Inspection on 28/01/09 for Little Orchard

This inspection was carried out on 28th January 2009.

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

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

Other inspections for this house

Little Orchard 12/04/07

Little Orchard 04/01/06

Little Orchard 25/07/05

Little Orchard 29/11/04

Little Orchard 01/07/04

Little Orchard 18/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 29/06/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Little Orchard 17 Lavender Road Hordle Lymington Hampshire SO41 0GF     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: Dianne Buchanan     Date: 2 8 0 1 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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 Orchard 17 Lavender Road Hordle Lymington Hampshire SO41 0GF 01425617217 01425617217 info@glyn-residential.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Glyn Residential Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Physical disability - PD Date of last inspection Brief description of the care home Little Orchard, 17 Lavender Road is one of three homes owned by Glyn Residential Limited and now provides personal care and accommodation for up to six people with a physical disability including two people in the learning disability category. There are two bedrooms upstairs for ambulant residents with a learning disability. The home can also provide day care. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 0 6 6 0 1 0 4 2 0 0 9 Brief description of the care home The home is situated in Hordle, where there are a small number of shops and facilities. Lymington is the nearest town, and the city of Southampton can be accessed by car. The home comprises of a chalet-style bungalow. All people living in the home have single bedrooms. Communal facilities include a kitchen/diner, lounge, activities room, which contains a kitchen, craft facilities [where people can cook, create craft projects and have physiotherapy]. Little Orchard is a non-smoking home. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced site visit was conducted on 28th January 2010. The inspection took place over one day. During the visit we were assisted by the registered manager. Information in this report was gathered from: the previous inspection report (site visit on 1st April 2009); the Annual Quality Assurance Assessment ((AQAA) a self assessment that was completed by the management of the home that focuses on how well outcomes are being met for people who use the service); service user feedback (Care Quality Commission survey forms); discussions with service users, staff on duty and management; observation of general practice; and sampling of records including, three service user files, two staffs files, home menu plan, staff rota, Quality Assurance documents, policy and procedures. 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: Service users do not have up-to-date care plans and risk assessment documents. This information is needed to enable the staff team to provide the care and support that service users are assessed as requiring. The current records provide limited detail about service user needs with infrequent reviewing to capture changing needs. A requirement has been made to review and update care plans and risk assessments for each service user, and to ensure that all other written documents required to support service users in this home are being provided. The health and personal care that service users are receiving is not based on up-todate assessment of their needs. For example, service users with dietary needs and pressure care management do not have records to provide detail of how these needs are going to be supported or met. A requirement has been made to ensure that each service users health care needs are reviewed and that the information is recorded. Staff have not had robust training on the administration and recording of medication, and the procedures to support them in practice have not been provided. This lack of training and information may lead to errors in practice and increase risks for service users. Service users are not fully protected from abuse as the staff team have not had up-toCare Homes for Adults (18-65 years) Page 7 of 31 date training on safeguarding practice. At this inspection visit we found gaps in staffs knowledge and training, and there were no guidelines in place to inform staff in practice on how to fully protect the service users in this home from abuse. A requirement has been made to ensure staff have training on the protection of vulnerable adults and that guidelines are in place. Staff in the home are not fully trained to support the service users in this service. Staff personal records do not provide up-to-date information on their training and the home does not have a training plan to provide details of staff training needs and achievements. Therefore it is not clear if staff have the necessary training to support the service users. A requirement has been made to ensure clear records of staff training needs and achievements are available, and that staff are receiving the right training to ensure they are meeting service users needs. The service users are not protected by robust recruitment practice as there are discrepancies in pre employment history and checks for some staff. A requirement has been made to ensure all the necessary employment checks are carried through before anyone is employed at the home. The issues raised at the last key inspection on 1st April 2009 surrounding reviewing and updating records have not yet been addressed by management. This lack of review and updating has led to a requirement to review and update all the written records in the home. 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. There is information available about this home to allow prospective service users and their representatives to make an informed choice. Evidence: The Statement of Purpose and Service Users Guide provides information on current facilities and services offered by the home. The information is in a written format but it would be good to see the documents in other formats, for example, pictorial since the home is supporting service users with communication needs (picture format information has been posted around the home and service users were observed using this format to communicate with staff on other aspects of support). The service user files that were examined had copies of terms and conditions for living in the home. The management advised that all of the service users had this document in their files. The three surveys returned by service users stated that they had received enough information about the home before moving in. The home has a policy in place which outlines the arrangements for new admissions. Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: This includes an assessment of the prospective service user, and an opportunity for them to visit the home. There have been no new admissions since the last inspection. 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 care plans and risk assessments have not been reviewed or updated, and the documents provide limited information to support service users needs and to ensure that risks are minimised. Evidence: Staff interaction with service users during the inspection was observed to be respectful, tailored to the individual needs and patient. Staff are aware of service users preferences, and based on discussions and observations it was obvious that these preferences were taken into account. Staff were observed to be specific with service users communication needs, for example, using accessible formats or sign language to facilitate conversations and communication. In talking with a service user they said that staff meet their needs and they are comfortable in the home. A service user said in the survey I feel that the home is doing good with my care and I am happy with the care that I am receiving from the home. However, the documentation of care needs and risk assessment needs to improve. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: Three care plans were sampled and each evidenced that there was very little up-todate information on personal, social and health care needs of the service users. One service user care plan had been reviewed two years ago and their risk assessment had been reviewed six years ago. One service user who had a fall in the past year did not have a risk assessment or plan, although they had been provided new equipment in consultation with health professionals to minimise the risk. At the previous site visit the care plans that were examined were seen to be in need of updating and the management had agreed to action this. However, when speaking with the management they confirmed that no action has taken place and that they are still in the process of reviewing and updating care plans. A requirement has been made to ensure that all care plans and risk assessments are reviewed and updated, and this must include all written records for service users. The management advised us that one service user has a terminal illness and felt that the home could meet their changing needs. In addition, the management felt that the assistance being offered by the community nursing team and other specialists would enable them to manage and support the service user. The management explained that they had not carried out their own reassessment of the service user and had not updated the written records. Therefore, the home was unable to demonstrate how they could meet the changing needs, provide specialist requirements or if there is a need for additional training for staff. The home has been required to review and update records for service users and in doing so will need to evidence to the Commission how they will met the changing needs of the individual service user. The home will need to demonstrate that staff have the necessary skills to support the service user, as per the requirement under training, ensuring that the staff team receive training appropriate to the work they are to perform. A staff member who talked to the inspector said that they do not refer to the service users file where the care plan is kept but use the daily record book. This book was examined, which provided some information about needs but did not link to the care plan information that was on file. This does not provide staff with a working document for the delivery of care for service users, and to ensure consistency in practice. In reviewing and updating the care plans and risk assessments, the home is also required to update and review all written records of service users. This is to ensure that the changing and specialist needs of service users are recorded. Care Homes for Adults (18-65 years) Page 13 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can take part in interesting and fulfilling activities, and are encouraged to be part of the local community. They also benefit from support from family and friends and enjoy a healthy diet. However, the individual written records of service users do not provide detailed information about the activities that they take part in or any associated risks. Evidence: From discussion and observation of the activities taking place and staffing arrangements we noted that people are able to make choices about their lifestyles and the things they do on a daily basis. Service users personal rooms reflected their hobbies and interests. Examples of activities that we heard about were swimming, day trips, holidays, dancing, evenings out at the local pub. The three service users who completed surveys said that they usually make decisions about what they do everyday. Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: The home has input from a newly appointed activities coordinator whose role is to source local activities and enable service users to integrate if they wish into the community. From conversations with service users we noted that the care home has been providing activity choices over a prolonged period, something that the service users were very positive about. This includes good involvement of friends and family. The care home has an up-to-date activity plan and photos of recent events that evidence this very positive aspect of support. Some aspects of this activity plan will need to be incorporated into the individual care plans and risk assessment. A requirement has been made to review and update care plans and risk assessments, to ensure all the information about service user needs have been recorded. During our site visit we observed a lunch time meal. The environment was very