Inspection on 26/01/10 for Grovelands Farmhouse

This inspection was carried out on 26th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Grovelands Farmhouse 07/03/08

Grovelands Farmhouse 25/07/06

Grovelands Farmhouse 24/11/05

Grovelands Farmhouse 16/06/05

Grovelands Farmhouse 22/09/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Grovelands Farmhouse Grovelands Tandridge Hill Lane Godstone Surrey RH9 8DD     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ruth Burnham     Date: 2 6 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Grovelands Farmhouse Grovelands Tandridge Hill Lane Godstone Surrey RH9 8DD 01883744128 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): grovelands@consensussupport.com www.caringhomes.org THF Care Estates Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category of service only: Care home only: to service users of the following category: Either whose primary care needs on admission to the home are within the following category: Learning disability - LD Date of last inspection Brief description of the care home Grovelands Farmhouse is a care home providing personal care and accommodation for eight adults with learning disabilities between the ages of 18 and 65 years. The home provides for service users with complex needs, particularly those of a psychological nature. The home is owned by THF Care Estates Limited. The company operates other care homes, in Sussex and Surrey. The company also owns a working farm next door to the home. A range of daytime services for people with learning disabilities operate from the farm and service users living at the farmhouse attend for individually planned Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 8 Brief description of the care home sessions. The farmhouse is in a remote country location, accessible via a single-track road. There is no public transport route nearby so visitors to the home use their own private car or taxi service. The home is situated close to the junction of the M23 and M25 motorways. The towns of Oxted and Godstone are easily accessible by car, and the home has its own minibus. The scale of charges range from 1190.00 to 1610.00 pounds per week Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced site visit, which forms part of the homes key inspection was undertaken on 26 January 2010. We were in the home for eight hours from 08:00 to 15:30. There are 8 people currently living in the service. Two people have recently moved into a newly refurbished, separate annex known as Primrose Bank which is divided into 2 apartments, the remaining six people live in the main house. We spoke with 2 people who live there and observed and spoke to the other residents during the day. We also spoke to 2 members of staff, the registered manager and the person in charge of the annex. We looked at most areas of the premises. We examined a number of records including staff employment records, daily records, incident records, risk assessments, medication records, reviews and care plans in both premises. Before the visit we sent surveys to people who live in the home; their advocates; Care Homes for Adults (18-65 years) Page 6 of 35 members of staff; health professionals and care managers. Ten surveys were returned: 4 from people who live in the home, all of which were completed by staff on their behalf, 4 from members of staff, and 2 from relatives, one relative telephoned us before our visit to tell us how delighted she was with the service her son has received since moving into the annex. Responses were largely positive. The last inspection took place on 7 March 2008. We found requirements made following that inspection have been largely met. There are 16 required actions at the end of this report. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: The Statement of purpose must be accurate to ensure people who are considering moving into the home have access to up to date and accurate information about the service. The manager of the service must have access to full assessment information to ensure care plans take account of all this information and provide staff with appropriate guidance to fully understand how to meet peoples needs. Care plans must contain sufficient, up to date information to ensure people who live this home can be confident their individual needs are fully understood and will be met. Regular reviews must be carried out in consultation with the individual and other relevant parties. Risk management systems must ensure peoples opportunity for personal development is not restricted and they are not exposed to risk of harm. Peoples religious needs and choices must be catered for. The approach taken to providing care and support must not limit peoples opportunity to excercise choice. Improvements to monitoring people health are needed to ensure all their health care needs are met. Accurate records must be kept of all medication administered in the home, clear guidelines should be available for staff to follow when administering medication to be given as required. The Complaints procedure must be updated and provided in a suitable format to all residents to ensure they know who to talk to if they are unhappy. Robust recruitment procedures must be followed and all the required checks must be carried out before staff begin working in the home to safeguard people who live there. Care Homes for Adults (18-65 years) Page 8 of 35 Some improvement to the environment is needed to enhance the quality of life and promote the safety and wellbeing of the people who live in the main house. Staff must be trained in safe working practices and the specialist needs of people who live in the home. Management roles and responsibilities must be clear to all and operate in line with information provided in the homes statement of purpose. Effective quality assurance systems must be in place to ensure the health, safety and well being of people who live in the home is promoted and the home is run in their best interests taking account of their needs, choices and expectations. