly like their rooms, which are individual and highly personalised. They are able to choose colour schemes and how their furniture should be arranged. Bedrooms generally meet peoples needs and are well furnished. There are some adaptations and equipment to assist older residents. One bathroom has a manual hoist for those who need assistance to get into and out of the bath. There are handrails in the front garden. Only one bedroom is available on the ground floor. Residents who can negotiate the stairs without assistance are able to go anywhere around the house. A significant number of residents have lived at Granby Place for some years and currently six are over the age of sixty five. The Registered Manager said that a passenger lift is needed to assist less mobile older residents and, although one person has moved to the ground floor bedroom, others in their sixties and seventies are accommodated upstairs. The Registered Manager explained that although the premises have been assessed as suitable and the organisation is supportive, they continued to wait for installation work to begin. Last years Key Inspection report in January 2008 noted, as residents age, there is a more urgent need for them to have the assistance of a lift to the first floor. There is an emergency staff call system throughout the home with the exception of the television lounge, the downstairs bedroom and downstairs bathroom. This is especially significant as these facilities are used by older resident with limited mobility and eyesight, who can be prone to falls. The Senior Support Worker stated that they did not need any mobility aids. The Registered Manager said that they were in the process of arranging an assessment from an Occupational Therapist regarding any adaptations or specialist equipment needed for individuals and the premises generally. The risks involved in the care of one individual have been mentioned previously under the Individual Needs and Choices section of this report. Care Homes for Adults (18-65 years) Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are protected by appropriately recruited staff, although this could be better reflected in records. They benefit from well supported staff, although this could be improved by formal staff supervision. There are systems in place for staff training which aim to meet the needs of service users, although this would be improved by the provision of up to date training for all staff and more thorough record keeping. Evidence: There were enough staff on duty to meet the needs of residents at the time of this visit. There are usually between two and three members of staff during the day, although this is flexible depending on the needs of residents. Presently one member of staff is awake at night in the home. The Registered Manager said that they were currently reviewing this together with the increasing needs of older residents to make sure there are enough staff at night. Staff support residents with cooking, cleaning and laundry tasks wherever possible. There are on-call systems and procedures in place for potential emergencies. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: Procedures are in place that aim to recruit suitable staff who can support the needs of residents. Many staff have been working at the home for some years. Residents are protected by appropriate pre employment checks. Staff files seen confirmed this, with the exception of photographic identification. The Registered Manager explained that this was kept at the Head Office of the organisation. The Registered Manager said that all newer staff had completed their induction training. There is a programme of ongoing training which aims to ensure that staff can meet the needs of residents. Examples of courses undertaken include first aid, food hygiene, health and safety, medication, fire, infection control, mental health, risk assessment, Dementia and Diabetes. Records and certificates seen generally confirm staff training, although two induction records seen were incomplete. There are a few gaps in records and whilst they show some courses as recent, others are not, including most entries for moving and handling and the protection of vulnerable adults in 2006. The Registered Manager said that all staff have obtained a National Vocational Qualification either at level 2 or 3, with the exception of two, one of which has an equivalent health and social care qualification. The Registered manager explained that the majority of Support Workers are trained in learning disabilities and they are in the process of arranging this for newer staff. The Registered manager said they together with members of staff regularly discuss any issues regarding the care and needs of residents. One member of staff spoken with confirmed that the Registered Manager is both approachable and supportive. Comprehensive meetings take place when one staff shift hands over to another. Although staff supervision takes place informally, records show that regular one to one sessions have not taken place recently. The manager assured the inspector that this would be re introduced shortly. Care Homes for Adults (18-65 years) Page 24 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. The quality of life of service users is enhanced as their views are sought about the way the home is run. Their welfare is safeguarded by the implementation of the homes policies and procedures. Service users benefit from a qualified and experienced Registered Manager, although this may be enhanced by a review to ensure they have sufficient time for the management and administration of the home. Service users health and safety is protected, although continued vigilance is needed to safeguard people with poor mobility and eyesight against avoidable trip hazards. Evidence: The Registered manager has been in post for some years and has obtained the Registered Managers Award. Currently the Registered Manager works a staffing rota, Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: which includes two days with the direct care of residents; this leaves three days a week for