Inspection on 16/03/09 for Meridan House

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 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meridan House 23/10/06

Meridan House 03/01/06

Meridan House 30/08/05

Meridan House 21/02/05

Meridan House 12/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Meridan House 1 Stonecrop Close Colindale Avenue Colindale London NW9 5RG     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: Daniel Lim     Date: 1 9 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 34 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 34 Information about the care home Name of care home: Address: Meridan House 1 Stonecrop Close Colindale Avenue Colindale London NW9 5RG 02082054048 02082052986 meridan.house@richmondfellowship.org.uk 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) : Richmond Fellowship care home 12 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 12 Foxlands and Meridan will have one registered manager and a designated deputy manager in each home. The homes Meridan House and Foxlands House will function seperately with their own registration and independent staff group to provide personal care only. There is one female service user at Meridan House over the age of 65 (D.O.B 30/11/1937). The CSCI must be informed when this service user no longer receives care at the home. Date of last inspection Brief description of the care home Meridan is a care home registered to provide personal care for a maximum of twelve younger adults with mental disorders. Most of the residents were previously patients at Napsbury Hospital in Hertfordshire. The home is operated by a charity called The Richmond Fellowship which also operates several other care homes for people with mental health problems in London. The stated aim of the home is to provide a home where residents can be cared for with dignity and where they can lead as independent a life as possible. The home is a Care Homes for Adults (18-65 years) Page 4 of 34 Brief description of the care home modern, detached two storey house which was opened in 1998. It has twelve single bedrooms. All bedrooms have ensuite facilities. The staff office, kitchen, diner and two large lounges are on the ground floor. The bedrooms and two smaller lounges are on the first floor. There are two communal bathrooms on the ground floor and one communal toilet on each floor. There is a small front garden and an attractive larger back garden which is partly paved and accessible to service users. The home is within walking distance of Colindale Hospital and about a mile away from Edgware Hospital. It is also close to shops, restaurants and public transport facilities along the Edgware Road. The fees charged by the home are based on a block contract with the local health authority, £1158 per person week. The provider must make information about the service available, including reports to service users and other stakeholders. Care Homes for Adults (18-65 years) Page 5 of 34 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 One star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out by Daniel Lim and Tom McKervey, Regulatory Inspectors, on 17 and 19 March 2009 and took a total of eight hours to complete. We were assisted by the manager, Richard Erbe and the Richmond Fellowship Area Manager. Stephen Robinson. Four residents were interviewed. Some communication difficulties were experienced. The inspectors attempted to deal with this by securing the assistance of staff and getting the opinion of relatives. The general impression gained was that the care Care Homes for Adults (18-65 years) Page 6 of 34 provided was varied. Five completed service users survey forms were received by us. These indicated that residents were generally satisfied with the care provided. Statutory records were examined. These included three residents case records. The premises including residents bedrooms, communal bathrooms, laundry, kitchen, garden and communal areas were inspected. Four care staff were interviewed regarding the care of residents and other areas associated with their work. They were noted to be knowledgeable regarding their roles and responsibilities. Staff records, including evidence of CRB disclosures, references, supervision and training records were examined. In addition, the minutes of residents and staff meetings were examined. These indicated that residents and staff had been consulted and informed of changes affecting the running of the home. The completed Annual Quality Assurance Assessment form or AQAA was received by CSCI. Information provided in the assessment was used for this inspection. What the care home does well: What has improved since the last inspection? What they could do better: The Statement of Purpose must be amended to reflect management changes in the home. This is to ensure that prospective residents and their representatives are fully informed. The provision of personal care to residents must be closely monitored to ensure that residents are well cared for. Improvements are needed in the arrangements for the administration of medication. Details of deficiencies which need to be rectified are provided in the body of this report. The home must have regular audits of incidents and complaints made and action taken in response. This is necessary to ensure that residents are fully protected. A recommendation is also made for concerns raised in residents meetings to be recorded in the complaints book. The missing tiles in the bathroom, identified to the manager must be replaced. This is to ensure that residents live in a pleasant environment. The defective microwave and fly electrocutor in the kitchen must be repaired or replaced. These are for health and safety