Inspection on 13/08/09 for Hillview

This inspection was carried out on 13th August 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hillview 20/08/08

Hillview 13/12/06

Hillview 07/02/06

Hillview 10/10/05

Hillview 14/02/05

Hillview 31/08/04

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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: Hillview 213 Eastbourne Road Polegate East Sussex BN26 5DU     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: Jo Mohammed     Date: 1 3 0 8 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: Hillview 213 Eastbourne Road Polegate East Sussex BN26 5DU 01323488616 01323487508 polegate@regard.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Regard Partnership Ltd care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Hillview is a purpose built bungalow, situated off the main A22 Polegate/Eastbourne Road. The home shares the same site as Oak Lodge, another service owned by the organisation. Local shops and public transport links are a short walk away. The home is registered to accommodate six younger adults with learning disabilities. Service users accommodation provides six single bedrooms, a communal lounge and kitchen/diner. There is one bathroom and one shower-room fitted with the necessary adaptations. There is a garden that runs the length and side of the house, however this is not currently used by service users due to the uneven ground. A patio area with seating is available at the front of the home. Car parking facilities are at the front of Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 6 2 0 0 8 2 0 0 8 Brief description of the care home the property. The Registered Providers of the service are The Regard Partnership Ltd. This organisation owns a large number of homes across England and Wales. More detailed information about the services provided at Hillview can be found in the homes Statement of Purpose and Service User Guide. Copies of these documents can be obtained directly from the home or The Regard Partnership Ltd as well as current fees. Care Quality Commission [CQC] inspection reports are available on request from the home. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This report reflects a key inspection based on the collation of information received since the last inspection including a review of the homes most recent Annual Quality Assurance Assessment [AQAA] and the last inspection report dated 20th August 2008. An unannounced site visit was conducted on Thursday 13th August 2009 between 9am and 5pm. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001,uses the term service user to describe those living in care home settings. Hillview is an established home that provides residential care to six people with Learning Disabilities. There are currently two vacancies. The home is part of a larger group of homes owned by The Regard Partnership Ltd. Care Homes for Adults (18-65 years) Page 6 of 31 The site visit included looking around the premises, examination of some care, medication, staffing, menus and general records. The visit also included meeting the service users, a new assistant Manager, a senior Manager and speaking with the staff on duty. Service user surveys were sent to the home prior to the inspection. Four were returned saying that due to service users severe learning disabilities they were unable to understand the contents of the questions in the surveys. 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. Care Homes for Adults (18-65 years) Page 8 of 31 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 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 10 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. The home provides prospective service users and their representatives with information about the home so that they can make an informed choice about where to live. Evidence: There have been no new admissions to the home since the last inspection in August 2008 when documentation relating to a service user who moved in was examined. Information supplied in the homes Annual Quality Assurance Assessment [AQAA] identifies the organisation would follow a very thorough pre-admission assessment process in conjunction with the Manager of the home to ensure any new service user would fit in with those who already reside in the home and they have the staff who can provide support for any specific requirements that future service users may need. The home offers new service users the chance to come and visit Hillview offering short visits, staying for a meal and an overnight stay. There are currently four service users who reside in the home and two vacancies. At the last inspection, a requirement about the homes Statement of Purpose was made. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: Senior Managers at the home confirmed this document had been appropriately completed with the necessary information in March 2009 and was available in a service user friendly format. The Managers were also aware that this document will require further updating to reflect the recent managerial changes and Care Quality Commission [CQC] contact details. It was said during the inspection and conveyed in the homes Annual Quality Assurance Assessment [AQAA] that a pictorial and audio version of the service user guide was in place. Care Homes for Adults (18-65 years) Page 12 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. Good progress has been made in devising care plans for service users with the intention to provide these in audio and pictorial format according to service users individual requisites. Ensuring that information contained within these records is known, acted upon and fully completed will further enhance this process. Evidence: A new care planning format had been introduced for all the service users since the last inspection. One service users records were examined in detail and another briefly. Service