Inspection on 20/03/09 for Magnolia House

This inspection was carried out on 20th March 2009.

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

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

Other inspections for this house

Magnolia House 03/09/09

Magnolia House 03/12/08

Magnolia House 24/11/08

Magnolia House 24/11/06

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Magnolia House 185 Rockingham Road Kettering Northamptonshire NN16 9JA     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Catherine Perrins     Date: 2 6 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Magnolia House 185 Rockingham Road Kettering Northamptonshire NN16 9JA 01536518689 01536513989 magnolia@consensussupport.com 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) : Caring Homes Healthcare Group Limited care home 19 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 19 Only one service user over the age of twenty five (25) years may be admitted to Magnolia House. Only service users between the ages of eighteen (18) and twenty five (25) may be admitted to Lily House. Only service users between the ages of eighteen (18) and twenty five (25) may be admitted to Violet House. The Home is registered to provide personal care to service users as follows: Learning Disability (LD) - Magnolia House (10), Violet House (4), Lily House (5). Date of last inspection Brief description of the care home Magnolia House provides care and support to younger adults with learning disabilities and autistic spectrum disorders. An established home, Magnolia House was taken over by the current provider June 2006. The premises consist of three units Magnolia House, Lily House, and Violet House, which are all on the same site. Magnolia House and Lily House are refurbished Victorian properties, and Violet House is a purpose built bungalow. Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home The home has 19 beds in total, 10 in Magnolia House aged 25-65, four in Violet House aged 18-25, and five in Lily House aged 18-25. Violet House and Lily House mainly accommodate residents with autistic spectrum disorders, and Magnolia House caters for people with learning disabilities. One Registered Manager is responsible for the three units, each of which has its own Team Leader and dedicated staff team. The home does not currently have a registered manager and is being managed by a temporary manager. The home is situated on a main road into Kettering, and has good transport links and a car park. Fees at the time of last key inspection ranged from 350 to 2,000 pounds per week. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor 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 zero star. This means that some of the people who use this service experience poor quality outcomes. This was an unannounced key inspection which means that we focused on the key national standards. The key standards are those considered by the Commission to have the most impact on outcomes for residents. As part of the preparation for this inspection a period of five hours was spent reviewing previous inspection reports the other information that CSCI has received about this service. Care Homes for Adults (18-65 years) Page 6 of 31 We sent out a number of questionnaires to the people who live at the home, their relatives and the staff who work at the home. We received four returned questionnaires from people who live at the home, two from relatives, four from staff and two from General Practitioners who visit the home on a regular basis. Some of the comments from these questionnaires have been included in this report. The inspection visit lasted fourteen hours hours during the morning and afternoons of two weekdays. An expert by experience assisted with the inspection on the first day. Experts by experience are people who have experience of using social care services. The expert by experience visited each of the properties, spoke to people who live at the home and to staff and made observations based on his experience. Comments made by the expert by experience have been included throughout this report. Two Environmental Health Officers also visited the property on the first day of the inspection. During the inspection three people were case tracked. This involves looking in detail at all aspects of their care and experiences at the home,including looking as their individual plans of care and other records, talking to them and talking to their care staff. Because people with learning disabilities are not always able to tell us about their experiences we also used observations of peoples state of well being and how they interacted with staff members and others. A sample of staff files were also viewed as part of the inspection. The temporary Manager was present for the majority of the inspection. What the care home does well: What has improved since the last inspection? What they could do better: The home must take steps to adequately keep people safe and minimise their risk of harm. The storage of medication needs to be reviewed to ensure that the home is able to store any controlled drugs safely and to ensure compliance with the latest requirements of the Misuse of Drugs Act Amendment 2007. All medication received into the home must be entered onto the medication administration record. A record of all complaints received and actions taken to investigate must be kept by the home. Care Homes for Adults (18-65 years) Page 8 of 31 Where staff notice any unexplained bruising or injury this must be investigated and followed up in line with local procedures and protocols. Magnolia House in particular and Lily House are showing signs of heavy usage and wear