reasons. In addition, the home must be fully cleaned. A review of staffing levels must be undertaken so as to ensure that there is sufficient staff to meet the needs of residents. The new manager must apply for his registration with the CQC. This is to ensure that he is suitable for the management of the home. The home must have an effective system of quality assurance. This must include a stakeholder or consumer survey. A report following the analysis of such a survey together with an action plan in response to any identified deficiencies must be prepared. This is required to ensure that the care provided is of a good quality. A minimum of four fire drills must be organised in a twelve month period. Fire training must also be provided for all staff. These are necessary to ensure the safety of residents and staff in the event of a fire. A risk assessment must be carried out on the cooker as it is still being used. This is for health and safety reasons. Care Homes for Adults (18-65 years) Page 8 of 34 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 34 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 34 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. Admissions are not made to the home until a full needs assessment has been undertaken by the manager. Admissions only take place if the service is confident that the needs of people to be admitted can be met. This ensures that the admissions to the home are appropriate. Evidence: The preadmission assessments which were examined were noted to be appropriate and comprehensive. The assessments included details of the personal, mental, cultural and spiritual needs of residents. Risk assessments had also been prepared for residents admitted to the home. The homes completed AQAA indicated that all prospective residents would be fully assessed to ensure that the home can meet the needs of individuals before their admission. No new residents had been admitted since the last inspection of the home. Residents who returned their completed questionnaires were on the whole satisfied Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: with the care provided. Comments made by residents included the following I am satisfied with the care given Staff treat me well. I am happy here. Yes, some staff support me. The new manager informed us that the statement of purpose had not been amended to provide information regarding the new management arrangements in the home. This must be done to ensure that the statement of purpose is up to date. Care Homes for Adults (18-65 years) Page 12 of 34 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 service recognizes the right of individuals to take control of their lives there is evidence that residents are involved in decision making about the home. Residents are consulted on how the service runs and activities they wish to participate. Each individual has a care plan, and residents are involved in the development of their care plans. The care plans include appropriate risk assessments. Evidence: The homes AQAA states We have consulted and listened to the residents. Service users individual case notes and individual Support Plans have their views stated and signed. There are risk assessments with residents comments and signatures. The three residents case records contained comprehensive and appropriate care plans, assessments and details of reviews carried out. The preferences of residents had been Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: documented. There was documented evidence that residents had been encouraged to be as independent as possible. Risks assessments had been prepared for residents. They were noted to be comprehensive and up to date. Staff were aware of action to be taken to minimise risk. There was documented evidence that the care of residents had been reviewed. The minutes of these reviews, including reviews done by health and social services professionals were kept in the case records and available for inspection. Care Homes for Adults (18-65 years) Page 14 of 34 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. The home had sought the views of residents and considered their varied interests when planning their daily routines. Links to specialist support are facilitated when needed. Residents have some opportunity to develop skills and are encouraged to be as independent as possible. The arrangements for the provision of meals take into account the preferences of residents and their dietary needs. Evidence: The AQAA of the home states We have activities for residents which are held in a day centre at the service. The activities at the service addresses every individual needs. Service users with high needs also attend a specific day service at the Richmond Fellowship Employment and Training Centre. The activities at the service include, arts and crafts, cooking, cinemas, Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: sports as well as going to community activities on every Thursday. Service users have been consulted about all activities at the service. Service users are consulted about holiday venues and provided with 5 to 7 days paid holidays every year. There was evidence that the home has a written weekly programme of varied activities for residents. This included holidays, day centre attendance and outings to places of interest. The inspector noted that two rooms had been set aside for promoting the personal development of residents. One was a resource room where reference books and magazines and a computer were provided for residents. The other room was now an activities room with a treadmill, exercise bike and a selection of art and crafts items. Meetings had been organised and residents had been consulted regarding the management