relaxed, service users could choose where to have their meal, and chose what they wanted to eat (from a pictorial menu). The meals provided were of high quality. We observed a service user being supported with their meal and the support was provided at the pace of the service user and with dignity. Care Homes for Adults (18-65 years) Page 15 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recording of service users health care needs must be improved. A medication system and policy and available. However, further guidance and training is required to ensure staff have specific information to support individual service users, and that there is sufficient medication procedures in place. Evidence: From talking with service users and staff in the home, viewing records and observing care practices we noted that health care needs are monitored and some level of records are kept. However, some information is not easy to locate on service users files and is not recorded in the single care plan document. This was raised at the last site visit (01/04/2009) and the inspector was advised by management that this would be addressed. Documentation reviewed during the visit indicated that the home has an active involvement of health care professionals, for example, Occupational therapist, Physiotherapist, Dietitian. Two service users were observed as having nutritional needs. Their written records Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: were viewed and there was no up-to-date information on their nutritional needs. At the last site visit the inspector found blank nutritional screening forms on file and was advised by the management that the forms would be filled out, however, they remain blank. One service users who has a tube feed did not have this information recorded on their file, for example, how they should be supported with their tube feed; how this should be managed; the times it is to be given and any risk indicators for the service user. For another service user who has liquid diet there was no information to support how they should be supported or what the risk factors might be. A requirement has been made to review and update service users records, and to ensure that information is recorded on nutritional needs. The home has various aids and adaptations in place and equipment is available to meet service users physical needs. The written records examined showed that the equipment is checked on a regular basis and that the home consults with health care professionals to get assessment for service users and to ensure that the right equipment is being purchased. Two service users who have physical needs did not have any documents in place to show that their pressure care management had been assessed and planned for, for example, a tissue viability assessment. It is important that assessment, monitoring and recording of these needs are maintained and reviewed due to the vulnerability of the service users in this home. At the previous site visit the inspector highlighted the same issue and at this time the management advised that they would undertake a review of service users health needs. As this has not been actioned and continues to be an area of risk for service users it is required that all health care needs are reviewed and recorded. At the last inspection visit it was noted that clear guidance for medication was not available and there were some gaps on the Medication Administration Records (MAR). The home has reviewed the MAR and as an outcome all prescribed medication is now provided by a pharmacist using a pre pack blister system. The records were sampled and found to be complete at the time of the site visit. A medication policy is in place. The policy document is the only guidance available to staff to support the administration and recording of medication. However, the management advised that they are working on the development of guidelines and are updating the records of service users. The management advised that only staff who have been trained are allowed to administer medication. At the last site visit it was noted that staff have been provided cascaded training and that the home needed to review this. This review has not taken place and it is difficult to clarify by viewing staff files and talking with them what level of training they have received. The home is must ensure that staff Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: have robust training for medication and that the homes procedures are ensuring that service users are protected and kept safe. 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. There is a complaints procedure available in the home. There is a safeguarding policy in place but training, written guidelines and recruitment needs to be more robust and reviewed to ensure that in practice staff have the necessary skills and knowledge to safeguard vulnerable adults. Evidence: Three service users who live in this home completed surveys with staff help. They said they know who to speak to if they are not happy and that they know how to make a complaint. During the inspection conversations with service users supported this. However, the homes complaints procedure is in a written format, which some service users may not be able to access and the home should look to providing this in an accessible format that meets the individuals needs. The questionnaires filled out by visitors/family members as part of the the homes Quality Assurance noted that they know how to make a complaint. A copy of the homes complaints procedure is located on the homes notice board. No complaints were reported to have been made since the last inspection and none have been received by the Commission. The home has had no Protection of Vulnerable Adults (POVA)referrals in the past year. A POVA policy is in place. We talked to one member of staff, examined two staff files, and asked for the homes training records and other written documents in relation to POVA. This was to establish staffs knowledge base, to ensure that there was written guidance available to inform and support their practice and that training has been Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: provided. The staff member that we talked to did not convey confidence about how to deal with the potential issues in practice, for example, not able to identify other agencies outside of the home that would be involved. One of the staff files examined showed that they had POVA training but this had been provided by their previous employer. The home did not provide the inspector with a training record or written guidelines. Therefore, it is not clear as to which staff members have completed POVA training and there is no written information available to guide staff on daily practice to ensure that their knowledge is consistent. The home is required to update their training records on POVA, whilst ensuring staff have the necessary training, that there is written information available to support daily practice and that the recruitment procedures and practice are robust. 