and tear. Our expert by experience said of Magnolia House The home looks tired and in need of updating. I would not like any of my family to live in a home like this. None of the windows in Magnolia House are fitted with window opening restictors, this can put people at risk from falling out of the windows. Where staff are using any form of physical intervention this must be assessed to ensure that it is in the persons best interests. The home needs to ensure that all pre recruitment checks are carried out to make sure that staff are suitable to work with people with learning disabilities. The home needs to appoint a manager who will apply for to become the registered manager for the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given good information and their needs are assessed prior to moving into the home. Evidence: People can find out information about Magnolia House from the homes statement of purpose and service user guides. The home has a statement of purpose which covers all three of the properties. Each property has its own service use guide; these have been written in plain English and contain pictures and photographs to make the information easier for people with learning disabilities to access. Records show that peoples needs are assessed before they move into the home to make sure that their needs can be met. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are generally well met and their preferences respected within all three properties. Evidence: Each person who lives at the home has an individual plan of care. This contains their support plans and other information that staff need to care for and support people in the right way. Individual plans of care from each of the three properties were viewed during the inspection. Support plans seen were comprehensive and covered areas such as eating and drinking, personal care, finances, relationships, mobility, culture and religion, health, continence, use of keys, travel and leisure. All support plans seen had been reviewed within the last four months and there was evidence that where peoples needs have changed their support plans had been updated to reflect this. Staff spoken to in all three properties showed a good understanding of peoples support needs. Our expert Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: by experience noted that staff he spoke to in Lily House seemed to understand the needs of the service users in this house. and that staff in Violet house showed a great deal of commitment and had a good understanding of the communication difficulties of the people they support. Support plans also contained detail about peoples preferences such as their likes and dislikes, what time they liked to get up and go to bed and how they liked to be supported with personal care. There was evidence in Violet and Lily House of people being supported to communicate using different methods. A staff member in Violet House explained to our expert by experience that she had been on a Makaton signing course and was starting to use this with some of the service users. Staff were observed using picture boards and objects to help people communicate. The menu in Violet House is being changed into a picture format so it is easy for people to make choices about what they would like to eat. Staff in Violet House described how they were working closely with peoples families and with the Community Learning Disability team. They gave a number of examples of positive outcomes and achievements that people had made within the last year in terms of improved communication, improved health and increased independence. Staff told us that the work that they have done with one person has been used as an example by the Community learning disability team when training staff from other settings. Individual plans of care contained assessments of risk to peoples safety or that of their support staff. These were on the whole comprehensive, however, there was one area where there was a known risk where the risk assessment would have benefited from being more specific. This was discussed with the tempoary manager during the inspection. Care Homes for Adults (18-65 years) Page 13 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The majority of people in the home enjoy an active life but this is not consistent for everyone. Evidence: In Magnolia House some of the people go to day centres or to college during the day. Staff told us that somebody comes to do music and movement once a week and someone else comes in to do massage. Staff were observed using sensory objects and going out for walks around the local area with one person . Staff in Lily House explained that the people who live there have a weekly programme of activities including swimming, bowling going to the park and shopping. Staff told us that one person often choses to stay in the house but the others are all fairly busy. They said that that there is generally adequate staffing during the day and in the Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: evening for people to go out if they want to. In Violet House staff explained that they are helping people to chose the activities that they would like to do. People enjoy activities such as horseriding, swimming going out for lunch, going to country parks and going to the snooker hall. In all three properties staff prepare the meals. In Magnolia House one person told us that the food is good. In Lily house staff told us that the menus were put together by observing peoples likes and dislikes. Where people have specific cultural needs staff explained how these were catered for within the menu and how advice is sought from family members to make sure