Inspection on 30/09/09 for Lynton

This inspection was carried out on 30th September 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lynton 19/04/09

Lynton 22/04/08

Lynton 16/04/07

Lynton 06/11/06

Lynton 03/11/05

Lynton 25/05/05

Lynton 20/09/04

Lynton 29/04/04

Lynton 22/07/03

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Lynton London Road Ashington West Sussex RH20 3JS     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: Annette Campbell-Currie     Date: 3 0 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Lynton London Road Ashington West Sussex RH20 3JS 01903893406 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: jallies@btinternet.com www.caremanagementgroup.com Care Management Group Ltd care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home Lynton is a care home, which is registered to provide personal care for up to three service users in the category learning disability (LD) who are between the ages of 18 to 65 years of age. It is a detached property, which has been adapted for its current use, and is located in a residential area of Ashington, a small village approximately 20 minutes from both Worthing and Horsham town centres. There are local shops and a pub in the village and residents can access nearby leisure facilities, colleges and work placements. There is a bus service from the village that connects with mainline trains. The property is a two-storey building providing private accommodation to service users in single bedrooms located on the ground and first floors. Communal accommodation is made up of a lounge and a dining room located on the ground floor. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 3 1 9 0 4 2 0 0 9 Brief description of the care home A well kept garden is available to service users, and is located to the rear of the premises. Fee levels currently range from £1,080.00 to £1,532.00 per week. Personal items such toiletries and hairdressing are not included. The registered provider of this service is the Care Management Group Ltd. Mr Peter Kinsey is the responsible individual for the home. The newly appointed manager is due to submit her application for registration with the Commission. Care Homes for Adults (18-65 years) Page 5 of 30 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: The quality rating for this service is 1 star. This means that people who use the service experience adequate quality outcomes. The previous key unannounced inspection was carried out on 19th April 2009. This key unannounced inspection was brought forward due to concerns that people in the home may not be fully protected following a number of safeguarding incidents in the previous nine months. We (the Commission) carried out the site visit over four and a half hours. The manager assisted with the inspection and the newly appointed regional director for the company was available for discussion. The manager has been in post since August and is due to send her application for registration to the Commission. The previous manager of the home had completed an annual quality assurance Care Homes for Adults (18-65 years) Page 6 of 30 assessment form (AQAA) before the previous inspection and this was used to help plan the site visit. The information and documents that we needed to make an assessment of the service were available. There are three people living in the home and five people are employed at Lynton including the manager. The people living in the home were spoken with, also three of the four care staff. The comments that people made have been used to help make an assessment of the service, as well as information gathered from a range of sources since the previous inspection. We saw the communal areas of the home, bath and shower facilities, the kitchen and one bedroom. We read the following documents: the case records and risk assessments for two people, the complaints policy and record book, the menu for the week, quality assurance documents, training records, samples of medication records, the medication storage and incident reporting records. We saw the administration of medication for one person and the handover session between the staff on the morning and afternoon shift. The outcomes for people living in the home have been assessed in relation to twentytwo of the forty- three National Minimum Standards for Care Homes for Younger Adults; including those considered to be key standards to ensure the welfare of people living in the home. The three requirements made at the previous inspection have been met, however when people present challenging behaviours more detailed guidance must be provided to staff. The providers have appointed a manager who is due to submit her application for registration with the Commission. Four requirements have been made following this inspection. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 30 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 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed before they move to the home, however it was not clear how a decision is made about whether or not the staff team at Lynton would be able to meet their needs. Evidence: The Care Management Group has a policy regarding the admission process. The manager said that designated staff from the organisation carry out the pre-admission assessments and involve the manager of the home in the discussions about whether or not Lynton would be a suitable place for the person to live to ensure that their needs could be fully met. There have been no new admissions since the previous inspection in April. At that time we found that a comprehensive assessment had been carried out with a person who had moved to the home within the previous eighteen months. The information included details about the persons background, health and personal care needs, communication issues, daily life choices, behavioural support and activity and occupational needs. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: We did not find evidence to show how the management team with other staff had come to the decision that the high needs of the person could be accommodated at Lynton and that they would be compatible with the other people living in the home. Staff spoken with at the time said that they had not been involved in discussions about the move. The AQAA received at the time did not include details about the admission procedure. Care Homes for Adults (18-65 years) Page 12 of 30 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. People living in the home are involved in drawing up a plan of their care. Not all care plans were holistic with sufficient detail about a daily programme for people who present a challenge to the service. People are supported in their independence however where a risk is identified there should be a system for recording incidents and detailed guidance should be provided to staff. Evidence: The manager has recently attended training about person centred care planning; the manager and the staff team are committed to involving each person in compiling a plan of their care so that their needs and choices can be taken into account. The previous manager in the AQAA said that each persons race and religious needs are incorporated into their care plans. The manager said that the organisation will be