Inspection on 25/06/09 for Little Oaks Residential Home

This inspection was carried out on 25th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Little Oaks Residential Home 13/10/08

Little Oaks Residential Home 21/04/08

Little Oaks Residential Home 04/10/07

Little Oaks Residential Home 25/07/06

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 16/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Little Oaks Residential Home 22 Bridgwater Road Taunton Somerset TA1 2DS     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: kathy McCluskey     Date: 2 5 0 6 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: Little Oaks Residential Home 22 Bridgwater Road Taunton Somerset TA1 2DS 01823322427 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: pam.degun@tiscali.co.uk Mrs Parminder Kaur Degun care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 5. The registered person may provide the following category of service only: Care home providing personal care 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 Little Oaks Residential home is a two storey detached bungalow dating back to the 1930s. The home is situated in a residential area of the town and is a short walk from local shops. There is adequate parking and good sized gardens. The home is registered with the Care Quality Commission (CQC) to provide personal care for up to five people with learning disability between the age of 18 and 65 years. The home is not registered to provide nursing care. The registered provider is Mrs Parminder Degun and the Registered Manager is Dawn Berry. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 5 1 3 1 0 2 0 0 8 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 unannounced key inspection was conducted over one day (5hrs) by regulation inspectors Kathy McCluskey and Jane Poole. This key inspection was brought forward to check how the home was being managed in the absence of the registered manager and to follow up on the quality of the service provided following a recent service review conducted by the Local Authority. The registered provider was available throughout this inspection. We were able to meet with four people using the service and spoke individually with four care staff. All records required for this inspection were made available to us. We would like to thank everybody involved for their time and cooperation with the inspection process. Care Homes for Adults (18-65 years) Page 5 of 31 The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Adults (18-65 years) Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The overall management of the home needs some improvements to ensure that people benefit from a well run home and so that staff ensure that care is delivered in a consistent manner in line with peoples assessed needs. Risk management procedures also need improvements. When we examined care plans we found that one in particularly required a number of improvements to ensure that care could be delivered in line with the individuals assessed needs. On speaking to staff it was apparent that care was not being delivered in a consistent manner. It was also apparent that the individual was not receiving the structured routine that they had been assessed as needing. A behavioral support plan did not contain sufficient information for staff on how periods of challenging behavior should be managed. We also found that physical interventions had been used when this had not been agreed for the individual and not all staff involved in these techniques had received training in physical intervention. We were informed that risk assessments were in the process of being completed though none were in place for those with an assessed need. The home needs to ensure that care plans are produced in an accessible format for each person using the service. Daily entries made by staff in care plans need to contain Care Homes for Adults (18-65 years) Page 7 of 31 reference to the outcome of an event or activity for the individual. We were informed that three people had keys to their bedrooms and were able to access their rooms independently. The home needs to review the restrictive practice of staff locking the bedroom doors for those people who cannot access them without staff assistance. The homes procedures for the management and administration require some improvements. Medicines not longer in use or no longer prescribed must be returned to the pharmacy. Where as required medication is being used on a regular basis, this should be reviewed with the individuals general practitioner. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home and services offered is available to people who are thinking about using the service so that they are able to make an informed decision about moving to the home. The service user guide has been updated so that it is more accessible to people using the service. The home has procedures in place to ensure that people are assessed before a placement is offered although there have been no admissions since the last inspection. Evidence: The home have produced a Statement of Purpose and Service User Guide which provide information about the home and the services offered. Since the last inspection the Service User Guide has been updated and is now available in a pictorial format which makes it more accessible to people using the service. This has recently been completed and we were informed that a copy would be given to each person using the service. Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: The group of people using the service has remained stable for some time and there have been no recent admissions to the home. This being the case, not all standards could be assessed. The homes pre-admission assessment procedures ensure that an assessment of an individuals needs would be carried out before a placement is offered. Part of the pre-admission process includes visits to the home and a trial period on admission. We spoke with staff about meeting the different needs of people using the service and no concerns were raised with us. We spoke with three recently appointed staff and they confirmed that they were never asked to undertake a task that they hadnt been trained to do. Existing staff told us that they were able to meet peoples needs and that the provider was proactive in arranging more training for them. Records examined confirmed that of the 8 permanent care staff employed, 5 had received the following specialised training; Autism, intervention planning and challenging behavior. We were informed that training in caring for people with a learning disability had been arranged for all staff in August of this year. We were also informed that the 3 most recently employed staff would be undertaking training in intervention planning. Two of these staff have also completed deprivation of liberty training. One carer has completed an NVQ2 in care and four are working towards this award. We were informed that the three most recently employed carers were soon to be registered. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes care planning procedures need improvements so that they are fully reflective of peoples needs and so that care can be delivered in a consistent manner. The home also need to ensure that care plans are more accessible to people using the service. The home must ensure that appropriate risk assessments are in place for those individuals with assessed needs so that they can be supported to take informed risks as part of an independent lifestyle and that any risks to individuals or others are minimised. People have access to a range of health care professionals thus ensuring that their health care needs are met. Procedures are in place for the management of peoples finances but these could be further improved through the risk assessment process. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: We examined three care plans at this inspection. Care plans had been signed by each individual using the service but, given the format of the homes care planning documentation, it could not be evidenced that the individual would fully understand what they were signing. It has been recommended that the home considers implementing a simplified care plan which is produced in a format appropriate to each individual. This would give people the opportunity to take ownership of their plan of care and would also help to ensure that individuals understood how staff would support them. Staff record daily entries for each person. On a separate page, staff record any activity/outing that a person has had. Regular entries are also made by the individuals key worker on a different page. We found that entries only focus on the task/activity undertaken and did not make any reference to whether or not it was enjoyed by the individual or whether there were any positive or negative outcomes. A recommendation has been raised. We examined a care plan and behavioral support plan for an individual who exhibited periods of challenging behavior and we found a number of shortfalls. Whilst identifying certain triggers the plan did not provide staff with sufficient detail as to how a situation should be managed. We spoke with a number of staff and it was apparent that there was not always a consistent approach being taken. We also found that in the last three weeks there had been 6 completed incident reports relating to the individual some resulting in risk to other people using the service and staff. Incident reports made reference to the individual having been restrained, but we found no agreement or protocol for this. This plan also identified the need for a structured routine for this individual, but we were unable to see evidence that this was in place. Within the plan we found a pictorial day planner but we were informed that this is not currently used for the individual. A requirement has been raised that care plans are fully reflective of peoples assessed needs and that there are clear instructions for staff as to how any challenging behavior is managed. We have also required that care is delivered in line with assessed needs. This relates to the individual who was assessed as requiring a structured routine. Staff informed us that they were, on occasions, having to physically assist one individual to get out of bed in the mornings but we found that this was not included in the plan of care. On the day of this inspection people using the service were taken on a trip to Minehead. We were informed that this had not been pre-planned but was an off the cuff trip. The home needs to consider the impact this may have on individuals who need a structured routine. We were unable to see that risk assessments had been completed for individuals where there was an assessed need. We discussed this with the registered provider who informed us that this was in the process of being completed. Personal belongings and some furniture had been removed from one individuals bedroom. We were Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: informed that this was to prevent the individual harming themselves or others. We were told that the individual had thrown items down the stairs or out of the windows. A safety plan had recently been developed but this only identified what had been removed and why. When we discussed this with the staff member, it was evident that there were no systems in place to ensure that this was reviewed and no plan as to how items would be introduced back into the individuals bedroom. We found peoples bedroom doors had been locked. On discussion we were informed that 3 people had their own keys and were able to access their rooms independently. The remaining 2 people were dependent on staff to open their doors. We were informed that bedroom doors were kept locked to prevent one individual from entering them and either damaging property or urinating. Risk assessments and care plans were not in place. We have made a requirement that this is completed within a given timescale to ensure that people are appropriately supported to take informed risks and that action is taken to minimise identified risks and hazards. Care