Inspection on 16/03/09 for Matlock Close 4

This inspection was carried out on 16th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Matlock Close 4 24/04/08

Matlock Close 4 04/12/07

Matlock Close 4 20/06/07

Matlock Close 4 11/09/06

Matlock Close 4 06/02/06

Matlock Close 4 21/07/05

Matlock Close 4 17/01/05

Matlock Close 4 17/08/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Matlock Close 4 Matlock Close 4 Barnet Hertfordshire EN5 2RS     The quality rating for this care home is:   one star adequate 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: THOMAS McKERVEY     Date: 1 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 30 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 30 Information about the care home Name of care home: Address: Matlock Close 4 Matlock Close 4 Barnet Hertfordshire EN5 2RS 02084499055 02084499055 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) : PentaHact Limited trading as Adepta care home 8 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: 8 8 Limited to 8 adults who have a learning disability (LD), and who may also have a physical disability (PD). Date of last inspection Brief description of the care home 4 Matlock Close is a large purpose built detached bungalow for eight adults with learning and physical disabilities and has been designed for people who use wheelchairs. The home has a substantial plot with gardens to the sides and rear. All bathrooms and toilets are adapted to meet the needs of people with mobility problems, and wheelchair access is very good to all areas of the home. There is a large kitchen and dining room, a comfortable spacious lounge, and a another lounge at the rear of the home where the residents can relax. There is off street parking to the front of the home for several vehicles. The home provides a vehicle with a tail lift for taking residents out in the community. The property is owned and maintained by Notting Hill Housing Association. The service is managed by an organisation called Penatahact, which trades as Adepta. The home is situated in a quiet cul-de-sac in a housing estate in High Barnet, which Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home has some local shops and is a short bus journey to Barnet Town Centre, Barnet General Hospital, Whalebone Park and primary schools are also located a short distance from the home. The range of fees for people living in the home is from £1,110 to £1,145 per week, depending on the level of their disability. The provider must make information available about the service, including inspection reports, to service users and other stakeholders. 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: This unannounced key inspection was completed in six hours, thirty minutes. There was no registered manager, but a manager from another Adepta home had been working as an acting manager at Matlock Close for about two weeks prior to this inspection. This person will continue to manage the home until the new manager arrives in April 2009. This inspection was overshadowed by anonymous allegations about how the home was being managed and concerns that were raised by health professionals about care issues relating to one particular resident. Barnet Local Authority held safeguarding strategy meetings about these issues, as a result of which, an investigation was set up to be carried out by a senior nurse from Barnet PCT. At the time of this report, the investigation was not completed. A director from Adepta is also investigating issues that were expressed in two anonymous letters, which were sent to Care Homes for Adults (18-65 years) Page 6 of 30 the Commisssion, purportedly from the staff. The conclusion of this investigation is also pending. In the meantime, Barnet Local Authority has placed a bar on any new admissions to the home until the outcome of these investigations is known. This inspecton consisted of discussions with the acting manager and her line manager who was at the home during this visit. Most of the people who live here are not able to converse but they can make their needs known in other ways that we were able to observe. However, we were able to converse with one resident, and spoke to two relatives who were visiting a resident. We examined three residents records, visited all areas of the home and spoke to all the staff who were on duty. We also examined the medication procedures and various records relating to the running of the home. 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 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 8 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 9 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Potential users of the service can feel confident that the home will provide good information about what to expect from the service and an assessment of their needs will be undertaken to make sure the home is suitable for them. People with physical disabilities are able to move about freely in all areas of the home. Evidence: At the time of this inspection there were six people living in the home and there were two vacancies. At the last key inspection in April 2008 the service was rated as adequate, which was an improvent from the previous inspection. However, following concerns about care issues, the local authority have put a bar on any new people being admitted to the home until an investigation has been carried out. All of the service users have lived in the home for a number of years. Residents files contained very good information about them; their background history, their needs and how they wish to be supported. These are further developed in their care plans. Each person has a tenancy agreement with the landlord, Notting Hill Housing Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: Association. This document is also supported by pictures. There was a letter in each persons file informing the resident about their individual financial contribution to the service. The majority of people who live in the home use wheelchairs. The home is purposebuilt for people who have mobility problems and all doors and corridors are wide enough to allow wheelchair access to all areas of the home. There are assisted baths and other adaptations provided throughout the building. Care Homes for Adults (18-65 years) Page 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home can feel confident that all of the staff have a good knowledge and understanding of their needs and how best to support them. Each person has a care plan and risk assessments to ensure that the staff know how to properly support the person in their activities. Evidence: All of the people who live at this home have highly complex needs and the majority are unable to communicate verbally. However, each person has a care plan that provides guidance for staff about how to communicate with them to help them understand their needs and wishes, for example by facial expression, gestures and using objects of reference. Three residents