introducing a new system for recording care plans, risk assessments and reviews. We looked in detail at the case records for two of the people who live in the home. For one person there was a holistic care plan that included details about the persons Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: needs and wishes in respect of all aspects of his care, although there was no detailed activity programme. The person centred plan (PCP) also included information about the things that are important in the persons life with photographs of activities in the home and in the community that he has enjoyed. There have been a number of incidents of aggressive and violent behaviour between two of the people living in the home. One of the discussions at recent safeguarding meetings has been to emphasise the importance for people in the home having a care plan that includes a detailed programme of activities, especially those who are presenting challenging behaviours. The clinical director has said that he has set up a programme called walk and talk to support a positive behaviour plan. There was a programme on file that included attendance at college for one person; however there was no detailed daily care plan for staff to follow so that they can provide a structure to the persons day that includes a choice of activities and supports him to take part in meaningful interaction or tasks in the home or when he is out. A requirement has been made that includes this issue. The manager said that staff know the activities that the person might enjoy and will try to encourage him on an ad hoc basis. Staff said they try to offer the opportunity to go out or take part in activities at home but his main interest is watching particular programmes on television and football. This person has recently begun refusing to attend college although he has signed an agreement to attend the courses he has chosen. The manager and staff have tried to encourage him to attend without success. Clear guidelines are needed so that staff know what procedures to follow to avoid triggers to challenging and threatening behaviour to protect himself and other people in the home. There was information on file about the other persons needs with more specific information in the PCP. While there were case records on file there was no clear holistic care plan to show the details of the persons needs and wishes with regards to all aspects of his life. This person has a clear structure to his week and is at home at weekends. His interests and wishes were noted in case records. There has been a recent review for this person that was carried out by staff at the home; there has also been a review at his work placement. The in house review covered aspects of the persons achievements for the previous year and included some personal goals such as going to the shop independently and wishing to hold his own medication. There had been no discussion in the review about the issues that have arisen with another person living in the home that have resulted in personal injury at times. There was no comment about how this had affected the persons life in the home or how such incidents could be avoided in the future. Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: Risk assessments had been carried out in many aspects of each persons life with guidance about how the risks should be managed. There was evidence to show that risk assessments had been reviewed. A new risk assessment with guidelines had been drawn up following recent incidents regarding the main trigger for one person who presents challenging behaviours. There was no evidence to show that a detailed specialist re-assessment had been carried out recently regarding this persons behaviours to show all possible triggers to the behaviours and step by step guidance for staff. Feedback from staff spoken with indicates that they are experiencing verbally threatening behaviour on a daily basis and that they manage this as best they can. There was no evidence to show that every incident is being recorded in a structured way so that a clear assessment can be made and the impact on other people in the home and on staff can be monitored. A requirement has been made regarding this matter. There are now guidelines in one persons case file regarding how the stair alarm should be used and when it should be activated to alert staff on night duty to any movements in the house at night. The manager and staff have a commitment to supporting people in their independence and encourage them to make choices in their daily lives. An example of this is that a plan is kept to ensure that one persons smoking does not impact on other people in the home. Care Homes for Adults (18-65 years) Page 15 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to take part in activities of their choice, more detailed daily programmes are required where this need has been identified. People are supported to maintain contact with their families. The home provides a nutritious and varied diet. Evidence: Peoples interests and hobbies were noted in the case records that we saw. One person has a supported work placement five days a week and is very keen on horticulture. He is being supported to set up a small business venture selling plants locally. He is responsible for keeping the gardens at Lynton in good order and they are very colourful and provide a pleasant area for people to enjoy. People are supported to attend college courses of their choice and are also encouraged to make use of community facilities, such as local shops and places of interest. One person was at work during the day of the visit and in the morning the other two people were taken out individually; one person went shopping and another went to a local pub for a drink Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: and snack. As discussed in the previous outcome area there is a need to ensure that there is a detailed daily programme in place for people who need this high level of support. Staff need to be provided with clear guidance about the steps to follow regarding motivating people to follow their activity programme. People are supported to maintain contact with their families when they choose to be involved in their care. The manager said that parents are welcome to attend social events in the home. The previous manager in the AQAA indicated that the home does not have a policy on sexuality and relationships, this should be provided to ensure that staff have the guidance they need to support the people living in the home in this area of their life. It was identified some time ago and highlighted again as part of a safeguarding investigation within the past twelve months that one person requires support with relationship issues; this has been requested by him again recently. The manager said that the clinical director for the company is now planning to provide some one-one sessions for this person. Where an urgent need for specialist support is identified a referral should be made to the appropriate specialist team and followed up to make sure that people are receiving the support that they need, especially where there may be safeguarding issues for other people in the home. A requirement has been made regarding this matter. People in the home help to choose the menu for each week. The main meal is taken in the evening when everyone is at home. There was a variety of meals on the menu that we saw. Care staff are responsible for shopping, preparing and cooking the meals. We were told that people are involved with these activities as much as they wish to and one person said that he likes to watch while staff are cooking. One person is being supported to attend a local slimming club and has lost 10 pounds since he started attending. He usually has a different meal to other people in the home, and chooses from a range of calorie counted frozen meals with additional vegetables. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the healthcare that they need however where a specialist need is identified this must be followed up without delay. Staff are not always provided with sufficient guidance with regard to managing challenging behaviours. Most of the policies and procedures regarding medication practices protect people in the home. People who wish to self medication must have a risk assessment of their competence and safe storage facilities provided for them. Evidence: The case records include some information about the way each person prefers their care to be provided. Male and female carers are employed so people could have a choice of having their care provided by a man or woman. Some people only require supervision and prompting with their personal care. Staff are provided with guidance about how to provide personal care in a respectful manner as part of their induction. The manager said that the home has a good relationship with the local primary care team. She said that she has begun developing health action plans for each person so that they will be able to take more responsibility for their own health and healthcare professionals will better understand their needs. It was evident on case records we Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: saw that people have appointments with healthcare professionals as required. There were notes about due dates for one person to see the dentist and the chiropodist. The issues already discussed regarding managing challenging behaviours for some people in the home including aggressive and threatening behaviours towards staff have an impact on people living in the home and on staff working in the home. The manager and regional director said that these matters are now being addressed, however they were highlighted at the previous inspection and while some progress has been made, more specialist assessment and guidance is required in order to protect peoples emotional and physical wellbeing. A requirement has been made regarding this matter. There are policies and procedures in place regarding the administration of medication. The staff have attended medication training and receive updated training as required. The facilities for the storage of medication are suitable and the sample of records that were seen were in order. One person has said that he would like to be in control of his own medication. The manager said that a risk assessment had been carried out but there was no copy on file. She said that the care manager has been informed but the GP has not been contacted yet. There is no lockable storage in the persons room; this should be addressed without delay so that this persons wishes can be supported. A requirement has been made regarding this matter. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints policy is now provided in a format that is suitable for the needs of people living in the home. More detailed guidance should be provided to staff to enable them to support people with their right to make a complaint in order to show that the policy works in practice. There are policies and procedures in place to help to protect people from harm or abuse; there must be more detailed guidance for staff in order to protect people living and working in the home. Evidence: There is a written complaints policy that is now provided in photographic format to help people to understand that they are entitled to make complaints. The people in the home were involved in compiling the document so that they are very familiar with it. The manager has a monthly meeting with each person that is recorded. This provides an opportunity for people to discuss any issues of concern. All those living in the home are able to express their views to staff. There is a system for recording complaints; none have been received from people living in the home, although there have been a number of incidents that have been investigated under the safeguarding procedures. The incidents have had a negative impact and have at times resulted in injury to people living in the home however no complaints have been recorded. The home follows the West Sussex Multi Agency policy and procedure for safeguarding vulnerable adults. All staff have attended training in how to recognise and report adult abuse. Eleven safeguarding alerts have been raised by the home in the past nine Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: months. Five safeguarding alerts involved violence and aggression between two people living in the home and two involved injury to staff from one person living in the home. There have been no incidents reported since 6th August although staff reported during the site visit that there are incidents of verbal aggression and threats to staff on a daily basis. A strategy meeting was held recently and the manager of the home and two senior managers from the organisation attended. Staff from West Sussex Adult Services contracts unit are monitoring the home and a review meeting is due to be held in six months. It was clear during the site visit that while the manager and staff are doing their best to support the three people living in the home, more specialist assessment and guidance is required to ensure that the safety and well being of people living in the home is protected. Care Homes for Adults (18-65 years) Page 21 of 30 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. People live in a comfortable home that is clean and well maintained. Evidence: The home is detached with gardens for people to enjoy in good weather. Lynton is in a residential area of the village. The communal areas including the kitchen and bathrooms were seen. The hallway and stairs have been redecorated and the home is bright, homely and pleasantly furnished. There is a bathroom with a toilet upstairs and a shower room with a toilet downstairs; both rooms are in need of refurbishment and the manager said that there is a plan for this to be done, although there is no clear timescale for the work to begin. One persons bedroom was seen and included personal items that reflect his interests. The home was clean with no offensive odours. Care staff are responsible for keeping the home clean and supporting people to take part in cleaning and tidying duties. People are encouraged to assist with clothes washing although one member of staff said that it can be challenging to explain why people need to be more independent with tasks in the home when they prefer things to be done for them. Care Homes for Adults (18-65 years) Page 22 of 30 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. People are supported by competent and experienced