Inspection on 21/04/09 for Hunters Moon

This inspection was carried out on 21st April 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hunters Moon 24/04/08

Hunters Moon 05/12/06

Hunters Moon 03/05/06

Hunters Moon 21/10/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hunters Moon Grittleton Road Yatton Keynell Nr Chippenham Wiltshire SN14 7BH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Pauline Lintern     Date: 2 1 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Hunters Moon Grittleton Road Yatton Keynell Nr Chippenham Wiltshire SN14 7BH 01452300025 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) : Holmleigh Care Homes Ltd care home 7 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 7 The maximum number of service users who can be accommodated is 7. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Hunters Moon is one of a number of care homes owned by Holmleigh Care Homes Ltd, which operates in Gloucestershire and Wiltshire. It accomodates seven people. The home is located in the village of Yatton Keynell, close to Chippenham. Care Homes for Adults (18-65 years) Page 4 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This service was last inspected on the 14/04/2008. The unannounced key inspection took place on 21/04/09 between the hours of 9:30 am and 5:30 pm. The manager of Hunters Moon is Mr Philip Pedersen, who was available throughout the day to assist us. Mr Pedersen has not yet submitted his application to CQC to become the registered manager. We sent Mr Pedersen an Annual Quality Assurance Assessment (AQAA) to complete. This was the services own assessment of how well they are performing and it gave us Care Homes for Adults (18-65 years) Page 5 of 32 information about their future plans. Information from the AQAA is detailed within this report. As part of the inspection process, we sent surveys to the home for people to complete, if they wanted to. We also sent surveys to be distributed by the home to people using the service and staff members, care managers, GPs and other health care professionals. One staff member, three healthcare professional and one person using the service responded. The feedback received, is reported upon within this report. We reviewed the information that we had received about the home since the last inspection. We looked around the home and also looked at) a number of records, including care plans, risk assessments, health and safety procedures, staff files and training records. The pharmacy inspector looked at the arrangements for managing medication, within the home. We had the opportunity to meet with staff members in private, which enabled us to obtain their views on the service provision. At the last inspection 12 requirements and 14 good practice recommendations were made. Six of the requirements have been met in full, four are in good progress and two have not yet been actioned. The majority of the good practice recommendations have been addressed or are in good progress of being met. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visit to the service and takes into account the views and experiences of people using the service. What the care home does well: What has improved since the last inspection? What they could do better: The service user guides should be available to each person receiving a service and in a format, which makes sense to them. The Statement of Purpose must be updated to take into account any changes within the service, such as the name of the manager and contact details for CQC. Although good progress has been made with regard to improving care plans and risk assessments, they must be dated and signed to evidence that they are kept under review and agreed by all parties. Each person using the service must have strategies in place to minimise any potential Care Homes for Adults (18-65 years) Page 7 of 32 risk, which may affect them. These must be recorded, dated and kept under review. Where restrictions may be placed on someone living at the home, a risk assessment must be in place and agreed as part of a multi- disciplinary team. This requirement was set at the previous inspection and remains unmet in full. The home continues to use agency staff to cover permanent vacancies. The home should aim at reducing the numbers of agency staff by filling the permanent posts as soon as possible. The electric gates at the front of the house need to be replaced or repaired to ensure that people are kept secure and safe. The home does not currently have a fire risk assessment in place. All environmental risk assessments should be signed and dated by the person who completed them. Mr Pedersen must submit an application form to CQC to become the registered manager of the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home need to update the Statement of Purpose and ensure that the Service User Guide is in accessible formats to meet the needs of the people living at the home. All people who use the service have lived at Hunters Moon for a number of years. It was therefore not possible to look at the admission process in practice. This judgement has been made using available evidence including a visit to the service. Evidence: Mr Pedersen reported that the Statement of Purpose and Service User Guide are both in need of updating. He confirmed that since being in post, he has focused on further developing care documents in the first instance and will update the Statement of Purpose and Service User Guide as soon as possible. We discussed how he may be able to develop the Service User Guide into a format, which makes sense to the reader. Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: Within our surveys we asked if people were asked if they wished to move into the home and if they received enough information about the service. Comments included; no, my mother was told there were no day care centres that were suitable for me, leaving my mother with no option but to agree to shared care, which very much upset my mother and myself, I did not receive information about the service. The social worker chose Hunters Moon for me. There have been no service users admitted since the last inspection. Previous inspections have found that the home has ensured service users needs and aspirations had been assessed prior to admission. At the last key inspection, this standard was judged as good. There has been no information to conflict with this view. Based on this, we have made a judgement, that the assessment process would ensure the service could meet the persons needs. Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall care plans and risk assessments have improved since our last visit to the service. However, care plans must be signed and dated and agreed by all relevant parties. Care needs to be taken to ensure that risk assessments are kept under review and that all potential areas of risk assessed, recorded and reviewed. The further development of aids to communication would empower people to make decisions about the way they choose to live their lives. This judgement has been made using available evidence including a visit to the service. Evidence: As part of the inspection process we sampled two care plans. Plans are now much more ordered and information is easier to locate. It was evident that Mr Pedersen and Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: the staff team have worked hard to improve the format of the care plans and risk assessments. Care plans are divided into separate plans, which cover all aspects of the persons life, such as environment, mobility, eating and drinking, emotional, daily living skills, communication, social skills, health, medication, cultural needs, personal hygiene, behaviours, finances, activities, accommodation, and transport. We noted that although care plans are in place they have not been dated or signed. We asked Mr Pedersen to ensure that all care plans are dated and signed and kept under review. Mr Pedersen reported that he was just waiting for the relevant people to visit the service so that they can read and agree each plan. Person Centred Planning work books are now in place for each person living at the home. The work books provide information on the persons circle of support (this is means people who are important to the person), what people like and admire about the person, how they communicate and how people should respond to them, what they understand and what they like to do in the evenings for fun, holidays and within the home. It records hobbies, foods they like and dislike, preferred routines such as time for getting up and going to bed, how they choose to celebrate, how they look after themselves, changes they would like to make, hopes and dreams, what is important to the person and the support they require. The last section records how the person can get ready for their next meeting. This includes my meeting action plan and possible questions they may wish to ask at the meeting. Each person is having a Person Centred Planning file developed. This includes a one page profile, which highlights important things about the person. It explains to the reader how the person communicates. One file states I can indicate if I am happy or sad and dont want to do anything, I do this by XYZ. There is a section within the file, which has photographs of associated objects. This may include photos of meal times, fruit, going out, their bed, bath, beanbag, going out boots etc. Staff members explained that they are in the process of taking photographs of all events and objects of reference to use to aid communication. A good practice recommendation was made at our previous visit to the service. This related to staff members attending training in Person Centred Planning. Mr Pedersen confirmed that both he and his deputy are receiving this training, which will enable the information to be filtered down to the staff group. At our last visit to the service we required that any incidents be fully recorded detailing interventions and outcomes. Mr Pedersen confirmed that this is now recorded both on the incident forms and within the daily records. They have also introduced monthly service reviews. The key worker completes the service reviews monthly. They provide a record of events/incidents that have occurred throughout the month. Mr Pedersen reported that this can provide an audit trail of events/behaviours, which may be shared with the visiting consultant psychiatrist. Mr Pedersen confirmed that the home now ensure that care managers are kept Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: informed of any events, which may affect their clients. Care managers confirmed that the information flow between them and Hunters Moon has improved. We noted that many risk assessments were in need of being reviewed, dated and signed. Mr Pedersen confirmed that he was working through them. Although two requirements relating to risk assessments, set at our last visit have been completed, we noted that for one person travelling in the car may pose a risk and this had not been assessed for this particular person. Therefore this must be actioned. We asked Mr Pedersen to ensure a risk assessment is completed for the person, who has restricted access to their en-suite and that this is agreed by all relevant people, recorded and kept under review. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are encouraged and supported to attend educational and social activities, if they wish to do so. Peoples rights and responsibilities are respected. Links with families and friends are maintained, if appropriate. This judgement has been made using available evidence including a visit to the service. Evidence: The home has three vehicles available, which enables them to access the local and wider community. Some people living at the home attend local Colleges. One person told us that they enjoy their College sessions. Mr Pedersen reported that they are working towards ensuring that everyone goes out every day. He added that some Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: people living at the home prefer to go for walks and car rides. On the afternoon of our visit one person was going swimming with three staff to support them. At our previous inspection we recommended that the people who remain at the home for the weekend, be offered opportunities to get out and about more as we saw little evidence that this was happening. Mr Pedersen reported that this has now improved as they ensure that there is always a driver on duty over the weekend, which makes it easier to arrange trips out. The deputy manager told us that he had been looking at other opportunities, which may be available for the people using the service. He had explored watching motor bike racing, speedway and dog racing. They had discussed which activity would suit each individual and which would be most appropriate to each persons likes and dislikes. One person using the service had been to the theatre to see The Blues Brothers, which staff said they appeared to enjoy, especially dressing up. Plans are also in place for another person to go to the theatre in Bristol. Mr Pedersen explained that they are planning to develop learning logs for each person living at the home. This will enable him to evaluate how successful or not each activity has been for the person participating. Daily diaries indicate that people are supported to keep in touch with their families and on trips home. One person told us that they would be visiting their mother the following weekend. Within our surveys we received the following comments, staffing and management changes have influenced behaviours and impacted on support levels for activities last year, hopefully X will remain at the home for some time and build on the strengths of the team he has inherited, I would like to see childrens DVDs, not have to watch television and I hope staff treat X well but I can see when staff bring X home that there are some people X likes and some X does not like. One health care professional commented in their survey they actively promote choice, and encourage community participation. Peoples rights and responsibilities are respected by the staff team. If someone does not wish to join in an activity this is respected. We observed staff members interacting with the people using the service and respecting when they chose to be alone. The conservatory is an area where one person chooses to spend time alone. Some progress has been made towards making menu planning more accessible to the people living at the home. For example photographs are being taken of different meal options, to enable people who cannot vocalise to pick their meal preferences. Menus sampled indicated that people are provided with varied and healthy food options. Within our surveys we did not receive any negative comments regarding the food provided by the home. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans now contain more detailed information on how peoples personal and healthcare needs are to be met. However, management plans and specific health profiles must be kept under review and risk assessed if appropriate. Evidence shows that advice and guidance is sought from healthcare professionals. People are protected by the procedures for the handling of medicines in the home, however the records of medicines must be maintained when they are taken away from the home. This judgement has been made using available evidence including a visit to the service. Evidence: One health care professional commented within our surveys the staff are aware of privacy and dignity issues and in practice they have been observed during my visits to hold these values highly in relation to caring for the people in their care. Care plans now provide information on how the person using the service prefers to have their Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: personal care delivered. One sampled file states X is independent when getting in and out of the bath. Staff are to allow X personal time when they are in the bath. Staff are to stay outside the bathroom. Staff are to use hand over hand support when offering support to X with washing and cleaning teeth. We noted that a risk assessment was in place relating to this activity, however it was due for review on 9/2/09 and we saw no evidence to confirm that this had been carried out. Another persons file states that X will push the staffs hand away when they have had enough interaction. One plan states X has autism and does not like crowds, however they enjoy regularly attending the hairdressers. We sampled one persons file and it contained an epilepsy profile, which shows the review date as 8/8/08. There was no evidence to show that this had been completed and there was no risk assessment in place to support this plan. Mr Pedersen explained that he was aware of the need for some epilepsy management plans to be reviewed however he was waiting for the relevant health care professionals to visit the home and complete the plans. We asked Mr Pedersen if people living at the home have health Action Plans. He confirmed that this had been discussed with the Nursing team, who confirmed that a new form is currently being developed and will be completed as part of the review process. All health care appointments are recorded within the appropriate care plan. Records show that the home has regular input, support and guidance from the Community Nurse, Consultant