care plans were examined at random. The person in charge is currently reviewing all the care plans to ensure that they are written in a more person centred way. The care plans address a wide range of needs, for example, mobility, nutrition and eating skills, social contacts and rituals. The persons preferred day and night routines and important rituals were documented in their care plan and Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: there were pictures used to illustrate these activities. Each resident has a key worker and there were records that showed that the key worker meets once a month with the resident to review the care plan and the risk assessments. One resident who is able to communicate verbally, said that they liked living in the home and liked all the staff who were very friendly and helped them. They said they were able to choose activities themselves and told staff what they liked to eat. They could go to bed when they liked and spend time on their own in their room if they wished. Most of the people who live in the home have difficulty in making their wishes known through spoken communication. The care plans guide staff about how to support people to make choices; for instance, about the colour schemes in their bedrooms and choosing meals, some of which are shown in pictures. There were a substantial number of risks identified in each care plan about a wide range of activities that the residents participate in at home and in the community. There were guidelines for minimising each risk so that the person was not restricted and was supported to enjoy these activities. Care Homes for Adults (18-65 years) Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home can feel confident that they will be supported to enjoy a wide range of opportunities to develop their personal and social skills and to choose how they wish to lead their lives. Residents have choice about their meals and staff make sure that people who need particular help with eating, are supported safely. Evidence: The people who live in the home are supported to participate in a wide range of activities. These include shopping trips, attending day centres and colleges and local clubs. There is a rear lounge which is intended to be a sensory area for the residents, but this has yet to be developed. An outside entertainer comes once a week to the home who plays a guitar and sings to the residents. We were told that this session is very popular, particularly by one person who joins in the singing. Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: One resident is an ardent football supporter and has several posters and photographs of their team. During the inspection, staff accompanied two residents to a nearby cafe for lunch. These activities are documented as tasks for staff in shift planners each day. One resident goes home to their family for a few days every week, and there were records of frequent visits by relatives in the visitors book. The residents can see visitors in the various communal areas or in their bedrooms if appropriate and safe to do so. All the residents have had a holiday in the past year at various venues around the country The home has its own wheelchair friendly vehicle, but public transport is also used extensively by residents when they go out. Appropriate risk assessments are recorded to ensure that staff are aware of any potential hazards to health and safety, for example boiling a kettle. There are records in each persons diary of what activities they had each day. For people who are non-verbal, pictures of meals are used to enable them to choose what to eat. The menus indicated that meals are varied and nutritious. There has been considerable focus and staff training in the home about how to support people who have a swallowing difficulty. These guidelines are clearly displayed in the kitchen and in care plans. Staff are not permitted to assist residents to eat until they have been trained in this procedure. Care Homes for Adults (18-65 years) Page 15 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 who live in this home can not be confident that their healthcare needs will always be properly safeguarded. There have been poor practices in the care of a specific resident and poor monitoring of residents weights which is an indicator of their wellbeing. The actions taken to address this must be maintained to protect residents wellbeing. More attention is needed in the accounting of medication stocks held in the home. Evidence: Extensive training was provided for all the staff last year by Barnet PCT speech and language therapists. This followed serious incidents when a resident choked on their food. Several residents have difficulty with eating solid food, so detailed guidelines are in place about ensuring that food is cut up finely or puried. Concerns were raised in January this year by health professionals into the care of one of the residents who had been discharged from hospital back to the home after treatment for an illness. The resident was to be maintained on peg-feeds and was not to have food by mouth. However, the dietician who visited the resident at the home found that they were not on the correct volume of liquid feed and had lost substantial Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: weight. A safeguarding alert was made and strategy meetings were held to investigate this matter. The meeting which was convened by social services, was attended by managers from Adepta, several health progessionals, and the Commissions inspector for the home. It was decided that a full investigation into the care of this person should be held by a senior person from Barnet PCT. At the time of this report, this investigation was still underway. It emerged in the strategy meetings that there were several issues which led to this residents health being put in danger, specifically poor communication between the hospital and the home about the correct amount of food to be given, poor monitoring of the residents weight, and the fact that the weighing scales in the home were faulty. This also affected all the other residents who were not being weighed correctly either. Adepta has taken these matters seriously and has put significant effort into the home to improve the service. This includes removing the person who was managing the home and putting in a registered manager from another Adepta service, pending the appointment of a new manager. The area manager is also spending the majority of her time in the home to support the staff. For this reason, the outcome of this group of standards is rated as adequate rather than poor, but the improvements need to be maintained. Because of these concerns, the local authority has barred any future admissions to the home until the outcome of the investigation is known. One of the residents had recently died in hospital from a chronic illness. Another person was due to have an operation soon, but all the other residents were reported as