that peoples cultural needs are met in relation to their diet and other areas. In Violet House staff explained that people are encouraged to make their own breakfast with staff support. The menus for dinner were in the process of being up dated to include pictures to make it easier for people to chose what they had to eat. Staff stated that if people did not like a meal then they could always chose an alternative. Staff in all three homes told us that people enjoy going on at least one holiday a year. Care Homes for Adults (18-65 years) Page 15 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are generally well met. Evidence: Individual plans of care seen contained good information about peoples personal and health care needs. There was evidence in all three properties of people receiving support from a range of heath and social care professionals including general practitioners, hospital consultants, community nurses, physiotherapists, dentists, chiropodists and opticians. Staff spoken to were all aware of the need to check the temperature of bath water before supporting someone to bathe. Records show that people were being supported to bathe at temperatures that were safe and comfortable. The administration and storage of medication was looked at in all three properties. The storage of medication needs to be reviewed to ensure that the home is able to store any controlled drugs safely and to ensure compliance with the latest requirements of the Misuse of Drugs Act Amendment 2007. This specifies how care homes should store Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: controlled drugs. Controlled drugs are prescribed medicines which some people abuse them by taking them when they have not been prescribed, there are laws and regulations about how these drugs should be stored and administered. In all three properties entries on the medication administration record had been signed to show that medication is being given as prescribed. Each person had a medication profile which included a picture and a description of the medication that they take, including any possible side effects. Spot checks of medication in Lily and Violet House showed all medication to be accounted for. In Magnolia House there was some medication that had been received by the home but not entered on to the medication administration record. Care Homes for Adults (18-65 years) Page 17 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not consistently safeguarded from harm and the risk of harm. Evidence: The home has a complaints procedure which was viewed during the inspection. A summary of the policy is available with pictures to make it easier for people with learning disabilities to understand the information. In their annual self assessment that they have to return to the Commission for Social Care Inspection the home told us that they had received six complaints in the past twelve months all of which have been resolved. Discussion with the temporary manager suggests that the procedure has been followed when investigating complaints that have occurred since he began managing the home but these have not been consistently recorded. One person who lives at the home told our expert by experience that if she complains nothing is done about it. Staff in all the properties attend training on safeguarding adults. Staff spoken to had a good understanding of their responsibilities to act on and report any concerns that they may have regarding anyones safety and well being. Records show that in two of the properties staff had noted unexplained bruising. There was no record of this being investigated or followed up to try and find out how the Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: bruising occurred suggesting that staff did not apply their knowledge of safeguarding adults. On the 24th November and the 3rd of December 2008 we conducted a random inspections at the home. A random inspection is a focused inspection that looks at a specific issue or concern. The reports from these inspections can be viewed on our website or by contacting the Commission to request a copy. Our visit on 24th November followed concerns about an incident where someone who lives at the home had been scalded while being supported to have a bath. We issued the home with an immediate requirement at this inspection. We make immediate requirements when we have concerns about the safety of people who use the service and we require the home to take urgent action to ensure that people are safe. The immediate requirement that we left on 24th November, 2008 concerned the bath water temperatures and the need to make sure that bath water is a safe and comfortable temperature for people to bathe in. On the first day of this inspection the shower in the upstairs shower room was dispensing water to a maximum temperature of sixty degrees Celsius. This temperature was taken by an environmental health officer. The temporary manager told us that this shower room would not be used until the shower was replaced with one that could have the hot water temperature limited to a safe level. On the second day of inspection, six days later, the shower had been replaced with a new one that dispensed water at a maximum temperature of 43 degrees Celsius. Where staff are using any form of physical intervention this must be assessed to ensure that it is in the persons best interests. Observation during the inspection suggested that the current written support guidelines for one person were not consistently the same as what staff were doing in practice. More specific guidelines would enable staff to be clear about what their approach should be. Other issues relating to peoples