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Inspection on 03/06/09 for Lowfield House Care Home

Also see our care home review for Lowfield House Care Home for more information

This inspection was carried out on 3rd 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The people living in the home are provided with a varied and balanced diet. The menu is flexible and the ingredients used are fresh and bought locally.

What has improved since the last inspection?

The home has now got an administrative assistant for twenty hours each week.Things are not as good as they were before.This may be due to a number of things including, a change of manager, a high turnover of staff and a number of safeguarding referrals all within a short period of time.

What the care home could do better:

The home was not found to be in a good state of repair or redecoration.The care staff working in the home need to do more training to help people living in the home.More activities need to be offered to suit everyone living in the home.The owners need to make sure there are enough staff to help everyone who needs it, so they can do the things they want to do as well as being helped with their care. The care plans need to tell staff more about what people need and what they want. They also need to say more about what people are like.Instructions from other professionals need to be followed by the staff.Risk assessments need to have all the information needed for people in them.The Acting Manager needs more time to do his job and needs to be registered with the Care Quality Commission.People living in the home need to be listened to, or have advocates who could help them with this. The care staff need to have regular supervision to make sure they know how to do their jobs properly. The daily notes should tell us more about people`s choices, what they like and decisions they make about their daily lives.

Key inspection report Care homes for adults (18-65 years) Name: Address: Lowfield House Care Home Cornwall Street Kirton-in-lindsey Gainsborough Lincolnshire DN21 4EH 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: Wilma Crawford Date: 0 3 0 6 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 41 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 41 Information about the care home Name of care home: Address: Lowfield House Care Home Cornwall Street Kirton-in-Lindsey Gainsborough Lincolnshire DN21 4EH 01652648835 F/P01652648835 lowfieldhouse@prime-life.co.uk info@prime-life.co.ukwww.prime-life.co.uk Prime Life Ltd care home 21 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 21 21 0 0 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 21 The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Physical Disability - Code PD Date of last inspection 1 0 0 7 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 41 A bit about the care home Prime Life Limited owns Lowfield House. The home is registered to provide care for 21 adults aged 18-65 who have a learning disability and additional physical and nursing needs. The home is situated in a residential area of Kirtonin-Lindsey and is close to local shops and amenities. It has a large private garden and a sensory garden. The home has 19 single bedrooms and one double bedroom; all bedrooms have a wash hand basin. There is a range of communal Care Homes for Adults (18-65 years) Page 5 of 41 rooms and facilities including a large conservatory and a spa bath. The home employs nursing and care staff. A qualified nurse is on duty at all times. Information about the home and its service can be found in the statement of purpose and service user guide; both these documents are available from the Acting Manager of the home. A copy of the latest inspection report for the home is available in the reception area. Information given by the Deputy Manager on 25th June 2009 stated that fees charged range from £329.70 to £1795 pounds per week, Care Homes for Adults (18-65 years) Page 6 of 41 including charges for additional hours. Care Homes for Adults (18-65 years) Page 7 of 41 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 Care Homes for Adults (18-65 years) Page 8 of 41 How we did our inspection: This is what the inspector did when they were at the care home This inspection report is based on information received by the Care Quality Commission since the last key inspection of the home on 10th July 2007, including information gathered during a site visit to the home. The site visit was unannounced and made by two inspectors over a period of nine hours. Six people living in the home and five staff were spoken with during the visit. The Acting Manager was available throughout most of the visit. The main method of inspection used was called case tracking Page 9 of 41 Care Homes for Adults (18-65 years) which involved selecting four people living in the home and tracking the care that they receive through the checking of their records, discussion with them the care staff and observation of care practice. The premises were looked at and the records of five people living in the home and three staff records were inspected. An Annual quality assurance assessment (AQAA) document asking for information about the home was sent out before the visit, but not returned. The range of fees charged is from£329.70 to £1795. These fees are based on a standard fee and an additional package of hours based on the individual needs. Additional charges are made for hairdressing, private Care Homes for Adults (18-65 years) Page 10 of 41 chiropody and transport. What the care home does well What has got better from the last inspection Care Homes for Adults (18-65 years) Page 11 of 41 The home has now got an administrative assistant for twenty hours each week. Things are not as good as they were before. This may be due to a number of things including, a change of manager, a high turnover of staff and a number of safeguarding referrals all within a short period of time. Care Homes for Adults (18-65 years) Page 12 of 41 What the care home could do better The home was not found to be in a good state of repair or redecoration. The care staff working in the home need to do more training to help people living in the home. Care Homes for Adults (18-65 years) Page 13 of 41 More activities need to be offered to suit everyone living in the home. The owners need to make sure there are enough staff to help everyone who needs it, so they can do the things they want to do as well as being helped with their