users have three files; one contains financial information. The day file contains profile information, assessment of capacity, support that the service user needs, an overview of care and assessment needs, likes and dislikes and an overall programme of activities for 2009. There are also a range of individual care plans and risk assessments that are interlinked. This information was easy to track and understand. For one service users records examined who has a visual impairment it was discussed with the seniors Managers at the inspection how they intended to facilitate enabling Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: this person to be involved in their care plan in a format that would suit this individual. It was reported that an audio care plan for this service user would be made. The details identified in this persons communication care plan says they are unable to use objects of reference and pictures as forms of communication and that a communication passport had been started. Examination of this showed this had not yet been fully completed. There was also a care plan in place for managing this service users anxious behaviour; some of the details recorded in this said if does not settle down to remove the service user from situation. This record was unclear and raised questions about how this was done. These matters were discussed with the senior Managers at the inspection to address and in particular if a form of restraint is used to ensure it is agreed within a multi disciplinary setting. In a third file for this service user were details relating to healthcare, appointments and therapy sessions. Notes made by the Occupational Therapist and Speech & Language professionals in this file identify for the home to look into using talking photo albums and tactile objects for this service user. This information was exchanged with Senior Managers during the inspection to make them aware of the details and advice recorded. Another service users care records examined were compiled in similar way and style and it was said this persons care plan was almost complete in audio and pictorial version. It is the intention of the home to produce and complete care plans in audio and as appropriate pictorial versions for all service users. Monthly one to one meetings are held with service users and their keyworkers with a record of minutes and previous review minutes kept. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have some opportunities for personal development and take part in education, community and leisure activities. However, this needs further and on-going development to ensure it is truly person centred, fulfilling and meets individuals personal requisites and preferences. More work is needed to find ways to fully involve service users with additional impairments in choosing their daily living activities. Evidence: On arrival,all the service users were at home. One person was being supported with their personal care. Two service users were sitting in the lounge with the Television on with a staff member. One service user was in bed. The Inspector met all service users during the course of the inspection. It was explained that a recent problem had occurred whereby a number of staff required an extra training certificate in order to drive the minibus and because of this and to some extent activities over the past two weeks had been affected. This included the activities planned on the day of the Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: inspection. It was conveyed that the programme planned for the day would not go ahead unless there was a driver on duty in another home located on the same site. This was subsequently resolved when a driver with appropriate qualifications working in another home on the same site facilitated service users planned activities for the day. Later on during the inspection, the senior Managers at the inspection confirmed that agreement to arrange for staff to supplement their driving qualifications had been approved and this would be achieved over the next four weeks. During the latter part of the day, it was said the weekly music session would take place from a visiting musician for both homes on the same site between 5.30-8pm. There is an overall activity and individual timetables in place for service users. Some examples of the type and range of activities available includes attendance at a day centre twice a week for one service user and going to Mencap. One hourly sensory sessions a week at college for two service users and for another service user twice a week. Other examples of activities identified on these timetables included lunch, coffee and walks out, activity box, story tapes, cinema or outing, train or bus trips, scrap books, memorabilia, music and personal choice. In respect of one service user, it was said this person did not like college and instead did jobs around the home and had 1-1 days either on a weekly or fortnightly basis. Information from senior managers advised that it was planned for this person to attend sensory sessions and they were looking into more swimming. It was also said that they were looking into doing chair exercises/movement to music and improve outings with a planned outing arranged to the Circus and an Airshow during the week. Examination of the overall timetable showed some gaps in recording as to whether activities went ahead or if alternatives were offered. This was raised with the senior Managers at the inspection to ensure the record was completed. It was also raised and suggested for the home to audit via their quality assurance systems and person centred planning forums the value, meaningfulness, enjoyment and benefit of certain activities for service users as next to an activity named as personal choice there was no further information to clarify the actual activity that had taken place. The home has pictorial notice boards in the