Psychiatrist and other health care professionals. During our site visit we were able to speak to one visiting community nurse. They spoke positively about the care being provided within the home and the staff members. She commented staff would ask for advice if they needed it, interactions are positive. Staff know what the parameters are for X. Mr Pedersen confirmed that all staff members attend training in manual handling during their induction period. Staff that we spoke to later confirmed this. Within our surveys we received the following comments relating to healthcare needs, health care needs are always met; they strive to meet health care issues, especially around the service user I am involved with, the home demonstrate they actively seek advice from professionals involved in the home, because of the nature of the care and the complexity of the individual cared for, health care needs are sometimes met by the service. The staff do not always have the skills necessary to provide care in a person centred way. They are open to advice and endeavour to act upon it and they seem to Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: manage most behaviour well and always try to treat the person as an individual living in their own home. They work well with parents wherever possible and involve themselves closely with adapting practices which work for individuals. Within the AQAA it states that the homes plan for the next twelve months is to to work with the local team on Health Action Plans, to include annual health check by G.P. and to ensure that professionals are involved in confirming or updating the care provision for each person in the home. Our pharmacist inspector looked at all the medication arrangements in the home. Medicines are stored securely, however the correct bolts must be used for the controlled drug cupboard to ensure that it meets current legislation. One medication was seen that was prescribed as directed. The correct dose was available in the care plan but not on the medication administration record. All people who have medication prescribed as required have a care plan for the safe and effective use of that medicine. The home has links with healthcare professionals including the nursing team who administer an injectable medicine to one of the people in the home regularly. All staff who administer medication have received appropriate training and information about medication is available to them. Medicines are recorded on receipt and return and regular audits are done. Some people stay away from the home with family on occasions and there is currently no system to record the medicines they take with them or return. Records are kept of a medicine that is used for emergencies that is taken out of the home with people who need it and is returned with them. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service have their complaints and concerns listened to and acted upon. Staff members receive training in the protocols to follow if they suspect any form of abuse may have taken place. This judgement has been made using available evidence including a visit to the service. Evidence: The home has a complaints policy in place, which is in a pictorial format. This had been updated in January 2009. Mr Pedersen explained that he is introducing a new process for raising any concerns. This will include photographs of the person being supported and provide a photograph of their named person to go to if they are unhappy. Mr Pedersen showed us an example of the form, which uses clear pictures and is more personalised. Within our surveys one health care professional reported that the service always responds appropriately to any concerns raised. The remaining two commented that they usually do. One comment included the service has mostly responded when concerns have been raised about care issues. One person using the service commented in their survey no, I do not know how to make a complaint. Provided my Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: mother has worked out that something is wrong then she can protest. We spoke to two people using the service during our visit and both confirmed that they are happy living at Hunters Moon. Within the AQAA the home states that they do the following well, have a complaints procedure is in place which is in more than one format, take seriously the views of service users and their families, ensure all staff are trained in the provision of Protection (POVA finance etc), use the appropriate process to report incidents, ensure investigations are carried out and outcomes followed through, operate a No Secrets policy, operate a Whistle-blowing policy and have Service User meetings. The home is signed up to the local Swindon and Wiltshire protocols for safeguarding people. Each staff member has the opportunity to attend safeguarding training. Staff members that we spoke to confirmed that they had received training in safeguarding and had seen the No Secrets guidance. The home has a whistle blowing policy. As part of the inspection process we sampled the arrangements for holding money on behalf of the people living at the home. We looked at transaction records and cash held within the home. We found this to be properly managed. Mr Pedersen confirmed that cash is checked against record sheets three times a day. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a homely, clean and hygienic home for the people living there. However, failure to repair or replace the electric gates could jeopardise the security of the home. This judgement has been made using available evidence including a visit to the service. Evidence: As part of the inspection process we toured the premises, which included communal areas and peoples bedrooms. One person living at the home kindly agreed to showing us their bedroom themselves. They told us that they were happy with their room. We noted that bedrooms have been personalised with photographs, soft toys, ornaments and posters. People have televisions and music centres in their rooms if they wish to do so. One persons bedroom has been decorated with large hand painted murals. Mr Pedersen reported that the acting deputy manager is a qualified art therapist and he had undertaken the murals. At the time of our site visit the decorators were at the home, painting a bedroom. Mr Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: Pedersen confirmed that the person had chosen the colour themselves and the painters confirmed that they had brought in colour charts for the people at the home. There is a large conservatory, which has bean bags and soft armchairs. There are an electric organ and music centre and bubble lamps and soft mats. It was noted that one roller blind in the conservatory needed replacing as it was badly soiled. Mr Pedersen confirmed that he was planning to have other areas of the home redecorated. He added that he has plans to purchase further equipment for the garden, such as a trampoline and swings etc. Mr Pedersen reported that he has arranged for each person using the service to have a sensory assessment carried out by the occupational therapist, to explore aids which may be available to suit individual needs. We noted that the electric gates were open on our arrival. We asked the manager why this was and he confirmed that the gates are broken. He added that they have attempted to repair them but unfortunately even though they have already paid out a large amount of money for work carried out, they still do not work. Mr Pedersen explained that people remain safe as the front door is always locked with a key code and the side gate is always bolted. We asked Mr Pedersen to ensure this is addressed as soon as possible. We found bathrooms and toilets to be clean and hygienic. However the bathroom downstairs was particularly damp, which appeared to have lifted the flooring slightly. There is an extractor fan in the room but it did not appear to be working efficiently. Mr Pedersen confirmed that they are waiting for builders to confirm what can be done to alleviate the problem. It was noted that a box of protective gloves were stored in close vicinity to the toilet. We asked the manager to find another place to site the gloves to avoid risk of cross infection. Anti bacterial hand wash was available through out the home. The home has a separate laundry, which houses a new commercial washing machine and a drier. All toxic materials were found to be stored securely. Accompanying data was available. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Due to the location of the home, recruitment can be an issue for the home. This therefore impacts on the amount of agency staff, which is used. Records demonstrate that people are recruited, inducted and trained properly. This judgement has been made using available evidence including a visit to the service. Evidence: Mr Pedersen confirmed that typically there are five staff members on duty during the morning, five in the afternoon and one person working a middle shift. This does not include the manager himself. During the night hours there are two waking night staff and one staff member sleeping in. We discussed the difficulties that the home experiences with recruiting new staff. Mr Pedersen reported that there is not a reliable bus service to the village and if staff are not drivers this can also impact on people applying for vacancies at the home. This said the manager explained that some of the bank staff are ex- employees of the home so are very knowledgeable about the needs of the people they support. He confirmed that they also ensure that any agency staff they use are qualified and Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: competent to meet the complex needs of the people living at the home. Within the AQAA it states that over the last twelve months the home has improved by, now having a management team in, by having an increased number of permanent staff and by reducing the number of shifts covered by bank and agency staff. Mr Pedersen explained the induction process to us. He told us that inductions run every month for one week. New staff spend one week at the home and the other week is spent at the head office, where they complete all their mandatory training such as , safeguarding, health and safety, fire awareness, manual handling, basic food hygiene and infection control. The training is provided by an external trainer. Medication training is provided by Boots. Training is also provided in specific areas such as rescue medication and physical intervention. One staff member told us that they attend regular refresher training in the use of non violent physical intervention. Within the AQAA it states that plans for the next twelve months are to ensure that all staff undertake a National Vocational Qualification (NVQ) at level 2, 3 or 4. However, some long serving staff members are reluctant to do this qualification. We sampled recruitment files and saw that staff are properly recruited and all safeguarding checks are carried out prior to commencing employment. At least two satisfactory references are sought and copies of identification are kept on file. Within our surveys we received the following comments relating to staff skills there are some staffing issues re: training and retaining skilled staff, the service could do better by providing more trained staff to deal with the service users individual needs, they appear to represent the needs of the service user we find in relation to their needs and those of the others in the home who have more severe challenging behaviours, there are a number of complex individuals living at the home- the staff appear to be able to respond to different needs of individuals and they appear to have a good insight into skills required to meet peoples needs. One staff member told us we are now finally getting there. Since Phil (Mr Pedersen) came aboard, we have started to turn things around, attitudes are changing to enabling people instead of parenting them. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The appointment of a new manager has been received positively by staff members. The home is continuing to develop ways to ensure that peoples views are listened to. Policies and procedures ensure that the health and safety of people living at the home is promoted. This judgement has been made using available evidence including a visit to the service. Evidence: Mr Pedersen has been in post since December 2008. He has many years experience working across the care sector, both as a placement officer and as a manager. Mr Pederson has a social work qualification. He has not yet undertaken his Management and leadership qualification. It is evident that since being at the home the manager has made many changes and developed new ways of working. This includes care plans and risk assessments and Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: working with a person centred approach. Mr Pedersen was observed interacting positively with the people using the service and staff alike. We require Mr Pedersen to submit his application to become the registered manager to CQC without delay, as he has now been in post for over three months. Mr Pedersen explained that Holmleigh care carry out customer satisfaction audits at least once a year. We were unable to sample any responses during our visit, as the manager explained they would be kept at head office. The Organisation has now recruited a quality assurance manager. Their role is to carry out monthly management reviews of the service being provided. We sampled completed audits, which cover the National Minimum Standards. Since being in post Mr Pedersen has introduced regular residents meetings. He reported that they have been very successful so far, with people contributing to the discussion more than he would have expected. Minutes are kept of all the meetings. Health and Safety policies and procedures are in place, which ensures that regular checks are carried out. The manager explained that he is planning to allocate health and safety tasks to designated members of staff, such as fire, infection control etc. Records demonstrate that checks are carried out on hot water outlets and fridge /freezer temperatures. All radiators are guarded to prevent people from scalding. The home has a current certificate for the testing of small electrical appliances and a current gas safety certificate. We noted that environmental risk assessments are in place and have been reviewed; however they do need to be signed off by the manager. The fire log book needs some attention. Mr Pedersen reported that he is in the process of updating the fire risk assessment. We asked that this be completed as soon as possible to comply with the Regulatory Reform (Fire Safety Order) 2005. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 1 5(a-f)(2) The registered person must 24/07/2008 ensure that each person living at the home has a copy of the service users guide in a format, which makes sense to him or her. The registered person must ensure that all risk assessments are kept under review and are signed and dated. 24/06/2008 2 9 13(4)14(b) Care Homes for Adults (18-65 years) Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 You must ensure that each 24/06/2009 person living at the home has a copy of the Service Users Guide in a format, which makes sense to them. To provide access to information. 2 6 15 You must ensure that all care plans are signed, dated and agreed with all relevant people. To ensure that peoples needs are being met. 24/06/2009 3 9 13 You must ensure that all 24/05/2009 potential risks to people using the service are identified, assessed, recorded and dated and kept under review. To minimise any potential risks. 4 9 12 You must ensure that any restrictions of liberty are agreed as part of a multidisciplinary team; risk 24/05/2009 Care Homes for Adults (18-65 years) Page 29 of 32 assessed, recorded, dated and kept under review. To minimise any potential risks. 5 19 13 You must ensure that each person with epilepsy has a risk assessment and epilepsy profile completed, dated and signed and that this is kept under review. To minimise any potential risks. 6 19 13 You must ensure profiles for the management of behaviours are updated and kept under review. To ensure peoples health care needs are met. 7 20 13 Medicines that people take 08/06/2009 with them when staying away from the home must be recorded when leaving and returning. This will ensure that a complete audit trail is maintained. To safeguard people 8 37 8 You must submit an application to the Care Quality Commission to become the registered manager of the home. 27/06/2009 24/06/2009 24/06/2009 To comply with regulations 9 42 12 You must ensure the home has an updated fire risk assessment, which is dated and signed. 27/06/2009 Care Homes for Adults (18-65 years) Page 30 of 32 To comply with legislation. 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 2 1 20 The Statement of Purpose should be kept under review and updated when changes occur. dditions to the medication administration record can be made if they are signed, dated and checked by two members of staff, and can be evidenced back to the prescribers instructions. All environmental risk assessments should be agreed and signed by the manager or the person who completed them. 3 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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