care. The care plans need to tell staff more about what people need and what they want. They also need to say more about what people are like. Care Homes for Adults (18-65 years) Page 14 of 41 Instructions from other professionals need to be followed by the staff. Risk assessments need to have all the information needed for people in them. The Acting Manager needs more time to do his job and needs to be registered with the Care Quality Commission. Care Homes for Adults (18-65 years) Page 15 of 41 People living in the home need to be listened to, or have advocates who could help them with this. The care staff need to have regular supervision to make sure they know how to do their jobs properly. The daily notes should tell us more about peoples choices, what they like and decisions they make about their daily lives. Care Homes for Adults (18-65 years) Page 16 of 41 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Wilma Crawford St Nicholas Building St Nicholas Street Newcastle upon Tyne Tyne and Wear NE1 1NB 01912333300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order Care Homes for Adults (18-65 years) Page 17 of 41 line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 18 of 41 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 19 of 41 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 A full assessment of need is carried out and people are given enough information about the home and its facilities before admission. This judgement has been made using a range of evidence, including a visit to this service. Evidence: Each person has their own individual care plan which includes a needs assessment from both the home and the funding authority. However, the care plans seen showed no evidence of consultation with the individual or their representative. Prospective service users are visited by the acting Manager or the Deputy Manager and an assessment of needs completed. A decision is made as to whether the individuals needs can be met and the person is invited to visit the home with their family for a meal or an overnight stay. This gives the individual the opportunity to see what they think about the home, before making a decision. Care Homes for Adults (18-65 years) Page 20 of 41 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 promotes 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. People living in the home have their physical needs met, but more information needs to be made available to promote their social and emotional well being. There also need to be more autonomy in decision-making so that they can lead more independent lives. This judgement has been made using a range of evidence including a visit to this service. Evidence: Each person living in the home has an individual care plan, but these do not all fully describe how their assessed needs should be met, nor are they all signed by the individual or their representative. The information around social and emotional needs, needs to be further developed. For example information to help staff with supporting people with eating and drinking needs to be further developed and this is linked with the fact that staff expressed the need for training in this area. Five care plans were seen as part of the case tracking process and they also reflected the need to develop support plans further, in that they did not indicate what support people preferred. When this was raised with the Acting Manager, he said that he was aware of this and had clear ideas around how the care plans could be improved upon, but had not had the time to implement this, although he considered it to be a priority. Care Homes for Adults (18-65 years) Page 21 of 41 Evidence: The risk assessment documents available in individuals’ files covered a range of areas of risk in daily living, but the majority were not fully completed, or reviewed, which indicated that staff were not provided with the full information they required, nor reducing the risks identified. For example; in one care plan there was specific information relating to regular monthly weight checks being maintained and tissue viability monthly risk assessments being reviewed, no information could be found to demonstrate that this had been completed. These were being further developed at the time of the visit and a Community Learning Disability Nurse was seen to check a sample of risk assessments during their visit to the home. Staff spoken to clearly express the view that some of these people are unable to make informed decisions of their own, but were unable to demonstrate good examples of how choices could be offered to this group of people, to encourage them to be involved in the decision making process. They were also unable to demonstrate an understanding of the way in which each individual would try to communicate with them and how they could encourage this, there was no information seen in care plans about this either. Within the individual care plans seen, there was little evidence to show how people can demonstrate their choices, when they do not have verbal communication. Staff spoken with, were unable to give examples of how this may be achieved. Again this is an area that has already been identified by the Acting Manager for further action. Regular reviews had been made, but information agreed at these had not always been transferred into the current care plan. The frequency of evaluations of care plans varied from monthly to four monthly. There have been no residents or relatives meetings held in the last year, nor was there any further evidence to demonstrate that any other method of consultation with individuals had taken place. The daily records were largely based on the physical tasks that individuals had been supported with and did not contain any details of their emotional or social wellbeing. Care Homes for Adults (18-65 years) Page 22 of 41 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. People who use the service experience adequate quality outcomes in this area. People using the service have limited opportunities to access a choice of leisure activities. This judgement has been made using a range of evidence, including a visit to this service. Evidence: The people currently living in the home are unable to access the local community independently. Not all of the people living in the home are involved in community based activities. The Acting Manager acknowledged that this was an area for development. He correctly identified that the skills and attitudes amongst the staff