Inspection on 21/09/09 for Harefield Road, 156

This inspection was carried out on 21st September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Harefield Road, 156 08/11/07

Harefield Road, 156 21/09/06

Harefield Road, 156 22/12/05

Harefield Road, 156 02/06/05

Harefield Road, 156 09/02/05

Harefield Road, 156 24/06/04

Harefield Road, 156 12/02/04

Harefield Road, 156 09/10/03

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

Key inspection report Care homes for adults (18-65 years) Name: Address: Harefield Road, 156 Harefield Road, 156 Uxbridge Middlesex UB8 1PP     The quality rating for this care home is:   two star good 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: Jane Collisson     Date: 2 1 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Harefield Road, 156 Harefield Road, 156 Uxbridge Middlesex UB8 1PP 01895254803 01895254803 hm156harefield@ealing.org.uk www.supportforliving.org.uk Support for Living care home 4 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 4 The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care need on admission to the home are wtihin the following categories: Learning Disability - Code LD Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home 156 Harefield Road is home to four men with learning disabilities and/or mental health needs. The home is owned by Notting Hill Housing Association and the service is managed by Support for Living (formerly Ealing Consortium) which is a not-for-profit organisation. The house is on a busy road and there are shops within fifteen minutes walking distance. The nearest large shopping centre is at Uxbridge and the premises are close to the A40. There are four single bedrooms, a bathroom and a separate toilet on the first floor. The home does not have a lift. The toilet and shower on the ground floor are generally used by the staff. The main lounge is on the ground floor Care Homes for Adults (18-65 years) Page 4 of 31 4 4 Over 65 0 0 Brief description of the care home and is also used for meals. The former dining room has been divided and provides a separate sitting area for residents who smoke, which leads to the garden. The ground floor also has a kitchen and a utility room. There are two offices on the top floor, one of which is used as the staff sleeping in room. There is a large garden to the rear, partly paved, and parking to the front of the house. The current staff team is the Manager, Deputy Manager and seven support workers. There is a minimum of two staff on duty from 8am to 8pm, with one staff sleeping in at night. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good 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: We carried out this unannounced inspection on the 21st September 2009 from 10.35pm to 6.10pm. The Manager and three staff were present. Three residents were in the home and met during the course of the day. The fourth resident was away for the weekend with his family and was not met. Since the last inspection in November 2007, the Registered Manager has left the home. The former Deputy Manager is now managing the home. There was a staff meeting planned for the afternoon and this took place with four staff and a Support for Living senior manager. Two of the staff on duty were from an agency. During the inspection we examined a variety of records including care planning files, staff files, the complaints log, incident files, medication and maintenance records. The inspection also included a tour of the home with the Manager, where we found a Care Homes for Adults (18-65 years) Page 6 of 31 number of maintenance issues which needed attention. We had some concerns, following a report from the home, about some aggression between the residents. We discussed the situation with the Manager and he explained that referrals have been made to the relevant professionals and they are awaiting the responses. The three residents in the home were able to follow their own pursuits during the day of the inspection. None of the men have chosen to attend day services. One person was looking forward to his birthday and staff were preparing food for the occasion. He had chosen a West End show to visit as part of his birthday celebrations. The home had a friendly and relaxed atmosphere during our visit, with a good rapport noted between the residents and staff. Two staff responded to the surveys we sent but none were received from the residents. There had been five requirements at the previous inspection in 2007 which have been met. Seven have been made at this inspection and are detailed in the what they could do better section. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Updated information is available for the current and prospective residents of the home and in a format to suit peoples needs. Assessment and admission procedures are in place should they be required. No new people have been admitted to the home, so the procedures could not be assessed. Staff receive some training to support the needs of the residents but could benefit from more advanced training. Evidence: We saw a copy of the Statement of Purpose, which had the previous Managers name on it and did not see an updated copy in the home. However, the Manager took action after the inspection to amend the Statement of Purpose and Service Users Guide and provided us with a copy of both which, with some small alterations, meet the National Minimum Standards. The Service Users Guide is well produced with symbols, pictures and photographs, including those of the staff. These amended versions should be provided to the residents and their families to ensure they have the current information. The home caters for people with both learning disabilities and mental health problems Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: and currently has residents across a wide age range, including one person over 65. Staff receive some training to support them to work with people with learning disabilities and mental health problems, but this should be extended to include more advanced mental health training and we have recommended, in the appropriate section of this report, that this is undertaken. There have been no new residents in the home for some years and so we could not examine the current admission process. However, we saw that there is an updated policy and procedure for assessment and admissions which would include visits to the home prior to admission. Some plans have been made for one person, who could be accommodated in a more independent setting, to move from the home and the Manager said that this process is still ongoing. The Statement of Purpose states that the home does not generally accommodate people in emergencies, or for respite, due to depth of the assessment which would be required before a person is admitted. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have detailed care plans to support their chosen lifestyles. People have the opportunity to participate in the running of the home but may chose not to do so. Risks are assessed and people supported to maintain independence wherever possible. Evidence: There is a new Person Centred plan in place for each resident that is prepared in a visual and easy read format. We examined all four files and found the plans comprehensively completed. They were very clear and fully detailed, giving good information about the person. The plans contain details of their background, what is important to them, their communication, social life, friends and family contacts. The Manager said that none of the residents was interested in holding their own copy of the care plan. Regular reviews are held and we saw evidence of this but were informed that none of the residents have a named social worker at Social Services. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: We saw in place a number of risk assessments for each person. These including those for going out of the home, medication, and moving and handling, as well as those which were relevant to each of the residents personal lifestyles. The staff keep a file of the incidents which have occurred. We saw that a number have been recorded in the last three months. Although the Manager and staff said that they deal with the incidents as they arise, there are times when only one staff is on duty alone in the home and the Registered Providers need to ensure that this is sufficient. The staff said, at present, most of the residents choose to go to their rooms quite early in the evening, so the single staffing cover is sufficient. There must be regular reviews of the situation and we have made a requirement in the appropriate staffing section. There is a restriction in place regarding the locking of the kitchen at night. There are risk assessments in place to support this but it needs to be kept under review to ensure that people are not unduly restricted by this. We saw that the residents are able to spend their time as they wish, which might be in one of the lounges or in their own rooms. Staff who responded to our surveys felt that the home helps people to develop and meets needs in respect of support with personal care, eating, a balanced diet, budgeting, shopping and domestic. There was information in the care plans as to how people might be supported to be more independent. We saw samples of the daily notes which staff record, and there is a page for each shift. These included notes on residents activities such as going to the pub, to church, and watching DVDs. Information on each persons budget and money handling was included in the care plan and there is a section for decision making. The Manager said that residents are able to help with their laundry, for instance, and supported and encouraged to do so in accordance with their abilities. We were told that none of the residents help with the cooking but one person has been undertaking a cookery course with a view to a move to more independent living. One resident works at another of the Providers homes, assisting with the cleaning, once a week. There has been an opportunity to increase a persons work experience but they have chosen not to do this. As part of their decision making, the Manager said that all of the residents had decided against attending day centres some time ago. The majority of activities are undertaken with the staff, which may be to go to the shops locally, or Uxbridge. Staff said that some of the residents prefer a routine lifestyle and this is respected. Care Homes for Adults (18-65 years) Page 13 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a choice about their activities and where they spend their time. Staff try to provide activities on an individual basis, taking into account their personal preferences. Dignity and privacy are respected. Meals are provided in accordance with the residents choices. Evidence: None of the residents choose to attend day centres, although have done so in the past. Once resident goes to another Support for Living home to help with cleaning, once a week. We found that the men are supported to undertake the activities they prefer. One person told us about his forthcoming visit to the theatre, which he had chosen as a birthday treat. Staff were preparing the food chosen by the person to help celebrate his birthday. As one person is independent in the community, we saw that there have been Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: guidelines drawn up to support the person when going out alone. One person attends a weekly club, but the others do not have any regular activities of this type. The garden is maintained, but with few plants of interest. The staff said that one person had been supported, last year, to plant vegetables in a raised bed, but had not shown an interest this year. The Manager explained that not all of the residents like to be away from the home for long periods, so that short breaks are arranged to suit the individual needs of each person. One person had enjoyed an overnight stay nearby, and another person had recently spent two nights at a holiday centre on the south coast. The staff said that it has been difficult to arrange these breaks for some people as they may change their mind but they try to work with the person to minimise any anxiety. One staff member responding to us felt that the home could organise more