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 35 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 35 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. People who are considering moving into the home may not have access to up to date and accurate information about the service. Lack of access to full assessment information may compromise the ability of staff to fully understand and meet peoples needs. Evidence: People who are considering moving into the home may not receive accurate information, particularly in relation to the management arrangements currently in place for the recently added annex. This part of the premises consists of 2 apartments which have recently been refurbished to provide accommodation to 2 people. The annex is known by all as Primrose Bank and is managed separately to the main house. There was no statement of purpose to be found in either premises. A statement of purpose that was submitted to the Commission before the annex was opened contains inaccurate information about the management of this part of the home which is misleading for people who live there and their representatives. The service user guide available in the annex did not contain any information about the manager of the service. One relative who responded to our survey said, My son has Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: only been living at Primrose Bank since August 2009. He has settled in well and seems very happy. This is very much down to the staff involved and the manager whos skills and care are of a highly satisfactory and efficient standard, long may it continue. In this instance the relative was referring to the senior team leader as the manager. Two people moved into the annex in 2009. Some documentation relating to the assessment process was available. One relative told us how happy they are with the care and support now being provided and how happy their relative is since moving into the annex. The statement of purpose states that it is the responsibility of the registered manager to ensure there are adequate staff and resources within the home to meet the assessed needs. In reality the registered manager has had no involvement whatsoever in the assessment process. One person moved in in August 2009, the other in November 2009. Documents seen show that assessments were carried out by a member of staff who carries out pre admission assessments on behalf of the company. Assessment documents seen for one person show that the process included a visit to the hospital, a brief observation in the hospital setting, discussion with hospital staff and the psychiatric consultant. Documents show that assessment reports were requested for speech and language, risk assessments, support plans, behavioural reports, medical history, incident reports, Psychiatric reports and Psychology reports. None of these reports were available in the home. The person in charge said she had not seen these reports. Assessment documentation seen indicates that the pre admission process was thorough however limited information was available in the home or to the person in charge of the annex to demonstrate that care planning has been based on professional assessment and takes account of all the persons needs. People who live in the main house have all lived there for a number of years, there have been no new admissions to the main house since our last visit. Care Homes for Adults (18-65 years) Page 12 of 35 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. People who live in this home cannot be confident their individual needs are fully understood and met. A reactive approach to risk management in the home restricts peoples opportunity for personal development in some instances and, in others, exposes them to risk of harm. Evidence: Relatives who responded to our survey were very satisfied with the service, although they were clearly confused about management arrangements in the annex. One relative told us. The service provided has been excellent. I cannot thank the manager enough for all she has done to make sure he as the right carers to understand his needs. She has been so helpful and gone to great lengths to ensure that he is health and very happy with the people who look after him. There is nothing they could do better because they work so very hard and I am sure they Will continue to do so in the future. People who live in this home cannot be confident their individual needs are fully Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: understood and met. We looked at 4 care plans in detail. We joined residents in the main house at breakfast. We also talked to one resident in private. Much of the information contained in the care records seen had not been signed or dated. Each person has a section in their file which contains some person centred information about their likes and dislikes and how they prefer to live their lives. This information has been written in the first person although the majority of residents would not have been able to communicate much of the information recorded themselves. It was of concern that some of the entries were inappropriate and demeaning. People who have recently moved into the annex may not have all their needs met where information obtained during the admission process is not available to the person in charge or staff. Support plans are task focused rather than person centred and most have not been signed by anyone, either the member of staff who recorded them or any representative of the person concerned. The homes statement of purpose says the registered manager will be responsible for developing and agreeing the individual plan with the service users, A copy of the plan will be given to the service user in a format they can understand. It will be reviewed every six months. These statements were not found to be accurate during our visit. The quality of the information contained in personal files varied. The manager told us that key workers complete the care plan and records for people in the main house and she has had no involvement in care planning for people in the annex. Some of the information seen had not been reviewed since 2008. Only 3 members of staff had signed to say they had seen one persons care plan. Some of the records seen show a lack of understanding about individual needs in areas such as sexuality, culture and religion. There