group are critical to a holistic model of care, including appropriate activities, the promotion of choice and indicated that staff would be developed to support this. An organisational activity plan was seen, which offers additional transport and a couple of trips to different locations each month for the people living in the home. The Acting Manager informed the inspector that a staff member had been identified to take on the responsibility for activities within the home. During the inspection visit three people went out on the minibus, no other people were observed in any type of activity apart from Care Homes for Adults (18-65 years) Page 23 of 41 Evidence: watching television. Some of the people living in the home have additional funding on a daily basis; these people were also seen not to be involved in any structured activity during the inspection visit. A record of activities is maintained which recorded details of trips out to the seaside, shopping and bowling demonstrating that some people were given the opportunity to go out a couple of times each month. This was confirmed in discussion with the Acting Manager and staff. No relatives were seen on the day of the site visit, but a record of relative’s visits was maintained in the home. Discussion with the manager, cook, people living in the home and examination of the menu, demonstrated tat a full and varied diet is available in the home. This has been planned in consultation with the dietician and people living in the home, based on their individual likes and dislikes. Weights and nutritional assessments were not being maintained within the home. Care Homes for Adults (18-65 years) Page 24 of 41 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. Overall people living in the home receive appropriate assistance and support to maintain their personal and healthcare needs. All but one medication was found to be stored appropriately and records are well maintained. This judgement has been made using available evidence including a visit to the service. Evidence: Information in care plans did not demonstrate that all of the people living in the home have their preferred routines respected. Discussion with some staff demonstrated that they did not have a full understanding of the wishes and choices made by each individual. For example, some of the staff spoken with were unaware of how long people could be left in their wheelchairs and what impact this may have on their tissue viability assessed needs. Additionally on two occasions, staff were observed pulling one person backwards in their chair with their feet dragging. When this was discussed with the two staff, neither was aware that this could present a risk to the individual and were acting on what they had seen other staff doing. The individuals care plan did not cover this area either. Another example of practice which could be improved upon was the lack of recording for an individual where professional staff had instructed that monthly weights be completed, this could not be found, and neither could an evaluation of the individual’s tissue viability, when it had been identified as high risk. This could potentially put people at risk, care plans need to include all areas of need and be kept up to date. A recommendation was Care Homes for Adults (18-65 years) Page 25 of 41 Evidence: made in respect of this. Examination of medication in the home found that overall the running total of stock levels was found to have been completed and accurately reflected the stock levels within the home. Examination of medication sheets were found to be completed, up to date and well managed. The home uses the Boots Monitored Dosage system and a locked trolley and locked cupboard are used for the storage of medicines. All staff who have responsibility for the administration of medication have received training. However when the controlled medicines were checked the stock balance for Temazepam, which was being stored in the home as a controlled medicine, was found to be less than the balance recorded in the Controlled Medicine Book. This was discussed with the acting Manager and the mistake was rectified on the day by the Operations Manager and the Acting Manager. A recommendation was made in respect of this. Care Homes for Adults (18-65 years) Page 26 of 41 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. The complaints procedure within the home is not always followed. The staff vetting procedure is sufficiently robust to ensure the safety of the people living in the home. This judgement has been made using available evidence including a visit to the service. Evidence: A copy of the complaints procedure is displayed in the entrance hall and is available in written and pictorial formats. Some people living in the home are unable to use the complaints process independently, these do not always have an advocate to represent them, but best interests meeting were found to have taken place for some individuals. Staff spoken to were able to describe how they could use the complaints process and the safeguarding process and their roles within this. Although complaints have been received by the organization about the home, leading to safeguarding referrals, these were not found to be recorded in the homes complaints log. A recommendation was made in respect of this. The safeguarding referrals have led to the home being issued with a recovery plan from the Local Authority to complete. A recruitment procedure is in place and the home manager oversees the recruitment process. An application form, two written references, a Criminal Records Bureau Check, and a Protection of Vulnerable Adults Check are all undertaken before anyone starts employment. One staff member whose Criminal Records Bureau Check had not been returned was found to be working under supervision of an established staff member. All of the staff team were aware of this and the fact that they were unable to be involved in the delivery of personal care. The risk of potential harm to people is reduced as a result of these procedures being implemented. Care Homes for Adults (18-65 years) Page 27 of 41 Evidence: Care Homes for Adults (18-65 years) Page 28 of 41 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. People living in the home enjoy a clean, safe, homely environment, but this is not well maintained. This judgement has been made using available evidence including a visit to the service. Evidence: The level of maintenance in the home detracted from