of the home. The minutes of these meetings were available for inspection. We note that on both days the activities planned for residents as mentioned in the programme did not happen. A carer on duty told us that it was due to staff shortage. The manager was unable to inform us of what activities had taken place in the home within the past two weeks. In addition, we were informed by a staff member that an activity planned for a resident during our second visit to the home had to be cancelled due to staff shortage. We were also informed by two healthcare professionals that they whenever they visited the home, they noted that residents were not provided with appropriate social or mental stimulation and there was little interaction between staff and residents. The kitchen was inspected and found to be clean. Daily recorded temperatures of the fridge and freezer had been kept. These were satisfactory. A fire blanket was in place. The menus examined appeared varied and balanced. The chef informed us that residents had been consulted regarding their dietary preferences and their cultural preferences had been responded to. We also note that he consulted with a resident who came for lunch on his return to the home. Residents were interviewed regarding the meals provided. One suggested more rice dishes while another wanted more choice. These suggestions were relayed to the manager. On resident made the following positive comment They cook good food for me. Residents interviewed stated that they had been in contact with their relatives. This was also confirmed by a relative who spoke to the inspector over the telephone prior to the inspection. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: The bedrooms of residents contained ornaments and souvenirs which reflect individuals interests and preferences. The manager stated that the home was in the process of being redecorated and the views of residents were being considered in relation to colour schemes and the way the home is furnished. Care Homes for Adults (18-65 years) Page 17 of 34 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 use the service have access to healthcare services in the local community. There is evidence in the case records that healthcare needs are monitored and appropriate intervention taken. Some deficiencies were however, noted in the arrangements for personal care and in the administration of medication. These place residents at risk and must be rectified. Evidence: The AQAA provided by the home stated that residents go for regular physical check ups with their GP. They also see their dentist, chiropodist and optician. Community nurse and occupational therapists are accessed when needed. Service users Individual health and personal care needs are recorded. This include tracking records of all health visits detailing outcome, progress reports and key working sessions. Medication is obtained, recorded, administered in line with the medication policy of the Richmond Fellowship. They further add that medication is reviewed periodically by the doctors and when staff have concerns such as side effects, they inform the medical team or consultant. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: We examined a sample of three residents case records. These contained appropriate care plans and assessments. There was evidence that residents had been consulted and were involved in care planning. Plans of care had been signed by residents or their representatives and these had been regularly reviewed. The care and plans of care of a resident who presented a fire risk was examined. It contained risk assessments and care plans which were appropriate and comprehensive. We observed that three of the residents we met were not cleanly dressed and looked unkempt. Two of the men needed a shave. One was not properly dressed as he did not have a shirt on under his jacket and he had pyjama bottoms on even though he had been out of the home and had just returned. One of the staff stated that there were occasions when they did not have time to do personal care in the mornings due to a shortage of staff. We examined the administration of medication. The home has a comprehensive medication policy and procedure. This was recently updated. All residents had been prescribed medication. None of them were self-medicating. Medication received had been recorded and the balance remaining after each medication round had been recorded. Most of the medication is stored in a locked cabinet which is secured to the wall. There is a second cupboard mounted on the wall where depot medication is stored. These are given by the community nurse. The downstairs medication room has a thermometer which read an acceptable temperature, but this is not being recorded. The upstairs medication room is used for storing stock medication, also in a locked cupboard. There is also a fridge in this room. The temperature is recorded daily. There is a photo of each resident in the Medication Administration Record, MAR folder. All MAR sheets were examined. Only one gap was noted for medication to be administered only if required. This was brought to the attention of the deputy manager. There is a monthly audit of medication which is good practice. There is a record of medication sent back to pharmacy and this is appropriately signed. There was no guidance for staff about what the effects and side effects of each medication and foods to be avoided, for example, those on Simvastatin should avoid grapefruit. To ensure that staff are fully informed, such guidance must be provided. We note that there were numerous old MAR sheets which go back to the previous year. To reduce clutter, these should be archived as they are no longer in use. Liquid medication