main hallway identifying staff on duty and activities planned for the day. It was raised how for example a service user with a visual impairment would know about this and that the board may be positioned too high for some of the other service users to see it. Whilst looking around the home, it was seen how a service user had audio/story tapes Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: with sensory materials and it was said this person was supported by staff to use these. It was also said that there are plans for a service user to have their own activity board in their bedroom. There was evidence that monthly service users meetings were held, the last one being on 30/7/09 with minutes and pictorial photocopies available. This format may not necessarily be suitable for a service user with a visual impairment. It was identified that scrapbooks were being developed for service users to illustrate where they had been. One service user regularly visits their relatives at weekends and service users are supported to maintain contact with their families and friends. Annual holidays also take place. There is a menu board on display in the dining room showing the main meal for the day and a varied menu was evident. Weekly menu meetings are held and minutes taken. A selection of picture cards are used in supporting service users to choose the menu and meals for the week. It was said that staff choose on behalf of a service user with a visual impairment and for another service user who it was said cannot choose or say what they would like. Thus only two service users look at the food picture cards. There has been no overall view or advice sought about the menu from a Dietitian and it was recommended this be pursued. Shopping is done weekly and it was said that service users are occasionally involved but they are not very keen. Food preparation is primarily done by staff with two service users occasionally helping to prepare vegetables and one person bakes cakes on a Saturday. Records are kept of meals and alternatives offered and it was reported that takeaway meals occur fortnightly. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported in meeting their personal health care needs. A health action plan and some medication information requires review and updating in order to fully protect service users. Evidence: Information contained in the homes Annual Quality Assurance Assessment [AQAA] identifies that all service users have a health action plan in place, are registered with a General Practitioner and have access to other health and social care professionals as required. Individual health support needs are documented in service users plans of care. Other information identified in the Annual Quality Assurance Assessment [AQAA] indicates all service users need support with their personal care and all have specialist communication needs. One service users health action plan viewed and dated 10/8/08 showed that in April 09 the Community Learning Disability Team identified for the home to complete a new one. This was raised with senior Managers during the inspection to address. Further examination of this service users records showed evidence of appointments with health care professionals. The management and storage of medication was examined. Medication blister packs Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: are used and the storage of this was satisfactory. It was explained that two trained staff undertake the dispensing and administering of service users medication together. In the medication folder is a photograph of each service user. No service users currently self administer medication and no controlled drugs are used. It was confirmed by the senior member of staff on duty that all staff are trained in medication apart from two new people. Medication training is done in a variety of different ways through e-learning, the Pharmacist and folders. Medication audits are done weekly. Guidelines relating to two service users in the management of their epilepsy was viewed; one service users guidelines contained within a purse with their medication was dated May 2008 and required updating. Contained within the homes main medication file are service users medication recording sheets. In this file, a number of gaps were found in respect of updating information relating to When required [PRN] medication protocols as these were found to be dated May 2008. Profile information relating to all service users were dated June 2008. Epilepsy and Diazepam guidelines for a service user were dated May 2008. It was also noted that for the same service a record is not maintained on this persons medication charts when they have administered prescribed Thick & Easy drinks which a senior member of staff said was every day with all drinks. In addition to this some generic medication risk assessments required review as these were dated April and June 2008. The contents of this medication folder and service users epilepsy guidelines requires review and updating. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place to protect service users from harm and abuse. The management and recording of service users finances is to change to afford them increased protection. Evidence: Information obtained from the homes Annual Quality Assurance Assessment [AQAA] identifies that all staff are trained and up to date in the protection of vulnerable adults and provided with annual refresher training. It also says that staff have appropriate training in Whistle-blowing and the complaints procedure. The AQAA identifies that service users know how to complain and who to complain to and this is displayed and available in an easy to read pictorial and audio format. Service users all receive a copy of a booklet containing information about complaints, bullying, their rights and protection from abuse. The AQAA identifies that staff are aware of the importance