safety have been highlighted in other sections of this report for example the need for thorough pre recruitment checks and environmental hazards such as the lack of window restritors. Care Homes for Adults (18-65 years) Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Violet House and the self contained flat provide a good standard of accommodation for the people who live there elsewhere, despite recent improvements, the home is not always maintained to an adequate and safe standard.. Evidence: Magnolia House and Lily House are large detached Victorian properties. Both are showing signs of heavy usage and wear and tear. Our expert by experience made the following comments about Magnolia House The front garden of the house is very bare and untidy looking. From the outside the house did not look very welcoming.The downstairs lounge is very noisy. The hall is in need of decorating, there are holes in the wallpaper. The upstairs lounge was very small and looked as though no one ever cleaned it, one of the sofas had holes in the arm. The home looks tired and in need of updating. I would not like any of my family to live in a home like this. None of the windows in Magnolia House are fitted with window opening restictors, this can put people at risk from falling out of the windows. The temporary manager explained that a request had been made to the company for these to be fitted. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: On the first day of inspection the shower in the upstairs shower room was dispensing water to a maximum temperature of sixty degrees Celsius. This temperature was taken by an environmental health officer. The temporary manager told us that this shower room would not be used until the shower was replaced with one that could have the hot water temperature limited to a safe level. On the second day of inspection, six days later, the shower had been replaced with a new one that dispensed water at a maximum temperature of 43 degrees Celsius. The kitchen in Magnolia House was being totally refitted during the inspection. In the downstairs bathroom in Magnolia House the door screens had been removed from the walk in shower. The had resulted in water flooding across the bathroom floor when the shower is in use. The temporary manager explained that a request had been made to the company to fit a gully to the floor to ensure that the excess water drains away. Until this is completed staff tell us that they have to mop the floor each time someone showers to ensure that the floor does not become wet and slippery. The access to the fire exit at the side of Magnolia House was observed as being restricted by ladders and a walking aid which had been left at the bottom of the stairs. These were moved during inspection. One of the bedrooms in Magnolia House had a very strong smell of urine. Staff explained that a new vinyl floor had recently been but into this room but it appears that the smell was coming from the floor boards underneath. Bedrooms seen in both Magnolia and Lily house had been made personal with ornaments and personal belongings. One person told us that they had chosen their own bedding and curtains. The stair carpet in Lily House was worn. Staff explained that they had requested a replacement. The main lounge in Lily House appeared to be comfortable and homely and of adequate size for the number of people who live in the home. Lilly House was generally clean throughout. Staff told us that repairs and maintenance work takes a long time to be completed. At the rear of Magnolia House there is a self contained flat where one person lives. She receives support from the staff who work in Violet House. The flat was clean, well Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: maintained and had been made personal by the person who lives there. Violet House is a purpose built bungalow behind Magnolia House. It appeared clean and well maintained throughout. The decor and furnishings reflected the age and style of the people who lived in the property. Each person in Violet House has their own en suite bedroom. Bedrooms seen had been made personal ornaments, pictures and effects. Communal areas consisted of a spacious loge / diner and a smaller quiet room. The kitchen in this property is very small. In the lounge there is a large cupboard which contains a sink and is used to store food and other kitchen items that cannot be fitted in the kitchen. Violet house has a small garden area that was well maintained and attractive. There is also a garden area at the rear of Lily house. Each property has its own laundry facilities. Care Homes for Adults (18-65 years) Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is evidence of some excellent care and support being given by the staff team, however, this is not always consistent. Evidence: Recruitment records were looked at for two staff members selected at random. Although most of the pre recruitment checks had been carried out to make sure that people were suitable to work with people with learning disabilities. In both cases adequate references from previous employers were not available. The home is managed by one manager. There is also a deputy manager who over sees all three properties. Each property then has a team leader. The deputy manager is also the team leader for Magnolia House. Each house has a team of support workers and senior support workers. The team leader in Violet House described the team that works in that house as a good mix of skills and experience - all very enthusiastic. Our expert by experience noted that the staff in Violet had a very friendly approach.... and seemed to understand (peoples) needs. One person who lives in