had not been dated when they were first opened. This is necessary as the expiry date is affected. The medicines handbook was out of date. A new handbook is needed. Allergies that residents have were not recorded prominently either on the MAR Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: charts or in the front of their case records. This must be done to ensure the safety of residents. The manager informed us that the medication charts are checked at each staff handover by staff on duty. In addition, the deputy manager also checks them weekly. Audits are further done by the area manager when he visits the home. Care Homes for Adults (18-65 years) Page 20 of 34 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 arrangements for responding to complaints and for adult protection were on the whole satisfactory. The home has an open culture that allows residents to express their views and concerns in a safe environment. Improvements are however needed to ensure that residents are fully protected. Evidence: The AQAA indicated that the issue of adult protection has been given prominence. It made the following statement We respond promptly to complaints. We treat service users with respect and dignity. We ensure that they are protected from abuse and exploitation. We have a detailed handover and share information with residents. We have key working sessions where residents are able to ventilate their feelings or concerns. We promote openness at the service. The complaints record was examined by us. No complaints were recorded. The manager explained that none had been recorded. As he was recently in post, he was unable to confirm whether any had been received or not. He however, reassured us that he will ensure that any complaints made in the future will be recorded. The protection of vulnerable adults was discussed with staff. They were aware of the procedure to follow when responding to allegations of abuse. There was documented Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: evidence that staff had been provided with adult protection training. In the past year, we were notified that three allegations of abuse were made against staff. We were concerned that the previous manager did not follow proper procedures proper procedures and the Police were not promptly informed of certain allegations of a criminal nature. The conduct of the service was discussed during adult protection meetings. The organisation has acknowledged that some errors were made and has now taken appropriate action to ensure that residents are safeguarded. Disciplinary action had been taken against staff following investigations made and new procedures to further safeguard residents are now in place. In view of the above, a requirement is made for the home to have regular audits of incidents and complaints made to ensure that concerns and complaints are promptly and appropriately responded to. This is necessary to ensure that residents are fully protected. A further recommendation is made for concerns raised in residents meetings to be recorded in the complaints book. Care Homes for Adults (18-65 years) Page 22 of 34 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. The home provides a physical environment that is aimed at the specific needs of the people who live there. People who use the service can personalise their bedrooms. However, the premises had not been fully cleaned and were not well maintained. Evidence: The homes AQAA stated that The service has a cleaning day when all staff and residents participate in keeping the environment clean. Each bedroom is decorated according to each service users style and choice. Our garden is mature with attractive and colourful plants and flowers. The residents participate in maintaining the garden as we have a gardening group. In addition, the garden is maintained by a gardening company bimonthly. The maintenance and safety of the environment is contracted out. It is serviced within the stipulated time. The service has a laundry room which is kept clean and hygenic. During our inspection of the premises, we note that bedrooms had been personalised by residents with their own pictures and ornaments. The bedrooms were well furnished. The two residents we spoke to said they were satisfied with the accommodation provided. Some areas of the home had been repainted. The gardens Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: were attractive and seating had been provided. No offensive odours were detected in the home. The required safety inspections had been carried out. The manager stated that no specialist equipment was required as all residents were independently mobile and did not require any specialist equipment. We found that some areas of the home had not been fully cleaned. There were numerous cobwebs in the small lounge near the kitchen, some windows were dirty, the area outside the kitchen was littered with cigarette butts and furniture in the smoking lounge was dirty. The carpet in one of the bedrooms on the first floor had a large stain. The manager stated that he was aware that the standard of cleaning provided by contractors was poor and he was in the process of rectifying the matter. To ensure that this important matter is attended to without delay, an immediate requirement was issued for the home to be fully cleaned. Following the inspection, the manager reassured us that the home had been fully cleaned. Several tiles in one of the residents bathroom on the ground floor were missing. A staff member said the tiles had been missing for several months. This was brought to the attention of the manager who agreed to ensure that the tiles are replaced. A requirement is made for the tiles to be replaced. We further note that the fly