Inspection on 02/12/09 for High Street, 56

This inspection was carried out on 2nd December 2009.

CQC found this care home to be providing an Adequate 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

High Street, 56 31/12/07

High Street, 56 31/08/06

High Street, 56 06/09/05

High Street, 56 15/04/05

High Street, 56 29/11/04

High Street, 56 13/04/04

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: High Street, 56 High Street, 56 Chislehurst Kent BR7 5AQ     The quality rating for this care home is:   one star adequate 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: Rosemary Blenkinsopp     Date: 0 2 1 2 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 29 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 29 Information about the care home Name of care home: Address: High Street, 56 High Street, 56 Chislehurst Kent BR7 5AQ 02084687016 02084687016 enquiry@community-options.org.uk www.community-options.org.uk Community Options Limited care home 10 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 mental disorder, excluding learning disability or dementia Additional conditions: 10 Elderly persons of either sex suffering with mental illness Date of last inspection Brief description of the care home This facility is part of the Community Options group of homes. This service is registered for ten residents in the category of mental disorder, excluding learning disability. At the time of the visit there were nine residents in the home, one was attending a hospital appointment. The home is a large detached house in the centre of Chislehurst High Street. There are three floors and bedrooms are located over two floors. There are two sitting areas and a separate dining facility. There is a dedicated smoking room. There is parking to the front of the building. The service is for those residents who have long-term mental health problems. The majority of the residents are now in their later years Staffing is provided throughout the 24-hour period including waking night staff. The fees for this home are made up of GBP 361.61 Local Authority contribution and GBP98.60 from the resident. 10 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was conducted over a one day period by one inspector. The person in charge, then the manager facilitated the inspection. Periods of observation were undertaken in the communal areas where some residents were spending time. Prior to the inspection the AQAA had not been completed nor were there any comment cards received prior to the visit. During the site visit we met with several residents. Staff were interviewed during the day. All of the information obtained from the sources identified above has been incorporated into this report. Care Homes for Adults (18-65 years) Page 5 of 29 Documents were inspected during the site visit including care plans, staff personnel files as well as health and safety records. Immediate requirements were followed up. Feedback was provided to the manager Mr Barry, at the end of the inspection. Other information, which was considered when producing this report and rating, consisted of information supplied and obtained throughout the year including Regulation 37 reports and complaints. Care Homes for Adults (18-65 years) Page 6 of 29 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 7 of 29 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 8 of 29 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. Residents are fully assessed and supporting information obtained prior to any trail period in the home. This assessment process provides residents with an opportunity to sample the service and staff to have information about the potential admission Evidence: Residents are usually referred through mental health teams who consider that the resident would benefit from placement in Community Options homes. In addition other Community Option homes may feel the residents needs can be better met in another facility, hence they are referred. We selected case files, looked at assessments and supporting records. Assessments are conducted by two senior people in the company. Once assessed the information is used to decide which service will best met their needs. The residents name is then put forward into a suitable service. The manager of this service may be involved in the initial assessment or as part of other assessments. Care Homes for Adults (18-65 years) Page 9 of 29 Evidence: Residents are offered opportunities to sample the service and as many as three visits may take place before admission. The information obtained during these visits is used to develop an initial care plan to address identified needs. Information relating to important issues such as medication, family networks and levels of assistance and support can be obtained during these assessments. As well as identifying the support required, any potential risks can also be identified and acted upon. Other information included CPA documentation care plans and risk assessments. In one file there there was information from the discharging hospital as well as reports from the members of the multidisciplinary team. We saw evidence of the license agreement and individual service agreements for residents. These were signed and dated by the residents. Residents are subject to a three month probationary period and this is confirmed by way of a letter. Written confirmation of the homes ability to meet residents needs are retained on file. A letter is sent to the next of kin advising of the move into High Street. The home provides residents with a Statement of Purpose and Service User Guide which details the service and facilities provided. These need to be updated to reflect the new Regulator and staff changes. In light of re current dependency in the home the Manager must ensure that the needs of the residents, who are already in the home, are carefully considered before any future resident is accepted. This statement is repeated from the previous key inspection. Care Homes for Adults (18-65 years) Page 10 of 29 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. The care plans set out the care required and the identified risks. Residents are enabled to be as independent as possible and risk assessments support this decision. Evidence: Within this home there are ten resident of mixed gender. Residents are usually on the Enhanced Care Programme Approach( CPA), this is a system of aftercare that ensures