staff. The recruitment policy and procedure protects people. Staff are not always provided in a timely manner with the training that they need to provide for peoples needs and keep them safe. Evidence: The manager said that there are always two members of staff on duty; for some shifts during the week she is on the duty rota to provide direct care. There is one member of staff on sleep in duty at night. During the week there are only two people at home during the day. In the evenings and at weekends all three people are usually at home. There are guidelines to ensure that two people are never together unsupervised; with only two staff on duty this could limit the opportunities for the third person in the home to go out especially at weekends. The manager said that additional staff can be included in the rota if necessary. There are currently only four care staff employed to work at the home and the manager when she is on the rota. One member of staff has recently left. While this provides a consistent approach for people living in the home it means that staff have a burden of responsibility to cover shifts. The regional director said that he would be reviewing the number of staff employed at the home in order to address this problem. The manager said that the home uses a recruitment agency when new staff are Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: required. The home is currently seeking a replacement for the member of staff who has recently left. We did not look at recruitment records because no new staff have been recruited in the past eighteen months. The previous manager said in the AQAA that all the required checks are carried out before someone begins work. Three of the four care staff have all achieved the National Vocational Qualification (NVQ) in care at level three and one person is studying for the award at level three. The home has an induction programme that the manager said all new members of staff would follow when they begin work. There is an ongoing programme of training that includes a programme of e-learning by computer. The training records that we saw showed that staff have undertaken training in mandatory topics. Two people have received training in working with people who are on the autistic spectrum. In the past all the staff have attended training in managing challenging behaviours however they have not been given updated training since the previous inspection when this issue was raised as an urgent matter in view of the serious incidents that were occurring in the home. The manager said that all staff are now booked to attend a practical training session in managing challenging behaviours in October. Where a training need is identified then this must be addressed as soon as possible, especially when lack of knowledge and skill could have an impact on the health, safety and wellbeing of people living in the home and of staff. Care Homes for Adults (18-65 years) Page 24 of 30 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 manager for Lynton is not yet registered. The views of people living in the home are sought and taken into account in the development of the service. The health, safety and welfare of people living in the home and of staff is not yet fully protected. Evidence: The current manager has been in post for two months and is due to submit her application to become registered with the Commission. There has been no registered manager in the home for over two years. The newly appointed manager has a Batchelor of Science degree in Social Care and has attended training in management and counselling skills. The manager has experience of working with people who have a learning disability and has provided good leadership to staff since she began in post. She has shown a committment to ensuring that changes are made in the service to ensure that people living at Lynton experience a better quality of life. The new regional director said that he would be providing the manager and staff with support to ensure that all the National Minimum Standards and Care Homes Regulations would be met. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: The manager said that it has been challenging to address the number of issues in the home that were in need of attention when she began in post. Senior managers must ensure that sufficient time is allocated each week for the manager to ensure that the required paperwork is in place and up to date so that the home is well run and people are kept safe. Each person living in the home has a monthly meeting with the manager where they can raise issues of concern. This meeting is recorded and the manager said any matters arising from the meeting would be addressed. Each person is given a questionnaire to complete every year, this is provided in picture format so that it is easier for people to understand. The regional director carries out monthly Regulation 26 visits and provides a written report. The regional director said that these reports would form the basis of the improvement plan for the home. There are health and safety policies and some measures in place to protect the health and safety of people living in the home and of staff especially in relation to the environment. There is a fire risk assessment in place and staff have been given guidance about evacuating the building in the event of the fire alarm sounding. Incidents are usually recorded and reported as required, however feedback from staff indicates that this is not always being done in a systematic way when verbal violence and threatening behaviour is involved. A requirement has been made regarding the need to make sure that specialist assessments and guidance are provided with regard to behaviours that could cause emotional and physical harm to people living in the home and to staff. Care Homes for Adults (18-65 years) Page 26 of 30 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 30 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 13 Peoples holistic care needs 30/11/2009 must be clearly documented and re-assessed when necessary in particular when it is becoming difficult to manage challenging behaviours. A detailed daily plan of the support each person requires should be drawn up with clear guidance for staff to avoid triggers to challenging and threatening behaviour in order to protect the person and others in the home. 2 19 12 Where an urgent need for specialist support is identified a referral should be made to an appropriate specialist without delay especially where there may be a safeguarding concerns 30/11/2009 Care Homes for Adults (18-65 years) Page 28 of 30 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 to ensure that people receive the support that they need and people in the home are kept safe. 3 20 13 People who wish to hold their own medication must have an assessment of their competence and safe storage facilities must be provided in order to support people in their independence and keep people safe. 4 37 8 The manager must submit an application for registration with the Commission without delay to ensure that the Regulations are met. 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 30/11/2009 31/10/2009 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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