Inspection on 19/03/09 for Mountearl House

This inspection was carried out on 19th 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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mountearl House 29/12/07

Mountearl House 16/06/06

Mountearl House 03/01/06

Mountearl House 04/08/05

Mountearl House 06/12/04

Mountearl House 09/08/04

Mountearl House 02/02/04

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Mountearl House 73 Leigham Court Road Streatham London SW16 2NR     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: Mary Magee     Date: 2 0 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: Mountearl House 73 Leigham Court Road Streatham London SW16 2NR 02087690322 02087690859 mountearl@robinia.co.uk www.robinia.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Robinia Group PLC care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Mountearl House is home to ten people with learning disabilities. Some have additional mental health needs. It is located in a large building close to the main shopping area of Streatham. It is managed by Robinia Care who manage several care homes for people with Learning Disabilities. Local amenities are located within a short walking distance away. The house is divided into two main areas, the main premises, and annexe area. The annexe area is detached from the main premises. It has two bedits as well as a separate lounge and kitchen. The home has a large garden to the rear of the property. Fees range from £1500 to £2000 per week. 10 10 Over 65 0 0 Care Homes for Adults (18-65 years) Page 4 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: We made two unannounced visits to the home to complete this unannounced key inspection. We met with the manager, four support staff and five residents. A visiting social worker was present on day one, she shared with us her views. A completed AQAA was supplied prior to the inspection. The relatives of four residents gave us their views of the service by telephone.. Five surveys were received from residents, key workers had assisted the residents to complete these. Care Homes for Adults (18-65 years) Page 5 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 6 of 30 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 7 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 8 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service admits new residents without undertaking a full needs assessment first. The home benefits from the availability of a stable staff team who know and understand the residents needs. Evidence: Mountearl has been home to the majority of the residents for many years. As a result residents are familiar with each others ways, good relationships have developed. The staff team have not experienced many changes among support workers which has established a good level of stability for residents. Case tracking was used to evaluate how the service is meeting individual needs. We case tracked how a new resident was supported with the transition to the home from another service. We used the records available to determine the pre admission assessment and admission arrangements. The resident had previously lived at two other homes managed by Robinia, both placements eventually were unsuitable and the placements broke down. We were notified at CSCI that the organisation planned to transfer this resident to Mountearl and that appropriate arrangemenmts were to be made with staffing levels to meet his needs. Needs assessment at previous placements had concluded that one to one Care Homes for Adults (18-65 years) Page 9 of 30 Evidence: staffing levels were required. It was disappointing to find that management from this home who are familiar with residents needs were not involved in the pre admission process. Assessments were completed by a representitive from the organisation unfamiliar with the service. The assessments we found were not well detailed and lacked some essential information. Records did not indicate that consideration was given to the needs of the other residents at the service, or how the needs of the new resident may impact on the people already living in the home. Information recorded in both previous placements was shared with the home. The residents next of kin was involved in the transfer. Despite the lack of full needs assessments. Fortunately the placement in the home has worked well for the new resident. In the annexe area of the home the accomodation is located. The flatlet is set apart from the main premises with a seperate entrance. The resident has his own spacious accomodation and also appropriate staffing levels with one to one support. He tells us that he is well settled and likes living at Mountearl. The home employs a number of suitably experienced permanent support staff that give stability and reassurance to residents. The athmosphere was calm on both visits with residents relaxed and enjoying participating in more activities. Staff are good at communicating with residents and understand the issues that may trigger challenges or on engagement in activities. Care Homes for Adults (18-65 years) Page 10 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. People living at the home receive support and assistance to lead as independent a lifestyle as possible. Individuals are encouraged and supported to manage risks appropriately. Personal support plans record all the support and assistance required by individuals to achieve their goals. Personal support plans are not always kept up to date to reflect individual needs. Evidence: We examined the support plans in place for two of the residents. Each resident at the home has an allocated key worker that is familiar to them, and that they feel easy and able to