electrocutor in the kitchen and the microwave were both not in working order. A requirement is made for both items to be repaired or replaced. Care Homes for Adults (18-65 years) Page 24 of 34 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. The service has a good recruitment procedure that is followed in practice. Management recognizes the importance of training and tries to deliver a programme that meets statutory requirements. Some deficiencies were noted in the staffing arrangements. These affect the ability of staff to care for residents. Evidence: The AQAA made the following comments Staff receive supervision and have opportunities to develop more skills to support residents. The recruitment process is very thorough and fair. All staff have satisfactory Enhanced Criminal Records Bureau and Police record Checks before starting work. All staff receive mandatory training and essential training such as First Air for 4 days, Equal Opportunity and Diversity, Induction Training, Fire Training, Challenging Behaviour, Mental Health and Recovery etc. These are to ensure that staff are trained to support the residents in recovery. We have staff who either have NVQ L 3 qualification and above or who are currently participating in NVQ training. Four staff who were on duty were interviewed on a range of topics associated with their work. They were noted to be knowledgeable regarding their roles and Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: responsibilities. There was documented evidence in staff records to indicate that staff had been provided with essential training relevant to their area of work. Staff stated that there was generally a good team spirit and they worked well together. The records of four staff were examined. These indicated that the required recruitment standards and procedures such as obtaining satisfactory CRB disclosures and references had been followed. There was documented evidence of regular formal staff supervision. This was also confirmed by staff interviewed. The supervision notes indicated that staff had opportunity to discuss any work related issues related to the care of residents and their training. We examined the duty rota. It indicated that in addition to the manager, there was normally a minimum of two care staff on duty during the day shifts and two care staff on duty during the night shifts. In addition, the home has a cleaner and a chef. The issue of equalities and diversity was discussed with staff. Staff demonstrated an understanding of the need to treat all residents sensitively and with respect regardless of disability, gender, race, religion or sexual orientation. They were aware that they must not discriminate against residents and they indicated that this was stressed to them during their induction. One relative of a resident who was interviewed indicated staff had treated her relative who lives in the home, with respect and dignity. Three of the staff interviewed indicated that there were occasions when the home was short of staff. One staff stated that she had to remain in the home on one occasion even though she had completed her shift, because no staff turned up for duty for the next shift. Another staff stated that personal care for residents was not provided on some occasions as there was a shortage of staff. In view of the concerns expressed and our observations noted in the section on Personal Care, a requirement is made in this report for staffing levels to be reviewed. This review must be carried out in consultation with staff and residents and their representatives. A report following this must be forwarded to the CSCI. This is necessary to ensure that the needs of residents are attended to. Care Homes for Adults (18-65 years) Page 26 of 34 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 service is planned to be user focused and take account of equality and diversity issues. It generally works in partnership with residents and their representatives. Staff supervision is in place. The manager has highlighted areas that are deficient and is working to improve the care provided. Further improvements are needed in the area of quality monitoring and in Health & Safety. Evidence: The manager was appointed recently. He informed us that he has experience of working with people living in local authority sheltered housing. He was keen to ensure that the home is well managed and residents receive a high quality of care. He has not applied for registration with us. We informed him that he must apply for registration with the registration authority. This is to ensure that he is a suitable manager. The issue of effective quality assurance and monitoring systems was discussed with the manager and service manager. We noted that concerns have been expressed regarding the quality of care provided in the home as mentioned in safeguarding Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: meetings and by two professionals who were interviewed by us. We were also informed that no consumer survey had been carried out in the past twelve months. The manager and area manager informed us that a survey is pending. The home must have an effective system of quality assurance. This must include a stakeholder or consumer survey. A report following the analysis of such a survey together with an action plan in response to any identified deficiencies must be prepared. This is required to ensure that the care provided is of a good quality. A current certificate of insurance was available for inspection. The financial record of three residents were examined. The records were well maintained and contained appropriate signatures for money withdrawn by residents from their accounts. The fire logbook was examined. The weekly fire