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 is clean, safe and comfortable, and accessible to the needs of the service users living there. Evidence: Since the last site visit two new ensuites have been added which provides five service users their own ensuite facility. A communal bathroom is available for all of the service users. All of the ensuites and bathroom have equipment specific to meeting the needs of the service users, for example, over head hoists, specialist baths. Inside the home all the radiators have been covered. Externally new paving has been laid around and at the front of the home and a ramp has been added to allow access via the front door of the home. The home was seen to be adapted and accessible to the service users. The management advised that the home has had a fire safety inspection and confirmed that recommendations of the fire officer had been carried through. They advised that emergency lighting had been installed outside, that new fire doors were in place and a specialist alarm had been fitted in the bedroom of a service user with hearing impairment. A risk assessment for fire was examined and seen to be up-todate. The home has a named fire officer, this role is to ensure that daily fire and safety checks are carried out. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: In the surveys from the service users living in the home they said the home was fresh and clean. The Quality Assurance questionnaires filled out by staff noted that the home was very clean. The home has a cleaner who has responsibility for managing the homes health and safety which feeds into the Quality Assurance. The cleaner provided the records of the checklists and written information to support this. This provided daily, weekly and monthly checklists of cleaning tasks. The laundry room was seen to be very tidy and organised and all of the COSHH (control of substances hazardous to health)was securely stored. The lounge has recently been redecorated and new curtains added. This was an outcome from the homes quality assurance were a staff member had fed back that it would be good to update this room. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by a good ratio of staff, who in day-to-day practice have a good understanding of their needs. The homes written documents do not provide staff with up-to-date information in meeting service users needs. The recruitment and training arrangements for staff needs further work to fully protect service users. Evidence: At the time of the site visit there was four care staff on shift, which included a senior carer. In addition a cook, cleaner and driver were also available in the home. From observation there appeared to be enough staff on shift to make sure peoples needs were met. We examined the staff rota to gain a view of the staffing levels, roles and responsibilities of staff in the service. The rota was provided in a plastic sealed document, which the management advised was used every week as the rota does not change. This document could therefore not show changes in staffing for example, sick leave, staff turnover, use of bank staff, nor could it show which member of staff had the responsibility for leading the shift. The management agreed that this document needs to be changed and that they would keep an accurate record of who has been Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: working on shifts, and be more specific to roles and responsibilities within the home. A new staff member talked to us about their experience of induction and supervision. The staff member had a written plan to follow for their induction, which included, health and safety in the home, meeting service users needs and equality and diversity. At the time of the site visit the staff member was seen being instructed by a senior member of staff on the use of equipment. The staff member showed us the written documents for their induction and supervision, and this gave a good record of the processes. This shows that the home is capable of providing written documents and evidencing that they can carry out good practice in certain areas. In order to establish the homes training and development plan we looked at the files of two staff members and asked the management for other supporting documents. On viewing two staff members files they did have some training records, but it was not clear as to when they had training or who had provided it. For example, in the safe handling of medication it was found to be cascaded within the home (this was noted at the previous site visit too). One of the staff members had training on the protection of vulnerable adults, which had been completed when working for another provider. Therefore, it is not clear to the level or quality of the training provided as it is cascaded or provided whilst working for another provider. The home has a staff development plan, however, at the time of the site visit this document was not available for examination. As the information is fragmented in relation to training and development and the fact that it has not always been provided within this care home, a requirement has been made to review and update training records and to ensure that staff have the necessary training to support the individuals who live in this home. In assessing the homes recruitment we examined the documents of two new staff members. In a CV (Curriculum Vitae) document there was a gap in one of the staff members employment history. The other staff member had commenced employment one month prior to the date on the Criminal Records Bureau check (CRB)being returned to the home. There was no Protection of Vulnerable Adults (POVA) first (which is fast tracking check that enables new staff to commence employment under certain circumstances until the enhanced CRB has been returned to the home). It is important that the home ensures that all pre employment information and checks are in place before staff have contact with service users to ensure that they are properly protected. A requirement has been made to ensure that this process is adhered to in all new staff members employed at this home. 