a homely,comfortable environment. At the last inspection visit there were a number of sash windows in the home, found to be rotting in the corners and in need of urgent repair/replacement. When this was raised with the previous manager, he showed the inspector a maintenance plan which indicated that the repairs/replacement of the windows was imminent. At the site visit the windows were found to be in the same condition. Locks to bedroom doors had recently been replaced, but the work had not been completed. Similarly walls that had been redecorated had not been completed to a good standard. One upstairs bedroom was found to have the window retainer undone, leading onto a flat roof. When this was pointed out a handy man was called to the home and the retainer put back in place. In other areas paintwork had been patched up. When this was raised with the Acting Manager, he explained that an audit of the homes environment was due to be undertaken by the maintenance team. A tour of the building was made and the home was found to be clean and free from odours. The bedrooms of people living in the home were varied with some being personalised, Care Homes for Adults (18-65 years) Page 29 of 41 Evidence: and decorated to suit individual tastes, while others were less personalised. There was no evidence of consultation about how people were involved in choosing colour schemes and soft furnishings for their rooms and other areas of the home, as residents meetings are not held within the home. Communal areas were found to be light and airy and there is a choice of sitting areas both within the home and in the garden areas, accessible to the people living in the home. Care Homes for Adults (18-65 years) Page 30 of 41 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 People living in the home are supported by staff that are not supervised but attend training. The staff vetting procedure is sufficiently robust to ensure the safety of people living in the home. This judgement has been made using available evidence including a visit to the service. Evidence: On the day of the visit there were seven staff rositered on duty, including a qualified nurse, a student nurse on placement, the manager and staff dedicated to supporting five people, who are funded for additional hours ranging from 2.5 hours to fourteen hours daily. In addition to this there is a cook available daily and 28 domestic hours and 8 laundry hours available weekly. Discussion with the manager, staff and examination of the staffing rota indicates that there are not sufficient hours to meet the needs of the people currently living in the home. Due to the high level of the support needs of people living in the home, the home presents as very task orientated, in order to meet peoples needs, leaving little time for interaction or the provision of social activities. Observations of people living in the home demonstrated that they were left for long periods of time with little interaction of any kind and were left in their wheelchairs. On day of visit three people went out, but there was no provision of activities for those remaining in the home, including the people with additional 1; 1 hours. Staff going out with people appeared to leave an increase in work Care Homes for Adults (18-65 years) Page 31 of 41 Evidence: and tasks for remaining staff. It was difficult to see how the people with differing contracts, ranging from 2.5 hours per day to 14 hours per day were supported to have their hours fulfilled and this was not clearly identified on the rota. Even those with additional hours did not appear to access any activities. Staff spoken with said that they felt that there were times where additional staff were needed throughout the day. The acting manager spends a lot of his time covering nursing hours(the previous manager was totally supernumerary, he was not a nurse) The nursing hours apart from the deputy manager and night staff are usually bank staff, which does not offer consistency to the people living in the home. not offering consistency. The Acting Manager has difficulty trying to manage his time to complete his management tasks. A recommendation was made in respect of this. All newly appointed staff completes an induction within the first six weeks of employment, these are signed off by both the individual and their mentor. Staff continue to receive a range of training courses including: Fire safety, First Aid Appointed Person and Moving and Handling. The staff team needs to access more specialised training in order to support the people living in the home with more specialised needs. Staff meetings are not held regularly within the home, nor is regular supervision in place. This means that staff are not getting the support or guidance they should have to ensure that they are fulfilling their roles effectively. A requirement was made in respect of regular supervision being put in place. Care Homes for Adults (18-65 years) Page 32 of 41 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. People using the service overall benefit from a safe, managed home. The judgement has been made using available evidence including a visit to this service. Evidence: Discussion with the Acting Manager showed that they have a nursing qualification and that they have completed the Registered Managers Award. They have made an application to become registered with the Care Quality Commission. He has several years experience in a senior role working for Prime Life. Fire safety checks, gas and electrical engineering checks were all found to be up to date. Other checks verified included the last portable appliance test, and viewing the certificates for gas and electrical safety checks. Risk assessments are in place to cover all areas of the home, including the kitchen and food preparation, fire safety and laundry use. However the risk assessments for the people living in the home were not found to be complete or reviewed on a regular basis. There is a quality assurance system in place for assessing the homes quality of care, which involves surveying people living in the home, relatives, visitors and other professionals. A detailed report is completed from the information collated and areas, in which the home excels or identified areas that need to be improved, are included. Care Homes for Adults (18-65 years) Page 33 of 41 Evidence: However there is currently no system in place to obtain the views of people living in the home, nor are advocates in use, for people who have