communicate with. Four of the residents have specialist communication needs. Observations were made during both visits to the home that residents mode of communication whether it is by gestures or the use of pictures is understood by the staff team. One of the residents selected for case tracking moved to the home in the past twelve months. According to the manager it was initially for a trial period. Due to the success Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: of the placement this is likely to be permanent. Shortfalls were found on the development of suitable support plans for this resident. Although the choice of accomodation did fully consider his needs to plan the most appropriate accomodation within the home, the annexe area was chosen because it has self contained flats. However the service did not develop new and appropriate support plans for the resident for this setting, but relied on those from the previous placement. The resident feels well supported at the home and spoke of the progress he has made. A visiting social worker also reported positively on the progress made, an indication that the placement is suitable and appropriate to the individuals needs. She found on her visit thatthe resident appears more stable and displays less episodes of challenging behaviour. However all residents need to have support plans in place that reflect the help and support needed to meet their needs. For one of the residents that has lived at the home for numerous years the relevant plans were up to date. Recent reviews took place and demonstrated that that support plans are helping the resident achieve his goals. We met with the resident before he went to the gardening club. He appears confident and has with the support of staff overcome some major obstacles. His records confirm that he consults with psychiatry and the probation service. He has more stimulation in his life which distract him from participating in harmful pursuits. Staff respect the right of individuals to make choices, they receive help and support with communication needs that they need to make decisions about their lives. Instances are recorded to demonstrate this. We saw how individuals are supported and guided to manage their personal finances. All procedures are documented and each transaction is signed for. This is documented and checked at handover periods. Bank accounts are held by each resident. Personal support plans should explore if individuals are able to develop their skills further in managing personal finances. For both residents staff enable them to take responsible risks, risk assessments are recorded on file, they give guidance on how to manage and minimise risks both in the home and in the community. For example one resident needs the support of one staff in house and two staff when in the community. We looked at how this is managed, regular key workers from the agency are engaged for the resident. We observed other residents files to determine how risks are managed. On occasions the risk assessments are not dated clearly to indicate that these are relevant. The home is providing the support that residents require. Staff use daily and monthly records to log the progress made and the state of well being. At handovers staff issues in relation to the welfare and wellbeing of individual residents are discussed in a confidential setting, staff also record relevant information on each resident. The records also indicate all the support and assistance given. Care Homes for Adults (18-65 years) Page 12 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 home provides a lively environment where people enjoy living. Suitable stimulation is available both internally and externally that considers individual needs and choices. Staffing levels at weekends may restrict the opportunities for residents. Evidence: Progress continues to be made in enabling residents to maintain appropriate and fulfilling lifestyles. Each resident has a weekly activity plan in place that they are supported to develop, this is displayed in the office. The activity programmes for both residents demonstrates that staff recognise the benefit of a structured routine. Weekdays we find have staffing levels that offer a good degree of flexibility in supporting residents in the community. However this is not the findings at weekends. Staffing rotas have less staff available to enable individuals pursue the same level of participation. Clearly the residents benefit from these and link them to individual needs. One resident spoke about his interest and his love of the gardening project. He Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: has shared with the manager his goal to get part time employment as a result of his volunteering experience. This is currently being explored. He also has developed cooking skills and is supported by key worker to do this. Of the eight residents at the home four people attend college courses and day centres. The other residents choose not to engage in further education and staff respect their choices. Activities in the community include vists to local restaurants, days out to the park , city attractions, and to seaside. Individuals are offered the opportunity to choose holidays. Support staff are engaged too assist residents pursue this. Relatives spoken to are satisfied with the services offered. On efamily commented that that more encouragement should be given to to residents that refuse to enagage in communal activities. Photographs are displayed in the home of happy residents enjoying their holidays at a variety of venues.. Residents are supported to maintain relationships with friends and family. A number of residents enjoy weekends away with family and friends