is insufficient detail or guidance in care and support plans or risk assessments to ensure staff understand how to support people appropriately. The lack of regular review could mean that information is out of date. Examples of these shortfalls were seen in support plans. Support plan sections contain a number of documents. These are each divided into aim, steps to achieve, and expected outcome. All the support plans seen in the main house were dated 2008. Some have been reviewed but little change or achievement of aims has been recorded. In one persons file, one support plan relating to speech and communication states the aim as, Has no speech, few words, makaton used. Steps to achieve states, Has full support to communicate from staff. However there is no guidance to tell staff how to do this. It was of further concern that the manager told us that this person does not use makaton as far as she knew although he uses some sign language. Staff have not received training in signing although the expected outcome is to make the person more confident with his communication skills. Five review dates have been recorded between 8/12/08 and 8/11/09, all say no change. There is no support plan Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: for this person re dressing, which the person needs support with, or for any emotional, social or psychological needs. A reactive approach to risk management in the home restricts peoples opportunity for personal development in some instances and, in others, exposes them to risk of harm. A number of blanket policies operate in the home. Examples of the former were seen in restricting access to food, toothpaste, money, or the kitchen during preparation of meals. In the latter, communal towels are used, exposing people to risk of infection because toilets have previously been blocked with paper towels. There are no individual risk assessments in relation to these issues. Each person has a number of individual risk assessments on their files. Those seen were largely generic covering topics such as, monies, cooking, showering, trips out, bathing, public and shopping, hot drinks, medication, bonfires, building and coshh, intimidation, aggression and violence. In one persons file seen the risk assessments were all drawn up on 27/10/08, they had not been signed by anyone and there was no evidence of review. Another persons file had been reviewed however the manager agreed this person would be capable of holding small amounts of money but is not given the opportunity to do so. Staff hold it and hand it to her to pay for things. The risk assessment leaves no room for development in this area. Care Homes for Adults (18-65 years) Page 15 of 35 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. People who live at the home enjoy opportunities to take part in a range of activities. People are supported to maintain contact with family and friends. Peoples religious needs are not being catered for. A paternalistic approach to providing care and support is limiting peoples opportunity to excercise choice and for personal development. Evidence: People who live at Grovelands have access to a range of activities. People who live in the main house work at the adjoining farm as well as attending adult education classes. In addition they undertake a range of leisure activities including trampoline, swimming, shopping trips and annual holidays. The main house has its own transport for the benefit of people who use the service. On the day of our visit four people in the main house were going to work at the farm, one person was going to college and another was going shopping. The two people who live in the annex each have their Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: own transport, they are always accompanied by two members of staff when they go out. On the day of our visit one person was going to the airport to watch the planes which he enjoys. Daily records in the main house had all been archived and were not available to show that activities are consistently provided. Interests have been listed in the care plans however records seen do not show evidence of regular review to ensure these continue to reflect peoples individual needs and wishes. Peoples spiritual needs are not being met in the home. In one persons file we saw in both personal information and their personal goals document dated 6/5/09 that the person had said they would like to start going to church. The registered manager was totally unaware of this aspiration and no arrangements have been made to enable the person to achieve this goal. Observation of interaction with people who live in the home demonstrated a paternalistic approach to providing care and support. Staff are kind, caring and friendly but there is limited opportunity for choice. Examples of this were seen at breakfast time where everyone was given porridge followed by toast, no other choice was offered. The registered manager told us that a choice of cereal was offered in the summer but she liked to make sure they all had something warm in the winter. We noticed that there was no toothpaste in the majority of bedrooms. The manager explained that toothpaste for most people is kept in a cupboard in the home and staff keep control of it. There were no individual risk assessments to support this policy and the manager agreed that this practice was not necessary for all the people to whom the policy is applied. We also noticed that people had to wait for a cup of tea until 5 pm when everyone was gathered in the lounge. The manager told us this was because she likes them all to have a bath before they sit down in the lounge for a drink. A member of staff also told us life for people who live in the main house was regimented. Records seen and discussions with people who use the service and the manager show that relationships with families and friends are valued by the Home and communication is good. A range of nutritious food is provided which people help shop for. There is a menu plan in the kitchen, however this is clearly for the benefit of staff and is not provided in an accessible format for residents. There are no residents meetings and no evidence that people who live in the