of recording all complaints received from service users and others. Three complaints have been investigated over the last twelve months and no safeguarding alerts or referrals have been made. The AQAA identifies there are robust systems in place and risk management plans in safeguarding service users monies. It says service users have financial account booklets that are checked twice a day. Audits are carried out by the organisations auditor on an annual basis and the monthly regulation 26 reports requires checks of Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: service users money. Examination of the complaints book showed the action the home had taken in investigating complaints and it was evidenced that a pictorial complaint folder and audio version was available. The senior Managers at the inspection were aware of the need to update the complaint information in respect of a recent change in management and to include the Care Quality Commission [CQC] contact details. Examination of records relating to service users finances were difficult to navigate and track, however a senior Manager explained that the system is to change when the East Sussex County Council take over appointeeship for all service users via the Court of Protection. It was said each service user would have an individual account, although not a bank account. Currently a monthly breakdown of service users monies is received from the organisations head office showing income and benefits and this money is administered through petty cash. Each service user also has a transaction book showing regular checks kept of balances. It was however unclear from this as to the source of monies other than saying safe. This was raised with the seniors Managers at the inspection to address. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a comfortable environment. The organisation has identified areas around the home that they intend to address in terms of maintenance/repairs and decoration. Evidence: Several areas of the home were seen including communal areas, bathrooms and some service users bedrooms. The home is a purpose built bungalow that can accommodate people in wheelchairs. It was found to be clean and free from odours. Since the last inspection, fencing has been erected to divide and separate the car park from the homes main entrance. It was said that soft furnishings, pictures and a fish tank had recently been purchased for the lounge. This was a comfortable and well presented room. All bedrooms seen were satisfactory and personalised. Two bedrooms are currently vacant. There are some ceiling cracks around the home and it is known that ongoing discussions with the leaseholders of the property to address these matters are taking place. No further decoration to the property has taken place since the last inspection. The home has a separate laundry room and sluice room. A bathroom with adapted bath and a wet/shower room. The kitchen/dining area was satisfactory. A senior carer Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: advised the garden is not really used by service users because of the uneven ground. The home has instead set up a patio area at the front of the house. Replacement bamboo fencing has been erected where old fencing had fallen down in a section of the garden. The most recent Regulation 26 report showed that new flooring for the shower/wet room and kitchen is to be fitted. Information obtained from the homes Annual Quality Assurance Assessment [AQAA] indicates the home wants to identify and accomplish all maintenance works around the home including re-decoration of communal areas and bedrooms. Care Homes for Adults (18-65 years) Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by a supervised and dedicated staff team. Ensuring staffs training, development and recruitment information is kept up to date will further enhance and protect service users. Evidence: The Inspector met with a senior manager, a new assistant Manager and two staff during the course of the inspection. Three staff were on duty on the day of the inspection. It was reported there are usually three staff on each shift between Monday to Friday apart from Friday evenings when there are two staff because of a service user going home. At weekends it was said there would be two staff on each shift including a staff member covering a middle shift. The Annual Quality Assurance Assessment [AQAA] identifies there is now a full compliment of staff. The current issue with staff requiring a supplementary driving certificate and how this is to be resolved is identified under the Lifestyle section of this report. There was evidence that regular staff meetings had been held in previous months and the home use daily and night shift planners to document activities and actions each day. The home has introduced E.learning training for staff. A staff member advised this type of training could be done either an hour before or after a shift or at home. In the homes Annual Quality Assurance Assessment [AQAA] it identifies that with the new E-learning Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: training, careful planning is required to ensure all staff have the opportunity to access this within work time. The assistant Manager advised the overall training matrix for staff was being updated. The one available to examine showed a number of gaps in staffs training that did require updating. Individual staff records are also kept. Recruitment information examined for two recently employed staff were on the whole satisfactory. It was identified how for one person, the overall checklist was incomplete and their contract on file was blank and unsigned. Information relating to a Criminal Record Bureau [CRB] check that was not initially found was subsequently produced and confirmed as in order. The Annual Quality Assurance Assessment [AQAA] identifies all new staff are subject to a six month probationary period. Part of the recruitment and selection process involves service users being given the opportunity to meet prospective staff with interactions observed and noted by senior staff. The AQAA identifies that on commencement of employment all staff receive a written job description, Social Care Council code of practice, terms and conditions of employment, disciplinary procedure and complaints policy. Staff also receive an induction handbook that comprises of a twelve week induction which is based on the Skills For Care Common Induction Standards. The AQAA indicates that staff receive regular supervisions and yearly appraisals. A staff supervision matrix was available to examine showing dates of staffs supervisions. Five staff have a National Vocational Qualification [NVQ] in care at level 2 or above. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users health and welfare is protected. Prior to the inspection, there had been another change in the management of the home. Measures have been introduced to reduce the impact of the recent managerial changes. Further development and evaluation of quality assurance audits and systems is necessary. Evidence: Since the last inspection, it was reported the appointed Manager had left the organisation last week. The Inspector met with a new assistant Manager who had commenced working at the home in June 2009. A senior Manager from within the organisation also joined the inspection. The new assistant Manager reported she had been working in both homes on the same site doing shifts with an office day once a week and she had been the acting Manager for the last six weeks. Since the appointed Manager left last week, the assistant Manager said her office days had increased to three with two working shift days. A senior Manager at the inspection later clarified and confirmed that the organisation had appointed a new Manager for the home who was due to start around the 13th or Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: 14th Sept 2009. This senior Manager confirmed she would initially base herself at the home twice a week to support the assistant Manager prior to the a new Manager commencing in post and then change this to provide support one day a week. It was evidenced that monthly Regulation 26 reports and visits are undertaken with current action plans and dates to complete matters identified. A record is kept of accidents and incidents. The fire risk assessment dated as being reviewed in July 2009 was examined; some dates within this document showed they had last been reviewed in March and April 2008. This was brought to the attention of the senior Manager at the inspection to address. In respect of Quality Assurance systems. The assistant Manager explained she had devised a template questionnaire for service users but was not sure if there was one for relatives, professionals or staff and that questionnaires had not be sent out. Examination of a file showed that relatives questionnaires had been sent and returned in March 2009. Also questionnaires were seen as being sent to other professionals, however it was not clear when and which year these related to. In the same file were staff satisfaction surveys dated 12/12/08. There was no evidence to show how the information in this file had been collated, evaluated or action taken in respect of any feedback received. This was raised with the senior Manager at the inspection to address. Information taken from the Annual Quality Assurance Assessment [AQAA] identifies that the home complies with all safe working practices, guidance and legislation appertaining to Health and Safety, Food Hygiene, Manual handling, Fire Safety, First Aid and Infection Control. Care Homes for Adults (18-65 years) Page 27 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 28 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 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 6 The Registered Person should ensure all staff and Managers are familiar with the details contained in service users files and the information regularly reviewed,completed and acted upon as necessary. The Registered Person should take steps to ensure that if any form of restraint is used, it is agreed within a professional multi-disciplinary arena. The content of a service users care plan and risk assessment about the management of their behavior requires review under this principle. 2 12 The Registered Person should ensure that service users activity records are fully completed. The Registered Person should ensure that the type and range of activities for service users are person centred and regular reviews of these activities is undertaken to ensure they are meaningful and fulfilling. The Registered Person should ensure that further development is undertaken in supporting service users with additional disabilities and impairments so that they are Care Homes for Adults (18-65 years) Page 29 of 31 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 enabled to be actively involved in their daily living in a way that suits their individual needs and understanding. 3 20 The Registered Person should ensure the contents of the medication folder are kept up to date including service users epilepsy guidelines. The Registered Person should update a service users health action plan. The Registered Person should ensure a record of prescribed medication that is administered to a service user is recorded on their medication chart. 4 35 The Registered Person should ensure that staff training records and staff recruitment records are kept in order and up to date. The Registered Person should ensure that quality assurance systems are evaluated more robustly. The Registered Person should ensure the content of the fire risk assessment is accurate and kept updated. 5 6 39 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). 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