ongoing follow up and motoring. Each resident under this system has an allocated care coordinator who ensures the care plan is implemented, regular reviews take place and a consistent approach to care and support is delivered. It is essential that the home works closely with the mental health teams to ensure residents receive the best care and signs of relapse are identified quickly. In addition each resident has an individual plan of care drawn up in the home, which sets out identified problems and risks. These reflect the care plan formulated under the CPA and work collaboratively on meeting residents needs. Those files selected had the issues identified and had good interventions stated for each of them. It is from Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: this information that staff can consistently assist and deliver care. Another document which is completed is my support plan, which gives a residents prospective of their needs. There was also an overview of risks set out, as well as the specific risks identified for that individual who was living in a community setting. One care plan was very confusing as it had the wrong residents name on the individual fire risk assessment , therefore it was unclear who the assessment pertained to. All residents may go out unaccompanied and can have periods of On leave staying with family or friends. The care plans in this organisation are cumbersome and to extract information can be difficult. At the random inspection we identified one resident who had many physical and mental health issues and was said to be very difficult to manage. The manager advised us of several incidents where verbal and physical aggression had taken place which had resulted in the police being called. The service had not been sending Regulation 37 reports to the CQC and this resulted in an immediate requirement being issued, these are now being forwarded. Other information regarding health appointments was located in the diary and in the Record master, which provided more details of the actual activities and daily lives.. Care Homes for Adults (18-65 years) Page 12 of 29 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. Rehabilitation activities are limited because of a number of factors including the residents ability and staff availability. Staff had little time to engage or support residents as they were involved in other activities in the home. Evidence: We spent time in the communal areas, there was no staff present for the majority of the time. The TV was playing although no one seemed to take much notice, in fact one resident was laid asleep on the sofa. Residents wandered in and out spending time in the smoking area or sitting room . There was two staff on duty in the home and one was out of the building escorting a resident. This left little time for the two staff to do any active rehabilitation activities and none were observed. Staff engagement with residents was also very limited, the main communication being around times for cigarettes. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: Rehabilitation activities are limited because of a number of factors including the residents ability and staff availability. Staff were occupied with other tasks answering the phone, answering the door and dealing with visitors including myself. Residents told me that they went out, and some did go out during my visit. One resident said they went shopping locally as well as other areas and their bus pass gave them free travel. Film evenings are organsied for the residents living in the home. Community Options also have a Christmas party where residents and staff are invited to attend. Visiting is open although we were advised there are few visitors to the home. Some residents may go to their family for the festive period- all resident are able to spend periods at home with family and friends to promote and encourage family links. We asked residents how they spent their day and they said going out, smoking watching TV. We asked about rehabilitation activities such as doing household chores doing their own washing etc, although they were unable to confirm that these activities occurred. We observed the lunch. The meal itself looked nice and it was served with good sized portions. One area of concern was the constant through fare in and out of the kitchen by staff and residents . Residents were not doing rehabilitation cooking programmes, so the reason for them being in the kitchen was unclear. There was no one seen to wash their hands, wear protective clothing, or take any precautions in this area. This is of concern as there are infection control issues relating to incontinence . Foodstuffs were checked and one item was found to be out of date. The two first aid boxes were both with out blue plasters. The records for fridge/freezer temperatures had many omissions over weekend periods, as well as a gap in November and others. No explanation was offered for the gaps. Care Homes for Adults (18-65 years) Page 14 of 29 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. There are insufficient staff to supervise residents or provide for their total health care needs. The lack of safe storage of medications alongside omissions in records introduce a margin for error and pose a risk to residents. Evidence: Residents were seen to be unsupervised for long periods, this could pose a risk, and there was little in the way of active rehabilitation or engagement between staff and residents. One staff member was off site accompanying a resident to the out patients department. Shortages of staff were evident throughout the morning. One resident stated that they had suffered some kind of seizure that morning yet she had little monitoring after the event, and was for long periods on her own. She was bruised in several parts of her body. Close monitoring after such events is necessary in case of further episodes as resident may be drowsy or uncoordinated . There are several residents in this service with physical disability and some equipment Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: is provided such as wheelchairs walking frames and a walk in shower. Male and female staff are employed to address gender care issues. One resident has external health care assistants who address her care . Prior to them arriving she wanted to get up although bed rails prevented this. No staff were available to reassure her or stay with