being in good health. The Commission was sent two anonymous letters, purportedly from staff, alleging poor care and negligence into two residents care. These allegations are currently being investigated by a senior manager from Adepta and will be reported back to the strategy meeting when concluded. During the inspection, we checked the weighing scales and we saw a document to show that they had recently been serviced and all the residents were being weighed monthly. The resident who is on peg feed only, was now on the correct amount of liquid food as advised by the dietician and was gaining weight. The acting manager had implemented a care plan which stated that staff provide mouth care for this person. We have made a recommendation that the plan states how often this should take place and a record is kept of this. In the case files examined, there were records of appointments with the G.P, consultant psychiatrist and speech and language therapist. Staff wear alarm devices which activate when they need to summon help urgently from anywhere in the home, for example if a person suffers an epileptic seizure. The speech and language therapist had inducted staff in the use of this equipment. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: The residents have Health Action Plans, which record their medical history, any allergies and immunisation status. None of the people who live in the home are able to take medication by themselves. We found that the medication was properly stored and temperatures of the cabinet were recorded as being satisfactory. We examined the records for the administration of medicines. We found that staff had signed for medication that was administered, but two tablets of Tegretol were missing from the stock and there was no record made re disposal. In addition, the quantity of medication received from the pharmancy was not recorded in some intances. However, there was a record of all medicines returned. We have made requirements about medication issues. Care Homes for Adults (18-65 years) Page 18 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. Residents and other stakeholders cannot be confident that their concens or complaints will be taken seriously and investigated. Staff are aware of the whistleblowing procedure and how to report incidents of abuse. Evidence: The complaints procedure is in picture format and is pinned to the residents notice board. There is a note on the procedure saying that it is available in Braile or audio format. The Commission was sent a copy of a complimentary letter about the home in August 2008, which had been sent to the acting manager at the time. The complaints log was examined. When speaking to a relative during the inspection, they informed us that they had made a complaint regarding the poor quality of the laundry. However, no complaints were recorded in the log. A requirement is made to address this. As commented under the Personal and Healthcare Standards in this report, serious concerns about the care of a specific resident were being investigated, which at the time of this inspection was still ongoing. The Commission received two anonymous letters from staff alleging poor care and also alleging inappropriate actions by the acting manager. As a result, the manager was removed from the home to allow for a full investigation by a senior manager from Adepta. At the time of this report, the outcome of this investigation was also pending. Strategy meetings were also held by social services, health professionals and the Commission to consider all these issues. It is worth noting that all the staff who were interviewed during this inspection, denied Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: any knowledge of these allegations, which in their view, were malicious. The staff also expressed anger and disappointment about allegations about poor care, and said they would have no hesitation about whistleblowing if they suspected abuse. Care Homes for Adults (18-65 years) Page 20 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. The residents live in a home that is well mintained and pleasant and in a good state of decoration. Evidence: All areas of the home, including residents bedrooms, were visited. The landlords had put in much needed investment in bringing the property up to acceptable standards in the past year, including redecoration throughput the home. There is a book for recording maintenance and repair issues and the response times. However, during the inspection, we noted that the washing machine was not working, but this had not been reported. A requrement is made to address this. The garden was well maintained and looked attractive. There are large paved areas around the building, providing a level surface, which enables safe access for wheelchair users. The bedrooms are decorated in the preferred taste of each resident. The bedrooms either have carpets or laminate flooring, depending on the needs of the resident. Each person had pictures and other personal mementoes on display. One resident has a particular interest in football and there were posters of their favourite team on the walls. The home is well equipped with hoists, assisted baths and other adaptations to assist staff in supporting the residents in a safe manner. There were records to show that the equipment is serviced regularly. We were told that the rear lounge area was going to be developed into a Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: sensory room, which will be a valuable asset for the people who live in the home. Buckets and mops were colour-coded to prevent the spread of infection. The kitchen furniture and cupboards were in good repair. The kitchen is large enough to allow access for the residents to sit in and eat if they wish. There is a large, very attractive conservatory-style room at the front of the home, which is comfortably furnished. A cleaner is employed in the home and at the time of the inspection, the home was clean and tidy and smelled fresh. 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 who live in the home can feel confident that the staff are able to meet their needs by being trained in how best to support them safely. However, this could be improved by more full- time staff being recruited to ensure continuity of care. The staff receive regular supervision to monitor their performance in meeting residents needs. Evidence: At the time of the inspection there were six people living in the home and we were informed that there were eleven staff vacancies. One member of staff was suspended from duty under the homes discplinary procedures. We were informed that three new staff had just been appointed and were waiting for their clearance checks before starting work. The staff rota matched the identity of the members of staff who were on duty. There are normally four staff on the early shift, four on the evening, one waking and one sleep in staff at night. The staff to whom I spoke said they were satisfied with this level of staffing. There were two new staff since the last inspection who were appointed as assistant managers. It was not possible to check their recruitment records as these are held at Adepta head office with the agreement of the Commission. We are satsfied that proper procedures are followed, including obtaining references and Criminal Records Bureau checks before staff start working in the home. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Agency staff make up for the vacancies. They have worked at the home on a regular basis for a long time, in some cases for two years, and they know the residents well. They have also undergone the competencies training required to support residents with dysphasia. The permanent staff said they monitor agency staff to make sure they support residents safely. Some staff have completed their National Vocational Qualifications and one is currently on this course. There is a spreadsheet that shows all the training that staff have undergone, including mandatory health and safety courses and any training that is still outstanding. We were satisfied that staff had been trained in protecting people from abuse, as well as specialist courses like epilepsy and dysphasia as mentioned above. There were records of regular staff supervision, and all staff had an annual appraisal in the past year. All of the above was confirmed by the staff who were spoken to. 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 residents cannot feel confident that they are living in a home that has been well managed in the past. However, the organisation has responded to this by implementing an action plan to appoint an experienced manager and is taking steps to improve the service overall. Evidence: This service has undergone several changes of manager over the past five years. None of the previous managers have stayed for very long. This has had serious consequences for how the service, which is reflected in previous inspection reports. The last inspection found some improvements had taken place which lifted the rating from poor, to adequate. However, the acting manager at that time has since been removed following the concerns about care isssues as identified earlier in this report. The Commission met with two senior managers from Adepta in January to express concern about how Adepta services were being managed. We were shown a new management structure and given an action plan that Adepta are implementing to appoint and support new managers where there were vacancies, including Matlock Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: Close. We were satisfied that the company were taking our concerns seriously and were responding appropriately. In speaking to the staff during the inspection, it was evident that they also had serious concerns about the constant turnover of managers, which they said had an impact on the teams morale. At the time of this inspection, a registered manager from another Adepta home was in charge, pending the arrival of a new manager who is due to start on 1st of April. We were informed that the new manager is very experienced in the field of learning and physical disability and was previously a manager of a care home with another company. There are two assistant managers in the home who have designated management responsibilities. The person in charge at the time of this inspection was very open about the problems she was dealing with and we were satisfied that she was competent in the manner in which she was addressing them. This included regular meetings with staff and formally supervising them. She was also reviewing and rewriting the care plans. Another area the acting manager had addressed was monitoring how staff were recording how care was being delivered. We were told that she would be working with the new mananger for a time to provide him with an effective handover. We examined the personal finance records of two residents at random. Receipts were being kept for purchases and two staff sign when they withdraw cash from residents money pouches, which are then sealed until the next transaction. The sums of cash remaining, balanced with the records. We saw minutes of staff meetings which are held regularly. However, we were informed that no residents meetings had been held for some time. A requirement is made to address this so that residents have an opportunity to have an input into how the home is run. Senior managers visit the home and monitor the service monthly. Reports of these visits are sent to the Commission. We noted that the area manager from Adepta is also spending significant time at Matlock Close to support the acting manager and the staff. Adepta carried out a quality audit of all its services, including Matlock Close last year. The views of relatives and other stakeholders were canvassed and the outcome was generally positive. Where there were less than positive outcomes for Matlock Close, a develpment plan was produced to improve those areas. We also saw a document relating to special supervision for staff at the home, which all staff must sign up to. This is to focus on areas of poor practice. It is hoped that this process will result in significant improvements for the residents. We found that the acting manager has been busy updating all the records in the home to ensure they are accurate. These include fire alarm tests and drills and temperature monitoring of fridges and freezers, which were up to date. The major service installations were serviced in the past year and there was a current insurance certificate on display. 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 20 13 The manager must investigate the issue of the missing Tegretol tablets and take steps to secure medication stock. To ensure that resident have received their prescribed medication. 30/04/2009 2 20 13 An accurate record of all 30/04/2009 medication stock that comes into the home must be kept on the MAR sheets. This ensures that proper auditing of medication stock is carried out 3 22 22 All complaints or concerns must be recorded in the complaints log, including how the complaint was investigated and the response. 30/04/2009 Care Homes for Adults (18-65 years) Page 28 of 30 This ensures that people will feel confident that their concerns will be taken seriously. 4 33 18 Managers must endeavour to recruit more full time staff. So that residents can have continuity of care from a fully established staff team. 5 40 24 Residents must be consulted 30/04/2009 about how the service is run. Regular meetings must be held with residents to ensure they have a say about how the home is meeting their needs. 30/04/2009 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 18 Guidance should be provided in a specific residents care plan about how often mouth care is to be caried out. Care Homes for Adults (18-65 years) Page 29 of 30 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. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!