outings and holidays for the residents. The residents are able to maintain contact with their families and one person stays regularly with a family member. We saw that one resident had a relative from abroad visiting recently and he was able to discuss this with us, and a member of staff. No specific cultural needs are required to be met. One person goes to church on a regular basis and another goes occasionally. We saw in the notes that both men had attended recently. We saw copies of the menu and the staff said that these are based on the meals that the men choose and enjoy. Notes are recorded in the daily logs of the meals taken. Care Homes for Adults (18-65 years) Page 15 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care is provided in the manner in which residents prefer. People are treated respectfully. Medical needs are met by the community services and people supported in accordance with their needs. Medication procedures are monitored to ensure correct administration. Evidence: Personal care needs are recorded in a separate care plan, which gives details of how the residents prefer to be supported with all aspects of their personal care. There is one bathroom for the use of the four men which has a bath with an overhead shower attachment. The ground floor shower is used currently by staff but could be used for the residents, if required. However, this would not have sufficient room for anyone who needed staff support with a shower. The Manager said that there is not usually any problem with the residents gaining access to the bathroom. There is a separate toilet. There is information in place on the health needs of each of the residents. These include a Health Action Plan. Residents attend the professional visits they require. We saw information on visits to mental health professionals and medication reviews. On Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: the day of the inspection, one person was being supported to go for a medical test. One resident has had recent epileptic seizures after a long period without any. Staff undertake training on epilepsy as part of their induction, and it is due to be updated every two years. We saw that four staff should have had updates already this year and one was due shortly. In view of the recent changes, the staff should receive their updated training as a priority. We saw that guidance was in place which, although suitable, needed to be updated to take into account the recent events, particularly as the home uses agency staff who may not be fully aware of these. The medication cupboard is located in one of the offices and we examined the medication, of which the majority is in a 28 day blister pack system. Those tablets which are not in the packs have their stock checked on a daily basis and we saw the audit sheets for these. We checked this medication and it was in order. We also checked the stock of the PRN, as and when medication, which was correct and staff had noted the reason for giving it on the back of the Medication Administration Record sheets as required. We saw evidence of staff training in the training matrix. One staff member told us about the training for medication administration and said that it was thorough. We had been informed about one medication error in March 2009, but the Manager said that there had been no further errors. He said that only permanent staff are allowed to give medication. This can occasionally cause problems if only agency staff are on duty. A staff member had been called out recently from another home, to give medication, but this problem should be alleviated by the home now having a full, permanent staff team. Care Homes for Adults (18-65 years) Page 17 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. No complaints have been made but there are suitable policies in place. People could be better supported and encouraged to voice their concerns when affected by events in the home. Staff are trained in safeguarding procedures but the reporting process have not been sufficiently robust to ensure the issues are followed through. Evidence: The home has a satisfactory complaints procedure, in a visual format. There have been no complaints recorded since the last inspection. As there have been a number of incidents recorded, we asked if the residents had been supported to voice their concerns where they had been affected. The Manager said they had not specifically asked to do so, but would be supported to should they wish to go through the procedure. We recommend that people are supported, possibly through their key workers, to at least raise their concerns. This would help to demonstrate that appropriate action is being taken. The Manager said that they had contacted the Local Authority for the new Safeguarding policy but found that this was still in production. The staff have training in safeguarding procedures, as part of their induction. We were provided with records for this and one of the newer staff confirmed they had undertaken this training. None of the staff required updated training in this subject until next year. Although the Manager said that the incidents regarding the residents are under Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: control, we saw there have been a high number. The home has kept us informed of the more serious issues. One had resulted in the police being called, following an incident between residents. This did not result in the Local Authoritys safeguarding officer being informed directly, but the Manager said that Social Services had been told of this. Arising from this, a referral had been made to the Positive Behavioural Support Team, but has not yet been actioned. All possible safeguarding issues need to be reported to the appropriate department of the Local Authority, and the Care Quality Commission, and the Manager needs to ensure that this is always done. Care Homes for Adults (18-65 years) Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most of the home is satisfactorily maintained and suits the needs of the residents. There are areas where work has not been carried out within a reasonable time frame. Repairs affecting