Residents were observed to participate in numerous hobbies, completing jigsaws, singing and conversing with staff. Regular and frequent meetings of residents take place to choose menus. Picture formats are used to enable all participate. Residents enjoy the meals served, it is to their choice. For residents individual risks associated with eating are recorded with support plans. Support staff demonstrate a good knowledge of these and are present to supervise and assist at meal times. Food was observed to be stored at suitable temperatures. Freezers and fridges are kept in good working order with regular daily checks made of temperatures. The temperature of hot meals is recorded. A record is held of meals taken by residents. Care Homes for Adults (18-65 years) Page 14 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. Personal support is flexible, consistent and reliable. People find that it responds to changing needs with emotional and physial support thagt supports and promotes independence. Evidence: Residents receive support with personal care in a manner that maximises privacy and promotes dignity. Times for getting up and going to bed,bathing, mealtimes and activities are flexible depending on support plans in place. Residents are supported to maintain good standards of hygiene and choose clothes and hairstyles that reflect personalities. We found that residents take a keen interest in their appearance. All of the residents are male, support staff are mainly female. The manager recognises that this is not well balanced and should be addressed. More staff of the male gender are needed. A number of residents have additional mental health needs. Records were seen of the outcome of regular consultations with mental health consultants. CPN visits take place to monitor residents. Continuity and consistency is assured by having support staff that are designated key Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: workers. For individuals with specialist communication needs the means of communication is outlined in support plans. The manager described how residents are supported to promote healthcare. All residents are registered with a local health centre that offers many additional facilities. Staff find that the GP provdes a good service. Annual health checks are provided, medication reviews take place regularly. Staff are vigilant and good at monitoring the emotional and physical health care of residents. Prompt action is taken to refer to relevant consultant or hospital specialist. Access to psychology and psychiatry is supported to those residents identified as requiring consultation. Records of CPA meetings and outcomes are held. Health cation plans are in place for resident. However for the most recently admitted resident the relevant health action plan was not developed. Important issues could be omitted because of this. Residents also have access to dental and optical care. For some residents the statutory reviews were completed. Internal reviews consider all areas of support including the promotion of healthcare. Although no omissions of signatures were found in the medication recording sheets attention is needed to some areas. For residents with prescribed PRN medication staff need to record and on appropriate documentation the name of the medication administered. Medication audits need to conducted with more frequency to highlight any defecits. Medication returns should be acknowledged with relevant pharmacist signature. According to the manager staff received training on medication procedure. However the training records do not indicate that this medication training is up to date. Care Homes for Adults (18-65 years) Page 16 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. Staff are knowledgeable on procedures that protect vulnerable adults. The service has a complaints procedure but an accessible format is not displayed prominently that residents can recognise Evidence: Despite this home providing a service for people with learning disabilities an accessible complaints procedure is not displayed prominently that residents can associate with. As there are no records of any complaints received, a contributory fact maybe because the procedure is not accessible to many residents. Regular resients meetings take place, these are minuted. The organisation has a national forum which represents the user group, and is made of a resident member from this home. All topics relating to issues for the client group are raised in this forum. A spreadsheet of staff training was supplied. It is not confirming that any recent training on medication procedures took place. According to all discussions with four support we received confirmation that staff are aware of the appropriate procedures to comply with safeguarding vulnerable adults. There were no allegations of abuse or neglect raised at the home. No concerns were raised at any statotiry review either. According to records plans are in place to provide refresher training to all support staff in safeguarding procedures. Care Homes for Adults (18-65 years) Page 17 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 service offers a safe pleasant well maintained environment where individuals enjoy living and where they can relax. Communal areas are spacious and comfortable and compliment bedrooms. The premises is retained to a good standard with repairs attended to promptly. The home is clean and hygienic. Evidence: The home was pleasant and homely. Residents feel comfortable and are able to relax. All seven bedrooms viewed were attractively decorated. A relative spoken to commented on the furniture supplied, she finds that storage is restrictive in her sons bedroom and that additional wardrobe