plans contained evidence that people had access to a range of health care professionals. We found appropriate records and monitoring sheets in place for an individual with nutritional needs. We were informed that the home assists three people to manage their personal monies. Money is kept in a locked cupboard and each person has an individual wallet. Individual records are maintained for each person. Records of transactions had been signed and receipts had been obtained for all withdrawals from cash point machines. We were informed that these transactions are then checked against bank statements. The risk assessment and care planning process must also include information about the amount of assistance required by individuals and details about the use of cash point cards. We were informed that balances are checked at the end of each shift. At the last inspection, we were provided with evidence that balances and transactions had been checked by an external auditor. The home has procedures in place for staff relating to confidentiality. This is also covered in the staff induction programme. We found all records pertaining to people using the service to be appropriately stored. 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. People are supported to access the local community and are offered opportunities for trips outside of the home and annual holidays. The home could further improve opportunities for people to develop or maintain independent living skills. The home needs to review the restrictive practice of locking bedroom doors for people who are unable to access them independently. Evidence: We were informed that one person using the service was supported to maintain employment in a local supermarket. Another attends workpower placement. We were informed by staff that some people using the service do the weekly shop with them though staff are responsible for the cooking of meals. We were also informed that Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: laundry duties are undertaken by staff and that night staff do the cleaning. Care plans examined did not contain information as to how people would be given opportunities to develop and maintain independent living skills. We were able to see evidence that people are supported to access the local community. We were informed that the provider is currently reviewing staff shift patterns to enable a more flexible approach to leisure time. This year everybody using the service was taken on holiday to Cornwall and we were informed that this was enjoyed by all. We were told that people are supported to pursue their own hobbies and interests. As previously mentioned in this report, three people using the service have a key to their bedrooms and are able to access their rooms independently. The other two rooms are locked by staff and people are unable to access their rooms without staff assistance. The rationale for this restrictive practice must be reviewed through the homes risk assessment procedures. Care Homes for Adults (18-65 years) Page 16 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. People require minimal staff support to meet their personal care needs though the home needs to ensure that assistance is offered in line with the plan of care. The home ensure that people have access to a range of health care professionals. The homes procedures for the management and administration of peoples medication are generally good. Evidence: We were informed that the majority of people using the service did not require staff assistance to meet their personal hygiene needs. Care plans contained details as to the level of support needed. As previously mentioned in this report, we found that a care plan was not fully reflective for one individual. This related to staff, on occassions, having to physically assist one individual out of the bath. A requirement was raised. We were informed that people make choices about what time they get up and go to bed. Care plans contained evidence that people have access to a range of health care Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: professionals. We examined the homes procedures for the management and administration of peoples medication. We were informed that one individual is supported to self medicate. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). We examined all available MAR charts and found these to be appropriately completed. We did note that one individual was receiving an as required medication on a regular basis though the rationale for this could not be ascertained. This needs to be reviewed. We also found a bottle of lactulose for one individual which had not been identified on the MAR chart. We were informed that this was because the individual had been prescribed an alternative medication. The home must ensure that medicines no longer in use are returned to the pharmacy. We were informed that staff involved in the management and administration of medication have received up to date training. This was confirmed by staff spoken with and certificated evidence was available in staff files examined. Care Homes for Adults (18-65 years) Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an appropriate complaints procedure in place which is in an accessible format for the people living there. The majority of the staff team have completed training in the protection of vulnerable adults and training is currently being arranged for the two most recently employed staff members. People could be at risk as some staff have been involved in physical interventions with an individual when they have not received appropriate training. Evidence: The home have produced a complaints procedure which is displayed within the home and in peoples bedrooms. The procedure has been produced in symbol format so that it is accessible to people using the service. The home have not received any complaints since the last inspection though we were able to see evidence that a staff disciplinary/grievance had been fully implemented through the homes procedures. No formal complaints have been investigated by the Commission since the last inspection. The Commission are currently involved in a safeguarding investigation instigated by the local authority. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: Training records made available to us confirmed that 6 of the 8 care staff employed have completed training in July 2008 and February 2009 in the protection of vulnerable adults. Training is in the process of being arranged for the 2 remaining staff who have recently been employed. This was also confirmed by the four staff spoken with at this inspection. Staff spoken with during this inspection demonstrated an awareness of the whistle blowing procedures and of the external agencies that can be contacted. Staff confirmed that they would not hesitate in raising concerns with the Commission if they had any. On discussion with staff and on examination of training records, we found that staff were involved in physical intervention techniques when they had not yet received training. Action must be taken to address this. Care Homes for Adults (18-65 years) Page 20 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. The home provides basic but comfortable accommodation for up to five people. Each person has their own bedroom which they can personalise. The standard of cleanliness is good and appropriate procedures are in place to reduce the risk of the spread of infection. Evidence: The home accommodates five males. There is one communal lounge/dining area and a small kitchen. The home is not fitted with any aids or adaptations. Given the size and layout of the home, it would not be appropriate for people with mobility difficulties. Four bedrooms are located on the ground floor and one on the first floor. This bedroom is accessed via a steep staircase. Bedrooms are fitted with locks which can be overridden by staff in the event of an emergency. One bedroom has en-suite toilet and shower facilities and one has the provision of a toilet. There is one communal bathroom/toilet which is located on the ground floor. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: There is a good sized garden to the rear of the property and there is parking for two cars at the front of the house. CCTV cameras are located to the front and rear of the property and this does not impinge on the privacy of the people using the service. The home has laundry facilities and we were informed that all cleaning and laundry duties are undertaken by staff. We found staff hand washing facilities to be appropriately sited and there were adequate supplies of liquid soap and paper hand towels. During this inspection we viewed communal areas and two bedrooms. All areas were clean and free from malodours. The home has a routine programme of maintenance in place. Care Homes for Adults (18-65 years) Page 22 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. Staffing levels are appropriate to the needs of people using the service. The home follows robust staff recruitment procedures that reduce the risk of harm or abuse to the people living there. Newly appointed staff follow an appropriate induction programme. A training programme is in place and this will ensure that staff receive the skills needed to meet the needs of people using the service. The home needs to aim for at least 50 of the workforce having achieved a minimum of an NVQ2 in care. Evidence: At the time of this inspection 5 people were living at the home. We were informed that there is a minimum of 2 care staff on duty during the day and a waking carer at night. In the absence of the registered manager, the provider is currently at the home during the week in addition to the care staff. We were informed that staffing is increased as required to meet the social needs of people using the service. We were also informed that less experienced staff are always on duty with staff who are more experienced. On the day of this inspection 3 carers were on duty and an additional carer was allocated to spend one to one time with one individual using the service. Recently Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: appointed staff informed us that they were always on duty with more experienced staff member. One staff member working on a POVAFirst, pending a full CRB, works in addition to the care hours. We spoke to four staff during this inspection and no concerns were raised about staffing levels. Staff were also positive about the on-call procedures in place. All staff are issued with a job description and those spoken with were clear about their roles and responsibilities. We looked at the homes procedures for staff recruitment. Five care staff files were examined. Each file contained all required information. We were able to see evidence of appropriate Criminal record (CRB) and protection of vulnerable adults (POVA) checks. Risk assessments were in place for staff working on a POVAFirst and there was evidence that these staff are supervised pending a full CRB. We were able to see that staff undertake an induction programme on commencement of employment. Following an in-house induction, staff follow the Skills for Care common induction standards. Staff files contained evidence of regular formal supervision and appraisals. Staff told us that they felt well supported. All staff spoken with were positive about training opportunities at the home and described these as much improved. We were provided with a training matrix and we were also able to see certificated evidence of training achievements in staff files. This told us that of the 8 care staff employed, 5 have been completed training in autism, 5 in intervention planning, 5 challenging behavior, 6 POVA/abuse, 5 moving and handling, 5 first aid, 5 food hygiene, 8 fire safety, 6 medication, 1 carer has completed an NVQ2 in care and 4 staff are currently working towards this award. The National Minimum Standards recommend 50 of care staff hold a minimum of an NVQ level 2 in care. We were informed that the 3 new staff members would be enrolled on this award. We were also informed that training in learning