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 written documents overseen by the management are not providing guidance or consistency to staff in meeting the needs of service users. The home needs to review and update records to ensure that service users needs are being fully met. Overall the management of this home is not effective as evidenced in the poor and adequate outcomes that are highlighted throughout this key inspection report. Evidence: At the time of the site visit we were advised by the Registered Manager that they are resigning from their post, and that a senior carer in the home will be taking on the management of the service. The new manager has made an application to register as manager with the Commission. We had the opportunity to talk with the new manager during the site visit and to examine their personal records. Their records did not include a job description and responsibilities for their new role, and the staff rota had not been updated to show the change. This does not provide the new manager with the necessary information to enable them to run this home effectively and to ensure that the needs of service users are being met safely. As noted before the home has been required to review and update the staff rota, making note of specific roles and Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: responsibilities. The responsible individual for the service was available in the home during the site visit and advised us that a job description would be provided for the new manager and placed on their file. This document was very brief and contained little information about the service, often with just two word answers. From examining other documents it is evident that the home is not reviewing or updating records in accordance with the regulations or good management practice, for example, care plans, risk assessments, training and development records, reviewing policy and procedures (no date on these documents at the time of the inspection visit). The management advised at the last inspection visit that they would be reviewing and updating records and this has still has not happened. This lack of review is not providing service users with the level of information required to ensure that their needs are being met safely. Overall, the home is not being effectively managed as the majority of the outcome areas in this report have been assessed as poor or adequate. The management have failed over time to ensure that the actions required have been addressed in order to safely meet the needs of service users. A requirement has been made to ensure that the management reviews and updates all records. At the last inspection visit a requirement was made to ensure that the home implemented a Quality Assurance Plan. This plan has been put in place and is now giving service users, their relatives, other stakeholders, including staff the opportunity to provide feedback on the service. A number of questionnaires were seen to be on file and the management explained that the results have not yet been collated but that they aim to have an action plan to address any issues. A sample of the returned surveys were viewed and confirmed a level of satisfaction in the home. It was noted that when issues were raised that appropriate and timely action had been taken by the management of the home, for example, a staff member highlighted the need for redecorating the lounge area and this had been actioned. At the time of the site visit a service users meeting and a staff meeting had taken place. The details of the meetings had been posted on the homes notice board. 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 The care plans, risk assessments and all other written information for service users must be reviewed and updated. In order to ensure that service user are provided with the appropriate care, support and supervision to ensure their safety and well being at all times. 24/04/2010 2 19 12 The management must ensure that the healthcare needs of service users are assessed, recognised and that procedures are in place to address them. To ensure that service users have their healthcare needs met, that they are protected from risk. 24/04/2010 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 3 23 13 The home must ensure that all staff have had training, and that guidelines are in place for the protection of vulnerable adults. To ensure staff are trained and aware of the protection of vulnerable adults to safely support service users. 24/04/2010 4 34 19 The documents specified in 30/04/2010 schedule 2 must be obtained before a person is allowed to work in the care home. To ensure that service users are protected by robust recruitment procedures. 5 34 17 All new staff members must have all the necessary pre employment checks carried out before they are employed at this home, and all of their records must be up-to-date. To ensure that the home has robust recruitment process in place that safeguards service users. 24/04/2010 6 35 18 Staff must receive training 24/04/2010 appropriate to the work they perform and a record of their training be available for inspection. In order to ensure that staff 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 have the skills and abilities to provide care and support needed by the service users living at this home. 7 41 23 The management of the home must ensure that the records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up-to-date and accurate. To ensure that all the necessary written documents are available to protect service users. 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 24/04/2010 1 1 The documents provided to those using the service should be in an accessible format. 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. 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