difficulty with communication. Staff are not being supervised regularly, either formally or during every day observation, neither are staff meetings being held on a regular basis. Care Homes for Adults (18-65 years) Page 34 of 41 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 1 33 18 The registered person must 30/09/2007 ensure that the home provides a staff team, in sufficient numbers to support service users assessed needs at all times, particularly during the evening to allow for impromptu or planned late activities e.g. to the theatre to take place. Ongoing 14/06/07 Care Homes for Adults (18-65 years) Page 35 of 41 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 Description 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 Description Timescale for action 1 6 12 Regulation 12(1) (a) (b) The 31/07/2009 registered person should ensure that individual care plans reflect the identified needs made in the individuals community care assessment, and give details of how people prefer to be supported. This would help care staff to understand what they have to do and how to support people in their preferred manner. 2 9 13 Regulation 13(4) (b) (c).The 31/07/2009 registered person should ensure that risk assessments are available, are fully completed and kept under review for all areas of risk identified within individuals community care assessments. Care Homes for Adults (18-65 years) Page 36 of 41 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 Description Timescale for action This would enable people to be supported appropriately to take responsible risks. 3 14 16 Reg16 (2)m The Registered Person shall consult service users about their social interests, and make arrangements to enable them to engage in local, social and community activities and to visit , or maintain contact or communicate with ,their families and friends. This would give people living in the home the opportunity to engage in a variety of appropriate activities and opportunities to engage in social events. 6 24 23 30/09/2009 Regulation 23(2)b The registered person shall having regard to the number and needs of the service users ensure that - the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. 31/07/2009 This would ensure that people living in the home could benefit from a safe, comfortable and homely environment. Care Homes for Adults (18-65 years) Page 37 of 41 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 Description Timescale for action 7 36 18 Regulation 18(2) the 31/07/2009 registered person shall ensure that persons working at the care home are appropriately supervised. To make sure that people are being cared for properly the work staff do should be supervised and staff should have a minimum of six line management supervision sessions per year. This would support staff to do their jobs properly. 8 36 18 Reg18 (1) a. The registered 31/07/2009 Person shall having regard to the size of the care home, the statement of purpose and the number and needs of service users-ensure that at all times suitably qualified, competent and experienced persons the care home in such numbers as are appropriate for the health and welfare of service users. To make sure that all people living in the care home are having the identified level of needs met and their contracted hours provided to them at all times. 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. Care Homes for Adults (18-65 years) Page 38 of 41 No Refer to Standard Good Practice Recommendations 1 6 Standard 6.8 The care plans should include the preferred method of communication of those who are profoundly handicapped and cannot communicate their care needs and include a description of what their sounds, facial expression and body language mean and how staff should respond. 2 6 Standard 6.3; Review the care plans of those that require assistance with their meals to include information telling staff what to do and how this should done for individuals living in the home. Standard 7.4 the daily records should contain descriptive words to reflect and show peoples choices, preferences and any decisions they make about how they live their daily lives Standard 12 To occupy and stimulate people living in the home, each person should have a planned programme of activities based on their individual needs and abilities and in particular those that are not mobile and cannot communicate their individual needs to others Standard 16.1 To make sure people are stimulated the daily routines should include regular interaction throughout the day with those who cannot communicate their care needs, physical support and emotional support needs. 3 7 4 12 5 16 6 19 Standard 19 The care plans of people using wheelchairs should indicate to staff how long people can be left in wheelchairs, their tissue viability and how to monitor and prevent pressure sores occurring. Standard 20.11 Reg 13 (2). It would be good practice to record Controlled medicines given in the Controlled Medicine Book as well as the MARR sheet and the balance altered to reflect this upon administration Standard 30.1 To prevent cross infection the broken wooden work surface in the kitchen needs to be replaced Standard 32.3 (111) To make sure people are safe and comfortable Staff assisting people with their drinks and meals should be trained to do this correctly. Standard 32.3 To make sure people remain safe staff 7 20 9 10 30 32 11 32 Care Homes for Adults (18-65 years) Page 39 of 41 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 should have training in how to give rectal Diazepam as over half of people living in the home are prescribed this. 12 32 Standard 32 .3 To enable staff to communicate better with people living in the home Intensive Interaction and Communication training may be beneficial. 13 33 Standard 33.11 To make sure people are provided with the correct level of care and support to meet their personal, social and emotional needs. Staffing levels are regularly reviewed to reflect service users changing needs. The Registered Provide should consider how some backfill can be provided to enable the manager to have dedicated hours to fulfill their management role within their contracted hours. Regular staff meetings should take place (minimum six per year) and are recorded and actioned. 14 33 15 33 Care Homes for Adults (18-65 years) Page 40 of 41 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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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