alarm tests, emergency lighting checks and fire drills had been carried out and documented. There is a recent fire risk assessment. The required health & safety inspections on the portable appliances, gas and electrical installations had been carried out. We noted that there were only three fire drills carried out over the past twelve months. A minimum of four fire drills is required. We also note that there had been no fire training in the home in the past two years and the home had recruited new staff during this period. Training must be organised for staff. These are necessary to ensure the safety of residents and staff in the event of a fire. Window restrictors were fitted and engaged. However, we found that the gas cooker was defective and a handle was missing. The chef stated that this had been the case for the past two months. He stated that he found it very difficult to use the cooker as it got too hot for his fingers when he was trying to remove food from the oven. This is unsatisfactory. The manager stated that he was aware of the problem and a new cooker was in the process of being purchased. An immediate requirement was issued for the registered person to carry out a risk assessment on the cooker. Overall, we are concerned that the management of the home has deteriorated significantly since the last inspection in 2006. We therefore suggested that the home should cease admissions for at least three months. This is to enable deficiencies identified to be dealt with and for improvements to be made in the management of the home. We discussed this with the manager and service manager. They informed us that they had already ceased admissions for the time being and are in the process of renegotiating their contract with the health authority. Care Homes for Adults (18-65 years) Page 28 of 34 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 29 of 34 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 1 30 24 The home must be fully cleaned. This is to ensure that residents live in a pleasant environment. 13/04/2009 2 43 13 A risk assessment must be carried out on the defective cooker. This is for health and safety reasons 10/04/2009 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 1 6 The statement of Purpose must be updated to inform on the management changes in the home. This must be updated to ensure that propective residents and their representatives are fully informed. 29/04/2009 2 14 16 Residents must be provided with appropriate activities. This is to ensure that they receive social and therapeutic stimualtion. 30/05/2009 Care Homes for Adults (18-65 years) Page 30 of 34 3 18 12 The provision of personal care to residents must be closely monitored. This is to ensure that residents are well cared for. 30/04/2009 4 20 13 Liquid medication must be dated when they are first opened. This is necessary as the expiry date is affected. 30/04/2009 5 20 13 Details of any allergies that residents may have must be recorded prominently in their files. This is to ensure the safety of residents. 30/04/2009 6 20 13 Staff must be provided with information regarding medication being administered by them to residents. This is to ensure the health and safety of residents. 30/04/2009 7 20 13 The temperature of the office where medication is stored must be recorded. This is to ensure that medication is stored at the correct temperature range 30/04/2009 8 22 2 The missing tiles in the bathroom, identified to the manager must be replaced. This is to ensure that residents live in a pleasant environment. 30/04/2009 Care Homes for Adults (18-65 years) Page 31 of 34 9 23 13 The home must have regular 30/04/2009 audits of incidents and complaints made to ensure that concerns and complaints. This is necessary to ensure that residents are fully protected. 10 33 18 A review of staffing levels and the roles of staff must be undertaken. This review must be carried out in consultation with staff and residents or their representatives. A report following this must be forwarded to the CQC. This is necessary to ensure that the needs of residents are attended to. This is to ensure there is sufficient staff to meet the needs of residents 29/05/2009 11 37 8 The manager must apply for his registration with the CQC. This is to ensure that he is suitable for the management of the home. 25/05/2009 12 39 24 The home must have an 12/06/2009 effective system of quality assurance. This must include a stakeholder or consumer survey. A report following the analysis of such a survey together with an action plan in response to any identified deficiencies must be prepared. Care Homes for Adults (18-65 years) Page 32 of 34 This is required to ensure that the care provided is of a good quality. 13 43 23 The microwave and fly electrocutor in the kitchen must be repaired or replaced. This are necessary for health and safety reasons. 14 43 23 The missing tiles in the bathroom, identified to the manager must be replaced. This is for safety reasons and to ensure that residents live in a pleasant environment. 15 43 23 A minimum of four fire drills must be organised in a twelve month period. This are necessary to ensure the safety of residents and staff in the event of a fire. 16 43 23 Fire training must be provided for all staff. This are necessary to ensure the safety of residents and staff in the event of a fire. 05/06/2009 22/05/2009 22/05/2009 08/05/2009 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 20 The home should have an up to date BNF medicines handbook. This is to ensure that staff are fully informed about medication they administer. Page 33 of 34 Care Homes for Adults (18-65 years) 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). 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