the management and administration of the home. The home has a quality assurance system, which aims to ensure that the home is run in the best interests of residents. This includes regular audits and visits by a person appointed by the organisation. Records seen confirmed this and included a written response by the Registered Manager as to how any issues raised were addressed. In addition annual questionnaires are used by residents, their representatives and staff. Results are collated by the organisation, sent to the home and any problems identified addressed. Written policies and procedures for the home are available, which aim to give staff the guidance they need in order to safeguard residents. The Registered manager explained that the organisation were currently in the process of reviewing and updating these. Examples seen included food safety, medication, adult protection and complaints. Accidents and incidents are recorded appropriately, the last seen being in 2008. Records showed that two incidents involved a resident with poor mobility and eyesight, tripping over objects left out in the hall. The Registered manager assured the inspector that this was addressed with staff at the time and had not reoccurred since. Records and certificates seen generally indicated the regular testing and maintenance of systems and equipment within the home. Fire prevention equipment was seen and records indicated regular testing. The Senior Support Worker assured the inspector that more detail would be recorded in future regarding fire drills and call points tested. Residents are protected by regular health and safety checks; risks regarding the environment and potentially dangerous substances have been assessed and recorded. A number of records have been looked at as part of this inspection. These have been mentioned throughout this report where appropriate. Care Homes for Adults (18-65 years) Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and as far as possible eliminated. 1. All risks to all service users must be recognised and assessed with action taken to reduce these as much as possible. 2. This must include risks specific to older service users, such as poor mobility, poor eyesight, mobility and eyesight aids, use of disability equipment, availability of staff call system, tripping over objects and falls. 30/06/2009 2 29 23 The registered person shall 31/10/2009 having regard to the number and needs of service users, ensure that suitable adaptations are made, and such support, equipment Care Homes for Adults (18-65 years) Page 28 of 32 and facilities, including passenger lifts, as may be required are provided, for service users who are old, infirm or physically disabled. 1. A suitable professional must assess individual service users and the general premises regarding any adaptations and equipment needed. 2. Service users with poor mobility and or eyesight must be provided with the adaptations and equipment they need. 3. All service users prone to falls must have access to the staff call system; this must be provided in all areas of the home they use. 4. Service users unable to negotiate the stairs without difficulty must be provided with suitable equipment to assist them. 3 35 18 The registered person shall, 31/07/2009 having regard to the number and needs of service users, ensure that persons employed to work at the care home receive training appropriate to the work they are to perform, including structured induction training. All staff training courses must be updated when Care Homes for Adults (18-65 years) Page 29 of 32 appropriate, including those for manual handling and the protection of vulnerable adults. 4 42 13 The registered person shall ensure that, all parts of the home to which service users have access are so far as reasonably practicable, free from avoidable risks and unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. The registered manager must complete their stated intention to ensure that no objects are left in a position that would cause service users with poor mobility and eyesight to trip over them. 08/04/2009 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 5 It is recommended that a review should be undertaken to ensure that contracts between all service users and DGSM have been filled in and signed. It is strongly recommended that, with regard to care plans: 1. Information in care plans should be organised, easily followed and clear 2. Regular reviews undertaken by the home should be recorded 3. All information in care plans should be up to date 4. All of the needs of older people should be recorded in detail 2 6 Care Homes for Adults (18-65 years) Page 30 of 32 3 4 9 20 It is strongly recommended that all assessed risks for service users activities should be recorded. It is strongly recommended that, with regard to medication administration records: 1. The Registered Manager should complete their stated intention to obtain pre printed administration records from the supplying pharmacy 2. All handwritten entries should be signed as double checked by two members of trained staff 3. All entries for PRN medication should show the precise details of dosage and administration time 5 23 It is recommended that service users agreement to pay for accommodation, travel and staff costs when on holiday, should be confirmed in writing, signed by the service user and.or their representative and care manager. It is strongly recommended that evidence of photographic identification used in staff pre employment checks, should be kept in the home. It is recommended that staff training records, including those for induction, should be kept up to date. It is strongly recommended that the registered manager complete their stated intention to re introduce regular, formal, recorded, one to one staff supervision. It is recommended that the registered managers work pattern should be reviewed, to ensure there is sufficient time allowed for the management and administration of the home. 6 34 7 8 35 36 9 37 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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