her until the care staff arrived. Health appointments are usually provided through the local community provision to encourage integration. Information regarding health appointments was located in the diary and in the Record master, which provided more details of the actual appointments and treatment. The medications were inspected. The door to the medication cupboard, where the medication trolley is kept, was found with the keys still in the lock and there were no staff in the vicinity. Th cupboard itself was untidy with staff handbags, coats, cigarettes, tins of coke and packets of crisps. The carpet was very dirty . The medication charts were without residents photographs, although these are in each of the care plans. The charts were without the allergies recorded, again this can introduce a risk to residents. Hand transcriptions had one signature, two staff signatures should be recorded to verify the information transcribed is correct. Care Homes for Adults (18-65 years) Page 16 of 29 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. The home has available and on display the complaints policy, which included external bodies for the referral of such matters. Staff had sufficient knowledge of adult protection and the reporting of such . Evidence: The home has available and on display the complaints policy, which included external bodies for the referral of such matters. Other documents such as the Statement of Purpose also included information on complaints. All document swill need to be updated to include change of Regulator to CQC an the new contact telephone numbers and addresses. Community Options have comprehensive complaints procedures, which details time frames for action and response times. In previous dealings with Community Options the inspector has found them to be open and receptive to complaints. The home has a complaints monitoring form for recording of complaints and this includes details of whether the complainant is satisfied with the outcome of the investigation. The CQC had been advised of concerns regarding care issues, infection control and staffing levels. This resulted in a random inspection 17 November 2009 and six immediate requirements were left. Action had been taken on the six immediate requirements, although continual and ongoing work in needed for some of the Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: requirements around the premises. Staff with whom we met knew about dealing with abuse and that they should report it. They named senior persons in Community Options as the people to whom they would refer information, they had less knowledge on external bodies to whom the could refer issues. They confirmed that they received training on POVA and this was included in health and safety updates. In respect of whistle blowing again staff felt confident to report these matters on and they had a working knowledge of the topic. Residents with whom we met said they would refer concerns/complaints to staff in the home their care managers or one person said they would go straight to the head office. Care Homes for Adults (18-65 years) Page 18 of 29 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. The environment is maintained in a domestic manner with some aids provided for physically disabled residents. Evidence: The building is located in the centre of Chislehurst close to shops public transport and all facilities. As we approached the building the bins were overflowing with rubbish and they looked very unsightly. There had been a previous random inspection 17 November where immediate requirements were left some of those related to the environment. There had been issues raised about infection control practices and the correct disposal of items which were soiled. These had been addressed. Another issue was around window restrictors, which were now applied to all windows. The home was cleaner, although more deep and ongoing cleaning, maintenance and regular replacement of furniture must continue. Please see previous section relating to the kitchen. Issues such as scuffed and chipped paintwork, swing bin lids missing and sticky door handles include areas that need attention. The ueven pathway to the front of the building also needs attention. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: Those bedrooms inspected had improved and several were personalised and reflected the interests of the resident. One residents bedroom had many items of memorabilia in relation to areoplanes something he liked. One resident continues to smoke in his bedroom we were advised - and this is further compounded by his refusal to use and ashtray hence cigarette butts and ash are disposed of on the floor. This must be actioned. We tried to view this room but it was locked and the resident unavailable. In the first floor bathroom there was masking tape around the edge of the skirting and a handle was missing from the unit. The Reality Orientation board in the entrance hall was showing the wrong day date and staff group - it was changed once we pointed this out. There is a hot water dispenser in the dining room from which residents take hot drinks. This area is unsupervised the majority of time. We requested the risk assessment for this and the manager was unable to produce it although did have risk assessment for hot water generally and hot pipes. This needs to be addressed . Bedrooms which were inspected had items of furniture in three bedrooms the drawers were stuffed with items of clothing one to the point they were overflowing. Residents should be assisted to maintain their rooms in a satisfactory manner . There is a lift in the home and some aids for those residents who are physically impaired including a walk in shower wheelchairs and zimmer frames. Care Homes for Adults (18-65 years) Page 20 of 29 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. There were insufficient staff to address the needs or sufficiently supervise residents. Staff are subject to robust recruitment procedures and provided with sufficient training to undertake their work. Evidence: The home seemed short of staff as we arrived. The domestic arrived at 10.30 am. There was one care assistant out escorting a resident to hospital which left shortages for residents support and assistance. On many occasions there was no one supervising residents when they were in communal areas making hot drinks etc. There was little in the way of active rehabilitation residents were simply watching TV -although some were sleeping and smoking. These points have been raised under previous sections although all indicated insufficient staff. We were told that staff had training provided through Community Options and had regular updates on the statutory topics. Supervision had said to have lapsed with few sessions taking place. One staff member was very enthusiastic about working in the home saying I love it here . Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: Staff training records indicted a lot of training within the last twelve months. Training on topics such as the Deprivation of Liberty Act, infection control, person centered planning,safeguarding were some of those provided. All training is supported by post training evaluation sheets to assess the staffs knowledge base. A selection of staff personnel files were brought from the Community Options head office by another home manager Gina Benjamin. In general the staff personnel files were organized with information easy to access. Sections indicated where items could be located. The standard of information included was good. Evidence that recruitment checks are made prior to employment were on file including application forms, interview information, two references, CRB clearance, offer letter and contract. The CRB Clarence is indicated by way of a form on the front of the file which has the CRB number and date, confirmed by the Chief Executive. One file viewed was without this date. CRB checks should be revisited every three years. Staff also felt that physical health issues were a large part of the day and there was little time to focus on rehabilitation or other aspects of care and support. The home has a vacancy for a deputy and another car staff on maternity leave. Vacancies are covered by bank staff. We spoke to three staff including one bank staff who had worked in the company previously and returned on the bank. They all confirmed that training was provided including mandatory updates. Care Homes for Adults (18-65 years) Page 22 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by an experienced and trained individual. Health and safety issues need to be tightened up to provide residents with safe accommodation. Evidence: The manager has completed several training courses and has experience in this type of setting . He has completed the NVQ level 4. In addition he has completed an advanced health and safety qualification and is level 2 trained as a risk assessor. The manager completed the National Certificate in Supported Housing in 2004. He had been within the Community Options group for approximately three years. A selection of health and safety certificates and records were inspected. Health and safety audits are conducted on a quarterly basis. Certificates were in place for the portable appliances electrical inspection as well as the five year inspection, and the lift inspection. The gas service had been conducted although no certificate was available Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: this needs to be followed up by the manager. The employers liability had expired 24 November 2009 , and no new certificate was available. The certificate may be at the head office this needs to be followed up by the manager. The fire records showed weekly fire alarm testing as well as checks on other fire safety . Fire doors are on automatic release when the fire alarm is sounded. Staff told us that they received fire training on induction and up dates on mandatory topics regularly. Fridge freezer temperatures with many gaps in records. One food item out of date expired October 09 . There were no hot water temperature records since May 09 . There was no risk assessment for the accessible hot water dispenser in the dining room. All of these indicated that health and safety issues were not taken seriously. This is of concern because of the nature of the residents in this facility who are both physically and mentally impaired. Recent Regulation 26 visits had been conducted, and a report on the findings made for August and October 2009 . We were advised that other visits had been made although the reports had not yet been received. Residents meetings had been held regularly up until August 2009 although there were no records after this date. There had been very few staff meetings this year no minutes of actual meetings were seen. Community Options conducts an annual staff survey the results of which are published and action taken on any issues that are of concern. Care Homes for Adults (18-65 years) Page 24 of 29 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 25 of 29 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 14 12 Residents must be supported to engage in appropriate rehabilitation activities. To ensure residents have opportunities to develop rehabilitation and social skills. 30/01/2010 2 17 13 Thoroughfare in the kitchen must stop To prevent contamination and infection control issues. 30/12/2009 3 20 13 Medication charts need to have the allergies clearly recorded on medication charts To prevent residents receiving medications which may cause an adverse reaction 30/12/2009 4 20 13 Medications must be safely stored in an area which is clean and tidy. 30/12/2009 Care Homes for Adults (18-65 years) Page 26 of 29 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 Medication storage which is not secure introduces an element of risk to residents.t 5 24 16 All potential risks must be 30/12/2009 assessed and action taken to reduce the risk namely the hot water dispenser To prevent harm coming to residents. 6 24 16 The manager must continue to maintain the home in a clean and hygienic manner to include items of bedding and furniture and redecoration. 30/12/2009 Residents need to live in clean and comfortable accommodation 7 42 23 The home must be safely 30/12/2009 maintained for residents and staff to live and work in. Comprehensive health and safety records need to be retained to evidence safety checks. 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 20 Hand transcriptions need two staff signatures to confirm Page 27 of 29 Care Homes for Adults (18-65 years) 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 accuracy of the information recorded . Care Homes for Adults (18-65 years) Page 28 of 29 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. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!