disabilities has been arranged to take place in August of this year. Recently appointed staff told us that they do not carry out any tasks until they have received appropriate training. Earlier in this report, we did identify that staff were involved in physical interventions with one individual and we found that these interventions had not been agreed and that not all staff had received the relevant training. A requirement has been raised. Care Homes for Adults (18-65 years) Page 24 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The overall management of the home would benefit from some improvements so that people receive a consistent approach to care in line with their assessed needs. The home has procedures in place which seek the views of people using the service, staff and other stakeholders. Procedures are in place which ensure the health and safety of persons at the home. Evidence: The registered manager Dawn Berry was not available for this inspection. The registered provider has been providing management support to the home in her absence. As detailed in this report, we identified a number of areas that required improvements to ensure that people receive care in line with their assessed needs. We found that some people were not always receiving a consistent approach to care and that staff were using physical interventions when they had not received training and where this intervention had not been agreed for a particular individual. We also found that risk assessments were not in place for individuals where there was an assessed Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: need. The overall management of the home needs some improvements to ensure that people receive a consistent approach to care and that care is delivered in line with their assessed needs. Risk assessment procedures also require improvements. Staff spoken with were positive about the support they received. The registered person needs to ensure that staff work in a consistent manner and in line with peoples assessed needs when supporting people using the service. Quality Assurance systems are in place to seek the views of people using the service and staff. Regular meetings are held for staff and the views of staff and people using the service are sought through the registered providers monthly unannounced visits, which are conducted in accordance with the requirements set out in the Care Homes Regulations. The home also sends out questionnaires on an annual basis and at the last inspection conducted in October 2008, we recommended that the views of other stakeholders and health care professionals are also sought. We saw evidence that this had been addressed and no adverse comments about the service were made. We found all records pertaining to people using the service to be well maintained and stored in accordance with the Data Protection Act 1998. We found that up to date procedures were in place relating to the health and safety of persons at the home. Five of the eight staff employed have an up to date first aid certificate. Appropriate records are maintained for all accidents in the home and the home informs the Commission of any significant events. Care Homes for Adults (18-65 years) Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 12 (1) The registered person must take steps to ensure that care is delivered in line with individuals assessed needs. This relates to the individual who has been assessed as requiring a structured routine. This is to ensure that people receive the care and support they need. 31/07/2009 2 6 12 (1) The registered person must ensure that care plans are fully reflective of individulals assessed needs and that instructions for staff contain clear information about action to be taken in relation to any challenging behavior. This is to ensure people receive a consistent approach and to reduce any risk of injury to the 31/07/2009 Care Homes for Adults (18-65 years) Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action individual, other people using the service and staff. 3 9 13 (4) The registered person must ensure that risk assessments are in place, and kept under review, for those with an assessed need. This is to ensure that people are supported to take informed risks as part of an independent lifestyle and that action is taken to minimise any identified risks or hazards. 4 16 12 (2) The registered person must review the restrictive practice of locking bedroom doors through the risk assessment process. This is to ensure that people are able to make choices and decisions about their lives. 5 20 13 (2) The registered person must ensure that medicines are administered as per the prescribers instructions and that any discontinued medicines are returned to the pharmacy. This is because we found that an as required medicine was being 31/07/2009 31/07/2009 31/07/2009 Care Homes for Adults (18-65 years) Page 29 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action administered on a regularly basis with no rationale. 6 23 13 (6), (7) & (8) The registered 31/07/2009 person must ensure that staff do not engage in physical interventions with people using the service until (a) - they have received appropriate training and (b) - that this is an agreed intervention for an individual. This is to protect people from the risk of harm or abuse. 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 Care plans should be accessible to people using the service. They should be produced in a simplified format which is appropriate to each individuals assessed need and ability. Any entries made by staff in peoples care plans should include details of the outcome of the event activity for the individual. The home should ensure that people are supported to maintain and develop independent living skills through the care planning and risk assessment process. The home should aim for 50 of the care staff team having achieved a minimum of an NVQ Level 2 in care. 2 6 3 11 4 32 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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