home are involved in choosing food or preparing meals. The dining room is very small and difficult for people to move around freely without disturbing others while they are eating. it is unfortunate that the kitchen only has a Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: range style cooker rather than an ordinary domestic cooker. Some of the residents attend cookery classes but would be unable to practice the skills they are learning safely at home with any degree of independence using the facilities available. Care Homes for Adults (18-65 years) Page 18 of 35 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. People are supported with their personal care in private in a way that promotes their privacy and dignity. Some improvement is needed to monitor peoples health effectively to ensure all their health care needs are met. Improvement is also needed in the administration of medication to ensure people who live in the home are protected from harm. Evidence: People are supported with their personal care in private in a way that promotes their privacy and dignity. Staff were seen interacting and supporting people who use the service in a generally respectful and sensitive manner. Information is available in the home to show that most peoples health needs are met. Three of the four files seen contained health action plans. There was evidence of consultation for some people with GPs and other health professionals. it was of some concern however that one persons health action plan was missing from his personal file. The manager said the keyworker must have it with them for review. Monthly evaluations have not been done. The last entry on the health monitoring form where health professional involvement is recorded was 8/1/08. There was no other evidence Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: in the file of any health professional involvement although the manager told us there had been regular visits to the GP, dentist and others. There was no evidence of Local Authority care manager review on this persons file. It was of further concern that this persons support plan relating to professional health support states the aim is for the person to request professional health support. This person has limited communication skills. In the steps to achieve section there were inappropriate comments and guidance that staff should encourage him not to complain so much. This was dated 8/11/08 and has not been reviewed since. This guidance, if followed by staff, could place this person at risk. Records seen during our visit show that people who live in the home may not be protected from harm through the safe handling of medication. A sample of medication recording sheets were inspected, there were a number of unexplained gaps in these records which were drawn to the attention of the manager. Other entries for medication to be given as required had been crossed out, the manager said this was probably because staff had decided the medication was not necessary. Guidelines for the administration of medication to be given as required to one resident could not be found. Medication is stored securely in the home. Care Homes for Adults (18-65 years) Page 20 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are listened to but may not know who to talk to if they are unhappy. People are being put at risk where appropriate checks have not been carried out before staff begin working in the home. Lack of relevant training and consultation with appropriate agencies could lead to people being unlawfully deprived of their liberty. Evidence: A number of the people who live in this home have limited communication skills and are reliant on the knowledge of the people who work with them to recognise and take action when they are unhappy. Our observations during our visit indicate that people are generally content with the service they receive. One person is waiting to move into more independent accommodation and is therefore less happy with life in the home. There is a complaints procedure however this requires updating to provide accurate information about how to contact the Care Quality Commission. Not all the people who live in the home have access to the complaints procedure in a suitable format for them. There have been no concerns brought to the attention of the Commission about this service since our last visit. People who we spoke to and relatives who responded to our survey confirmed they were happy with the service. A number of the people who live in the home experience challenging behaviours. Staff have received some training in safeguarding. Strategies are recorded and guidance Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: provided for staff to help them manage these behaviours. We were concerned to find guidance for one person included an instruction to staff to lock them in their apartment in certain circumstances. This strategy had been developed without any evidence of consultation with appropriate external agencies. The manager of the service had no knowledge of this strategy and the Commission had not been notified of a serious incident which had given rise to its development. The Responsible Individual gave assurances following our visit that no one in the service had ever been unlawfully deprived of their liberty and the guidance has been removed. We have not therefore made a requirement on this matter. People who live in the home are being put at risk where recruitment procedures have not been followed and staff have been employed in the service before appropriate checks have been carried out. Care Homes for Adults (18-65 years) Page 22 of 35 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 in the home benefit from the spacious and generally well equipped accommodation. Some improvement to parts of the premises is needed to enhance the quality of life and promote the safety and wellbeing of the people who live there. Evidence: A site visit to assess the suitability of the accommodation at the annex was carried out on 14th May 2009. An existing single storey building that was used as offices by the previous owner, located in the grounds of the main house, has been converted to provide accommodation consisting of