space would be beneficial. Repairs are attended to promptly. The home was clean and hygienic and odour free. Additional touches such new plants and carpets adds to the ambience of the home. Bathrooms and toilets were viewed. All were in good working order. The temperatures of water in bathrooms and showers are monitored daily to ensure that theyare within safe limits. Individual space is complimented by a range of communal areas. The main area of the home has a comfortable well furnished lounge with large sofas. I In it for residents comfort are a television and music player. Residents also store Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: jigsaw puzzles and books here. A dining room is located off the kitchen on the first floor. It offers a range of dining tables and chairs. The annexe area of the home is detached from the main building. In addition to bedrooms are a lounge and kitchen area for the sole use of residents in this part of the building. Care Homes for Adults (18-65 years) Page 19 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. Residents benefit from the presence of a stable experienced staff team that are familiar with their methods of communication. Staff are missing out due to non participation in essential training and development that retain and develop their skills. Appropriate staffing levels are available during the week, however the weekend staffing levels may restrict the residents pursuit of leisure activities. Staff recruitment is not sufficiently robust as staff are not vetted thoroughly, this has the potential to place vulnerable residents at risk. Evidence: We3 spoke to four staff. All staff are clear regarding their role and what is expected of them. People experiencing the service report that staff working with them know what they are meant to do, and that they meet their individual needs in a way that they are satisfied with. The experience is that there are always staff on duty that can communicate with residents. Staff retention was found to be good. Residents have confidence as they feel comfortable with familiar staff. They benefit from a consistent and stable staff team that relate well to their needs. Staffing levels during the week are found to be appropriate to the needs and number of residents. However this is not always the experience at the weekend, lower Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: numbers of support staff are on duty at weekends which staff finds restrictive in supporting residents pursue leisure activities.More residents remain confined to the home as a result. Recruitment procedures were explored. We found that these are not robust. We looked at the personnel files for three new staff. Evidence was present of CRB Enhanced Disclosures for these staff before they begun employment. Application forms were completed. Two files were satisfactory. However for one new support worker the recruitment procedures were not robust. It was not identified that somea previous employer supplying a reference had limited knowledge of this employee. There were also discrepencies regarding the referee and company checks were not made to confirm the authenticity of the reference. Another reference supplied was received from overseas by fax. It was not legible and had no stamp provided. The manager took immediate action and suspended the staff member from the workplace until the required information was received. Recruitment procedures must be improved so that vulnerable adults are protected by staff that support them. There has been some slippage in the training provision in the past twelve months. The number of staff participating in ongoing training has reduced significantly. From the spreadsheet seen it is identified that not all staff are up to date on required training, many gaps were observed in essential training especially on conditions that are associated with current residents. A good proportion of support staff have acquired relevant NVQ qualifications. The majority of staff hve experience and skills developed over the years, however these need to be retained and refreshed through ongoing training. Supervision is becoming more consistent with frequent and regular one to one supervision sessions. Team meetings are held regularly too. Care Homes for Adults (18-65 years) Page 21 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 home benefits from the presence of a manager that is experienced and familiar to the home. Relevant training and development is required by the manager to equip her with the skills an knowledge for the role. The home has procedures in place that promotes a safe environment that safeguard residents and staff. The service is not operating procedures that Evidence: A change of management has taken place at the home. The new manager has valuable experience as deputy manager, and is familiar with residents. The manager has the necessary experience to run the home and is aware of the processes set out in the NMS. She demonstrates a great awareness of residents needs and the areas that need attention. Observations made were of residents feeling comfortable and engaging with the manager. The manager is aware of the need to keep up to date with practice and to develop management skills She will need to undertake relevant traning to equip her for the role of registered manager. She will also need to complete the managers application to register with CQC. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: The home is not demonstrating that the service operates in the best interest of residents . It is not operating an effective quality assurance process. All sections of the AQAA were completed, the information gives a limited picture of the current situation within the service. The evidence to support the comments made is satisfactory, although there are areas where more supporting evidence would have been useful to illustrate what the service has done in the last year, or how it is planning to improve. The AQAA gives us some limited detail about the areas where they still need to improve. The ways that they are planning to achieve this are briefly explained. The data section of the AQAA was completed, although there are some inconsistencies.The service needs to have a self monitoring review and development process for the home. The quality of the service needs to be monitored and evaluated at appropriate intervals based on seeking the views of residents and stakeholders. We observed procedures in place to promote a safe environment. Hot water temperatures in bathrooms are checked daily so that they are maintained within safe limits. The premises and the furniture and fittings are maintained safely. Fire fighting equipment is serviced and maintained in good working order. Regular fire drills take place. Staf receive training in fire evacuation procedures, although some staff are overdue this training. Health and safety checks are undertaken within the premises. It is unclear from risk assesmentsif these are planned for monthly or quarterly as recent records are unclear. A recommendation is made Care Homes for Adults (18-65 years) Page 23 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 24 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 2 14 The service must not 30/04/2009 provide accomodation to a person at the care home unless the persons needs have been fully assessed by staff familiar with the home and the residents, and that the home confirms in writing that it is able to meet these assessed needs. So that new residents know that this is the correct setting 2 5 5 Each resident must be supplied with a copy of the contract/agreemnt specifying terms and conditions in relation to accomodation provided including the amount and pay,mnet of fees. To be confident that a contract is in place 30/04/2009 3 6 15 For each resident following a 30/04/2009 needs assessment a written Page 25 of 30 Care Homes for Adults (18-65 years) 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 support plan must be developed as to how the residents needs in respect of health and welfare are to be met. So that all areas of need are considered 4 13 18 Staffing levels at weekends must be reviewed. The levels must be appropriate to support residents pursue activities in the community. To provide continuity and support for residents in pursuing activities in the community. 5 19 13 Health action plans for residents must be maintained up to date. To ensure that all necessary action to promote health care is taken. 6 20 17 Staff must ensure that daily records are made of all prescribed PRN medication adminsitered. So that records are maintained up to date and current 7 20 13 Regular medication audits must be undertaken with records maintained. 30/04/2009 30/04/2009 30/04/2009 30/05/2009 Care Homes for Adults (18-65 years) Page 26 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To identify any inaccuracies 8 22 22 A complaints procedure that is appropriate to the needs of residents must be made available to residents To make it accessible to residents 9 34 19 Recruitment procedures must be robust, all staff need to be fully vetted before employment begins. The service must ensure that the authenticity of references is verified. references To safeguard vulnerable residents. 10 35 33 Staff must receive the required training and development they need. So that all have staff are equipped for their roles. 11 37 9 The service must ensure that the manager receives the relevant training in NVQ 4 and management to equip her with the skills for the role 30/10/2009 31/07/2009 30/04/2009 30/04/2009 Care Homes for Adults (18-65 years) Page 27 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 12 39 35 The service need to develop and operate a quality assurance system based on including the views of residents and stakeholders. So that the service operates in the best interest of residents 29/05/2009 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 7 Personal support plans should explore if individuals are able to develop their skills further in managing personal finances. Risk assessments should be reviewed regularly and dated and signed to acknowledge this It is recommended that residents choosing not to engage in college or day centre activities are encouraged to see these as opportunities for enjoyment and development. Efforts are need to explore further options. The service should endevour to recruit more male support staff. Medication for support staff should be kept updated, also evidence of competency levels in administring medication should be held on staff files. All medication returned to the pharmacist should be acknowledged by relevant signature in medication book All support staff should receive refresher training in safeguarding procedures. Training records should be updated with this information. Consideration should be given to providing additional storage facilities in bedrooms for residents requiring it. 2 3 9 11 4 5 18 19 6 7 20 23 8 26 Care Homes for Adults (18-65 years) Page 28 of 30 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 9 10 11 37 42 42 The manager should complete the relevant managers application form and submit it to CQC. All staff should receive updated fire prevention and evacuation training. Clarity shuld be established on the frequency of health and safety checks for the premises 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. 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