Magnolia House told in a survey I think that the staff should listen to me more and not always be looking after (others). One staff member told us Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: that some of staff are very committed but some do not seem to understand service users needs. Staff in Violet House and Magnolia House have received commendation from visiting professionals who have commented on the high standard of support people received and how this has led to an improvement in peoples well being. New staff under go a period of induction which involves attending training courses and working alongside an experienced colleague. After this they are assessed by the deputy or team leader to make sure that they are able to carry out their job to the agreed standards. Staff attend an ongoing programme of training including food hygiene, moving and handling, health and safety, safeguarding adults, autism, communication and personal care. Care Homes for Adults (18-65 years) Page 24 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home would benefit from a structured management approach informed by ongoing quality assurance measures. Evidence: The home does not currently have a registered manager. A temporary manager who works for Consensus is currently over seeing the management of the home. The home has made a number of recent improvements and met the requirements set following the random inspections carried out in 2008. Random inspections focus on a specific issue rather than looking at all of the key standards. The commission conducts random inspections when we receive information that suggests that peoples safety may be at risk. The provider needs to ensure that they appoint a permanent manager to coordinate the further improvements needed to meet the requirements made in this report and to ensure that all of the people who live at the home experience a good quality of life. The home did have some quality assurance measures in place. The area manager for Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: the company conducts regular inspections of the home, these are recorded and actions agreed for any areas of development identified. The company is also due to conduct a full audit of the home against all of the national standards. The results of the previous audit were not available on the day of inspection. Staff told us that each of the properties holds regular residents meetings where the people who live in the home and their relatives can discuss various issues concerning the running of the home. Staff told us that people discuss things such as activities, holidays and menus. Minutes to these meetings could not be located during the inspection. The temporary manager explained that the home will be issuing satisfaction surveys to the people who live at the home and their relatives. The results of previous surveys were not available at this inspection. Records seen during the inspection were generally comprehensive, up to date and in good order. The home does however need to ensure that recordings made in staff message books complies with the Freedom of Information Act 2000 and that entries made about individuals can be accessed by that person without compromising the confidentiality of others. Fire safety checks had all been completed in line with recommended timescales however our expert by experience noted that there did not appear to be a signing in book at any of the three properties. This could be a security risk, if there was a fire there would not be a record of who was in the building. Care Homes for Adults (18-65 years) Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 The storage of medication must be reviewed to ensure that it complies with the latest requirements of the Misuse of Drugs Act Amendment 2007. This is necessary to ensure that all medication, including controlled drugs can be stored safely. 03/07/2009 2 20 13 All medication received must 01/05/2009 be entered onto the medication administration record. This is necessary to ensure that it can be audited and accounted for. 3 23 13 Where signs and indicators 30/04/2009 of possible abuse are observed they must be investigated in line with local safeguarding adults procedures and where necessary a referral made to the local authority safeguarding adults team. Page 28 of 31 Care Homes for Adults (18-65 years) To make sure that the risk of anyone suffering abuse or harm is minimised. 4 23 13 Any restrictions placed on a 02/07/2009 person must be assessed and documented as being in their best interests. Details physical interventions should give specific guidelines about how staff should intervene. To make sure that people are not having any unnecessary restrictions placed on their rights and liberty. 5 24 23 Repairs and maintenance must be completed to ensure that the home is safe, clean and reasonably decorated and furnished. In order to meet the needs of the people who live there. 6 30 16 The home must be kept free from offensive odours. To ensure that peoples dignity is respected and they are able to live in a pleasant and hygienic environment. 01/06/2009 01/10/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 Risk assessments should be written in a way that they give specific instruction about how the identified risk should be minimised. Page 29 of 31 Care Homes for Adults (18-65 years) 2 34 Where character references are obtained these should be to supplement not replace the previous employers references. Where someone has previously held a care position that employer should be approached for a reference. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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