two separate apartments, an entrance hall and a staff sleep-in room. Since that time a separate office has been created in an adjacent building. A portaloo has been placed next to the office as waking night staff cannot access the staff toilet in the staff sleep in room at night. The annex is well equipped, decorated and furnished to a good standard. The two people who live there benefit from their spacious accommodation and well designed facilities. The main house provides accommodation for six people who each have their own bedroom. There are also spacious communal facilities although the dining room is very small. Decor in the main house and the outside of the property is tired and would benefit from some attention to improve the environment of people who live there. Wooden flooring in some areas is shabby and does not look clean although the Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: manager said it just needs polishing. The garden also needs some attention to ensure that it is safe and accessible to all the residents. unsafe paving slabs in the garden have been taken up and replaced with bark chippings which not all residents can negotiate safely, making the garden a no go area for at least one person. The annual development plan dated 2008 identifies areas where the premises need improvement, this has not been done. The majority of bedrooms in the main house, although personalised, were messy. One of the residents who showed us their room said he did not choose the stripe wallpaper, it had been there when he moved in. most of the bedrooms in common with the rest of the home would benefit from redecoration. Not all of the bedrooms have a comfortable chair where residents can relax. We were concerned to find some practises which are placing people at risk of infection. Communal towels are being used in all areas and there were communal bathmats in bathrooms. The manager told us that residents block the toilets if paper towels are provided. The decision to remove paper towels made in response to this risk is compromising the safety of people who live and work in the home. No risk assessment had been carried out before the decision was made. There are 2 bathrooms and a shower room, these areas would benefit from upgrading to provide a more pleasant and homely environment for the people who use them. There are adequate laundry facilities, however the location of the laundry means people have to go outside the house and enter the laundry through an external door to avoid taking dirty laundry through the kitchen. The manager confirmed that this procedure was always followed to avoid risk of cross infection. Care Homes for Adults (18-65 years) Page 24 of 35 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. People who live in the home benefit from the support of a team of staff who are friendly and kind. However the failure to follow the companies recruitment procedures is placing people who live in the home at risk. The competency of staff of staff could not be demonstrated as evidence of appropriate training was not available in the home. Evidence: People who live in the home benefit from the support of a team of staff who are friendly and kind. Throughout our visit staff were seen to be caring and respectful. The annex is staffed completely separately from the main house. Here each resident is supported by two members of staff during the day and at night there are 2 members of staff on duty, one waking and one sleeping in on the premises. Although the location of the home is rather isolated, there are enough drivers on the staff team to ensure people are able to go out and about in the community. All of the staff who work in the annex have been recruited in 2009. There is a stable staff team in the main house. Only one member of staff has been recruited since our last visit. This means staff know the residents well and they continue to benefit from the continuity of care and support provided. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: There are robust recruitment policies and procedures. Four files were examined in detail for recently recruited members of staff to test whether these procedures are being followed. We found that people are being put at risk where, for two of the four new members of staff, adequate checks had not been carried out before they began working in the service, Criminal Record Bureau checks were not carried out and employer references were not taken up before these staff began working in the home. In both of these cases the registered manager had no involvement in the recruitment process. It was not possible to make a judgement about the competence of staff to carry out their roles. The manager told us that staff training is dealt with centrally. There were a few training certificates held in the home and evidence was seen that some staff have engaged in e leaning courses. Records available for new staff showed that there is an induction course. However only two of the the four staff files seen indicated that this had been completed. The manager was asked to provide an up to date record of staff training following our visit. Care Homes for Adults (18-65 years) Page 26 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Confusion about management roles and responsibilities and ineffective quality assurance systems mean people who live in the home cannot be confident the home is being managed in their best interests or that their views are taken into account when decisions are made. The health and welfare of people is not being promoted where staff are not trained in safe working practices. Evidence: There is a manager for the service who is registered with the Care Quality Commission. However the manager has had no involvement with the annex and does not supervise any of the staff who work there. The person in charge of the annex is a Senior team leader who is line managed by the Responsible Individual for the Company. This situation conflicts with homes Statement of Purpose and has led to some hostility between the two staff teams. It was of further concern that outside agencies and relatives who have involvement in the care of the people who live in the annex believe the person in charge to be the manager. Our concerns about the situation were discussed with the Responsible individual who informed us that an application was being made to register the annex as a separate home. Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: We could not find evidence of any effective quality assurance systems in the home. There is a QA file which contains a business plan dated August 2008. This stated that the outside needs repairing completely. The RM confirmed this has not been done. There was no evidence of any evaluation of customer satisfaction surveys for people who live in the home since April 2008. There are no residents meetings and it was difficult to see how people who live there are being involved in the decision making processes which affect their lives. The registered manager was unable to tell us of any quality assurance systems she uses to ensure the way the home is run is based on an annual cycle of planning, action and review. A representative of the company conducts regular visits to the home. We looked at the last three reports but could find no evidence that individual care records have been monitored. The shortfalls in care planning, risk management, restraint procedures, recruitment, staff training and management indicate inadequate overall management of the service. People who live in the home are not always protected through safe working practices. A number of staff have not had up to date training in moving and handling, infection control, fire safety, basic food hygiene, health and safety or first aid. Risk management processes are inadequate to minimise risk and promote the health, safety and wellbeing of people who live in the home. Care Homes for Adults (18-65 years) Page 28 of 35 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 29 of 35 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 6 The statement of purpose and service user guide must be kept under review to ensure information provided to all stakeholders is sufficient and accurate . To ensure all parties understand the management arrangements in the home. 31/03/2010 2 2 14 The registered manager must have copies of all the assessment reports so they have access to all the information obtained. To ensure the persons needs are understood and can be met. 31/03/2010 3 6 15 Care plans must contain 31/03/2010 sufficient, up to date information and guidance for staff. Regular reviews must be carried out in consultation with the Care Homes for Adults (18-65 years) Page 30 of 35 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 individual and other relevant parties. To ensure people who live this home can be confident their individual needs are fully understood and will be met in line with their individual abilities. wishes and expectations. 4 9 13 Individual risk assessments must identify all risks and have clear action to minimise risks and promote independence. To ensure peoples opportunity for personal development is not restricted and they are not exposed to risk of harm. 5 12 12 Peoples religious needs and choices must be catered for. To ensure they have opportunity to attend church if they choose to do so. 6 16 12 The home must ensure people are involved in decisions about lifestyle choices. To ensure the approach taken to providing care and support does not limit peoples opportunity to 31/03/2010 31/03/2010 31/03/2010 Care Homes for Adults (18-65 years) Page 31 of 35 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 excercise choice and control over their own lives. 7 19 12 There must be effective systems in place to monitor health care needs and ensure regular access to relevant health professionals. To ensure peoples health is promoted and all their health care needs are met. The registered person must ensure people are provided with an up to date complaints procedure in a suitable format. To ensure they know who to contact if they are unhappy with the service. 31/03/2010 8 22 22 31/03/2010 9 23 19 The registered person must 31/03/2010 not allow a person to work in the care home unless they have obtained all the information and documentation specified in the regulations. To ensure people who live there are safeguarded. 10 24 23 The registered person must ensure all parts of the care home are kept clean and reasonably decorated, and that gardens are well maintained and accessible. 31/03/2010 Care Homes for Adults (18-65 years) Page 32 of 35 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 To promote the well being of people who live in the home. 11 30 13 Hygiene practices such as the use of communal towels in the kitchen and bathrooms must be reviewed and appropriate action taken as necessary. To ensure people are not exposed to risk of cross infection. 12 35 18 The registered person must 31/03/2010 ensure all staff are suitably qualified and competent to carry out their roles. Training records must be available in the home. To ensure the needs of people who live in the home are understood and met in a way that promotes their health and welfare. The registered provider and registered manager shall, in relation to the conduct of the care home, maintain good personal and professional relationships with each other and with service users and staff. In that all parties and stakeholders must be clear about management arrangements in the home 31/03/2010 31/03/2010 13 37 12 Care Homes for Adults (18-65 years) Page 33 of 35 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 which must not conflict with information provided in the statement of purpose. To ensure people understand who is responsible for the management of the service and can be confident the home is being managed in their best interests. 14 39 24 The registered person must 31/03/2010 ensure there are effective quality assurance systems in the home. To ensure people experience and are involved a continually improving service. 15 42 18 The registered person must ensure staff are provided with appropriate, up to date training in safe working practices. To ensure people are protected from harm. 31/03/2010 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 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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