hygiene are not prioritised. Evidence: We found the the home was being maintained in a reasonable condition in most areas but there were some concerns regarding the speed at which repairs are undertaken by the Housing Association, who are the landlords. There is one bathroom for the use of the four residents and the Manager said that this is sufficient, as there is a separate toilet. There had been requirements at the last inspection for the bathroom ceiling to be decorated and the toilet flooring to be replaced. These have been carried out. The toilet had also been professionally cleaned but there was still a strong odour of urine. The Registered Providers need to consider a more impermeable surface, such as tiling, which may be easier to clean. The bath has been without a panel for some time and this was seen to be reported in June 2009 to the Housing Association but has not yet been repaired. There are also issues with the tiles on the windowsill which need to be repaired, and repositioned, to ensure that the water from the shower runs away properly. This has also been Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: reported to the Housing Association. The tiles around the bath need to be replaced where they cannot be cleaned because of mildew stains. The Manager told us that one of the bedroom carpets is to be replaced and quotes have been obtained for this. We were shown one of the bedrooms by the resident. It is plainly decorated and furnished, without curtains, in accordance with his choice. The carpet is stained and should be considered for replacement if it cannot be satisfactorily cleaned. One of the walls has a number of holes, and these need to be repaired. There was also a hole in the kitchen wall, also reported, which was open to vermin. While this has been blocked at present, it also needs to be repaired. The Registered Providers must ensure that all necessary outstanding works are completed within a reasonable timescale. All but one of the bedrooms are over 10 sq. metres in size and are single rooms. None of the residents currently require any equipment to support them and all are required to have a good degree of mobility as there is no lift, and the bedrooms and bathroom are on the first floor. Care Homes for Adults (18-65 years) Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing numbers are satisfactory but the single staff cover must be kept under review. People are not protected by the current recruitment processes. Staff induction is comprehensive. Staff have the opportunity to undertake NVQs. Staff are supported through regular supervision and meetings. Evidence: The Manager told us that, with the recent appointment of a new staff member, the home is now fully staffed. He said there are now sufficient staff to cover the home with two staff from 8am to 8pm, and one staff on an additional mid shift of 9am to 3pm or 4pm. The Manager works two of the shifts each week, with management duties for the remainder of his hours. Agency staff cover shifts for holidays, sick leave or training. We examined the records for staff recruitment. Staff are recruited through the Registered Providers Head Office and the original records are kept centrally. The Care Quality Commission allows for information to be held on a pro forma in the home. These forms should record all of the information of the staffs employment records, required under the Care Home Regulations, and be signed off by the Providers Responsible Person. However, when we checked the information held in the home, we found that the records for the last three staff recruited were not available. The Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: information for the agency staff currently working was also not available. The records which were being held were not updated or detailed, and were not signed off by the Responsible Person as required. The Manager said that the information had been requested from the Human Resources department but had not been provided to the home, although two staff had been in post for some months. He confirmed after the inspection that he had obtained all of the agency information but had not yet been provided with the information for the permanent staff. The Registered Providers must ensure that the information is kept in the home, as agreed with the Commission. This must be available from when staff take up their posts, so that it is available for inspection. The information must be sufficiently detailed to show that it meets the Care Homes Regulations. Information for the agency staff must be obtained, before they commencing work, to show that they have a Criminal Records Disclosure, references and the necessary training, which is all up-to-date. We also saw information that the right to work of one staff member had not been checked for some time and had no evidence it was valid. The Manager undertook to get this updated. He said that he had received some information from the Human Resources Department, but this was not available for examination. There must be systems to ensure that this information is checked regularly, both by the Manager and the Registered Providers. There were training records in place, but a small number of recent courses had not been added. The Manager undertook to complete them and provided them to us just after the inspection. This showed that most of the staff had the basic training required. Some courses were still being booked, and the Manager explained that some of the new courses would be by e-learning using computers. We spoke to one member of staff who had recently undertaken the induction training. We were shown the folder, detailing a comprehensive programme in place, including two weeks of various courses which cover all of the basics, including manual handling, safeguarding, first aid, health and safety, fire safety and food hygiene. The Learning Disability Qualification is undertaken before staff commence the National Vocational Qualification. Five staff have the National Vocational Qualification at level 2 or above and the target of above 50 being qualified is met. Some staff have had basic mental health training. The Manager informed us that a number of staff have had training sometime in the past and others have basic training as part of their induction. In view of the incidents which have taken place, we recommend that a further advanced, training course is sought which could help staff to develop their skills and update their knowledge. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: There was a staff meeting on the day of the inspection and the staff said that these are usually held weekly. We also saw samples of the staff supervision, and were informed that sessions are planned on a monthly basis. These appeared to be comprehensive and staff said that they were supported. Two staff returned surveys to us and were generally complimentary about the support and the services provided. Care Homes for Adults (18-65 years) Page 24 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory but support is required to ensure that all of the Regulations are met. Most records are in place but would benefit from streamlining and archiving. Evidence: The Manager who was formerly the Deputy Manager, has been in post since the previous Registered Manager left in 2008. He has commenced the registration process but this was on hold at the present time. He has an NVQ Level 3 and has attended the Providers management development course. It is planned he will be undertaking the NVQ Level 4 in due course. We found the home to be reasonably well managed, although there were some shortfalls in the recruitment documentation. We saw that the Registered Providers have carried out their Regulation 26 monthly visits, and we saw reports for most of 2009. However, although there were some action points seen to need completion not all of the records appeared to have been checked. For instance, monitoring of the recruitment records would have found that these were not complete and the missing information from the Human Resources department should have been sought. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: We found that the home has a pleasant atmosphere, and that a good rapport was noted between the staff and the residents. We examined a sample of the maintenance records. There is a completed fire risk assessment. Two of the residents smoke and a room is available for this purpose which has doors to the garden. The London Fire and Emergency Planning Authority last visited the home in July 2008. There is an evacuation plan for the home which would require a full evacuation of the home to be attempted. The last fire drill was in July and, prior to this, four were held in 2008. We recommend that in view of the twelve hours of single staff cover, and that two of the residents smoke, that these should be held more frequently. A log of maintenance items showed that they were reported to the Housing Association appropriately but the work was not always completed within a reasonable timescale. The Registered Providers need to ensure that repairs are carried out to keep the home safe and hygienic. The Manager has made efforts to streamline the files but they are still large in number and contain information which could be archived to make them easier to use. We noted that files for residents and staff are stored confidentially. The Annual Quality Assurance Assessment was provided in detail to us and this has information about the homes management, its plans for the future and statistical information. The AQAA reported that the Providers policies and procedures were last updated in October 2008. Care Homes for Adults (18-65 years) Page 26 of 31 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 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation 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 19 12 The Registered Providers 31/10/2009 must ensure that the guidance for epilepsy for the residents is current. To ensure that all staff are fully aware of the current guide lines for assisting residents with medical needs. 2 19 18 The Registered Providers must ensure that the training for epilepsy is provided for those staff for whom a refresher course is due. To ensure that all staff have current training on this topic. 30/11/2009 3 23 13 The Registered Providers must ensure that all incidents which may involving safeguarding issues are reported to the appropriate organisation as 31/10/2009 Care Homes for Adults (18-65 years) Page 28 of 31 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 soon as possible after the incident. To ensure that all issues are investigated and the appropriate action is taken to protect people. 4 24 23 The Registered Providers must ensure that all of the outstanding repairs are carried out. To ensure that repairs are carried out and any hazards to health, safety and hygiene are eliminated. 5 30 16 The Registered Providers must ensure that the first floor toilet flooring is suitable to maintain hygiene. To ensure that the smell of urine can be eliminated and the toilet kept clean and fresh. 6 33 18 The Registered Providers must have a system for regularly reviewing the staff rota to ensure that single staff cover remains suitable to meet the needs of the residents. To ensure that residents and staff are supported. 31/10/2009 30/11/2009 30/11/2009 Care Homes for Adults (18-65 years) Page 29 of 31 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 7 34 18 The Registered Providers must ensure that all of the information required to be held for permanent and agency staff currently working is in the home for inspection, is complete and is up-to-date. To ensure that people are protected by robust recruitment practices. 31/10/2009 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 22 That there are processes in place which encourage and assist people to voice their concerns so that they can see that action is being taken to address any issues. That more advanced training in mental health is provided for the staff team to help them to support the residents. That more regular fire drills are carried out to ensure that staff working alone have the practice of evacuation. 2 3 35 42 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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