Inspection on 09/03/09 for New Lodge

This inspection was carried out on 9th March 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

New Lodge 29/01/08

New Lodge 03/10/06

New Lodge 20/02/06

New Lodge 23/08/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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: New Lodge 971 Lightwood Road Longton Stoke on Trent Staffordshire ST3 7NE     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: Wendy Jones     Date: 0 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 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: New Lodge 971 Lightwood Road Longton Stoke on Trent Staffordshire ST3 7NE 01782388370 01782269187 stoke.enquiry@caretech-uk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Delam Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 4 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 4 The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 4 Date of last inspection Brief description of the care home New Lodge is registered for four younger adults with learning disabilities. The home was commissioned specifically for the people currently using the service. The specific needs of the user group are complex including autism spectrum disorder, severe learning disability, challenging behaviour and physical disability. The home is located on the main road in a semi-rural location on the outskirts of a small village. It is a spacious four bedroom detached house with a large front and a paved patio area at the rear, that is set back from the road with parking facilities for staff and visitors. The Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home home provides single bedroom accommodation for all people living there. Three bedrooms are provided upstairs and one on the ground floor. The home is not suitable for permanent wheelchair users. There are few facilities in the immediate area and the people using the service have their own transport which they fund, this enables them to access to the local community and educational, social and leisure activities away from the home. The fees charged for the service are recorded for each individual in the Service User Guide and currently range from 800-1746 pounds per week. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection site visit of this service undertaken on 11 March 2009. In total we spent approximately 7 hours in the home. The purpose of this visit was to assess the services performance and to establish if it provides positive outcomes for the people who live there. The visit included checking that any requirements and recommendations of the previous inspection visit of 28 January 2008 have been acted upon; looking at information the service provides for prospective users of the service, their carers and any professionals; looking at information that the service provides to people who use the service to ensure that they understand the terms and conditions under which they have agreed to live at the home and the fees they should pay. Care Homes for Adults (18-65 years) Page 6 of 31 Other information checked included assessments and care records, health and medication records; activity and records relating to the menus, finances, staff training and recruitment, complaints and compliments, fire safety and health and safety checks. The manager, staff and people who use the service were spoken to during the site visit and a brief tour of the building was undertaken. Before the visit began, the service provided its own assessment of its performance, in the form of an Annual Quality Assurance Assessment (AQAA). Surveys were sent to the home for distribution to people who use the service, relatives, any professional that has involvement in the service and staff. At the time of writing this report we have received three staff surveys and one health professionals. The main points are included in this report. What the care home does well: What has improved since the last inspection? At the last inspection we asked the service to provide an improvement plan to tell us how they intend to address the concerns we had identified, they did this within the timescale we asked them to, and we have been satisfied that the service has acted to address the main areas of concern and consequently made improvements to the service. Work has been undertaken to improve the bathing and toilet facilities in the service, redecoration of the communal areas has taken place, the kitchen has been refurbished and new flooring fitting. The flooring for the first floor landing, corridor and stairs have been changed. The service is using fewer agency staff than at the last inspection and the turnover of staff has slowed down. Care Homes for Adults (18-65 years) Page 8 of 31 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service can be sure that they receive information about the service in a format that can be more easily understood. Evidence: The service told us in the AQAA that there is a considerable amount of information available for prospective clients such as an up to date service user guide (in userfriendly format with photographs and pictures), and an up to date statement of purpose. A full written assessment would be completed by the manager and discussed with the prospective clients and their supporters. We saw that the Statement of Purpose has been updated since the last visit and gives an accurate account of the service provided. The service user guide has also been reviewed and produced in a format that people using the service may more easily understand. Each persons care file has a copy of the guide in it and their costs for the service they receive. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: The service has an admission policy and procedure for staff to follow. We understand should a vacancy become available any prospective person would have their needs assessed and would have the opportunity to visit the home prior to making a decision to move in. No new people have been admitted to the service since the last inspection visit. The current resident group living at the home have done so since it was first registered. We have been made aware that there are some concerns about compatability due to some individuals difficult to manage behaviour, and understand that reviews of peoples needs are being undertaken. This is intended to offer the best possible service to all of the people at the home while ensuring that they are protected. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be confident that their support needs are known and plans are in place to inform staff how these needs can be met. Evidence: The service told us in the AQAA that, All of the clients at New Lodge have individually tailored support plans that focus on achieving the best possible outcomes for them. The plans have adopted a person centred approach ensuring that the clients needs and wishes are absolutely paramount. Support plans are evaluated every month having reviewed the daily notes written regarding each client. We saw that each person has a person centred plan(PCP) which explains what their needs and goals are, support plans and positive intervention plans are in place where a need has ben identified. We saw that evaluation of plans are carried out regularly on a monthly basis and reviews twice per year, at least one of these more formal reviews is with the social worker and persons family/representative. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: The PCP documentation is very good, but the information is currently kept in the first floor office, it would be more beneficial if this information is more accessible to people using the service and the support workers who deliver their care. Where necessary there are risk asessments in place, the records also show they are up to date and relevant. Since the last inspection better efforts have been made to liaise with specialist services to ensure that the service promotes best practice when managing behaviour that challenges the service and to safeguard people in the service. All of the people using the service have limited verbal communication skills requiring support to ensure that their needs are understood. Communication passports have been developed, these are intended to help staff and people who use the service communicate effectively. From the evidence we have available to us we recommend that further work is undertaken in this area to ensure that all staff are familiar with how to use them properly. One person is from a minority background, but we understand that he does not practice his faith and his relatives have not identified any specific dietary issues that the service need to be aware of. We saw evidence that specific events relating to his culture are celebrated with his family, and include other people living at the home. We looked at a sample of peoples financial records to ensure that the service manages their money properly. The evidence of the records we saw that the records accurately reflect the amount of money saved in the home on behalf of people. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience 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, do have some opportunities to be involved in activities both in and out of the home, but this is limited and needs to be developed further to ensure that each persons potential in this area is fully realised. Evidence: The service told us in the AQAA that, Clients likes and dislikes are well documented and understood by the staff, and home life and activities are structured around this. At the last inspection visit we expressed some concerns about the limited opportunities for people to enage in meaningfull activity both in and out of the home. There is evidence in the records and from discussion with the acting manager that efforts have been made to rectify this, but also clear evidence that further work is necessary. Information from a health professional states, the service could improve by providing Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: more activities outside the home for people, but may have difficulty in the area locally. A member of staff said, we need more staff to ensure that we can take people out more and we are limited also because we dont have many drivers. At the last inspection we commented that one person had a computer that he was not able to use because of its location at that time and because it needed repairing. The acting manager told us that the estimated costs for repair are quite high at 500 pound, so the service has sought advise about the suitablity of the computer and the soft ware needed from speech and language therapists and from the specialist day service the person attends. The outcome of their advice indicates that the person would not gain any therapeutic benefit from the computer, and has shown no or little interest in similar systems at the day care facility he attends. While this is accepted it is of concern that the computer was purchased for him, it is recommended that this is raised at the next review of this individual to establish how the decision to purcase the computer was arrived at, and whether it was done in consultation with advocates for the person. If necessary the individual may need to be reimbursed. One person has sensory equipment fitted in his bedroom. The acting manager confirmed that all people using the service have regular contact with relatives. We have forwarded surveys to the service to distribute to relatives and other supporters, but have not yet received a response to them. From the sample of records we saw that menus are devised based upon individuals known needs, staff said the deputy manager produces these menus. The service also has food/communication aid in the kitchen intended to support people to make choices. These consist of pictures of food stuffs and meals to show each individual so they can make an informed decision about the meals they have. We spoke to one member of staff who stated that she didnt know how the commuication tools are to be used and hadnt been shown how to use them properly. This is an area for further development. Staff training records show that 8/16 staff have received basic food hygeine training we have discussed this further under the staffing section of this report. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience 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 can be sure that their health needs are met and staff know what action to take to meet them. But must be sure that medication is stored properly and instructions are clear, so that people using the service can be sure that medication is safely managed. Evidence: The service told us in the AQAA that, At New Lodge each client has an individual Health Action plan, which provides details of their health needs. Privacy and dignity are promoted in all aspects of personal support. Personal support is also offered in a way that promotes independence encouraging clients to partake as much as they are able to in their own personal care needs. Health action plans have been introduced and in the two examples we saw, they contained explicit information about the health needs of people and the action needed to ensure that the needs are met. We also saw evidence that the service has sought to involve health professionals in assessment and to support appropriate strategies for the management of challenging behaviour. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: The records also show that people are registered with a GP and have access to other community health services such as dental, chiropody, opthalmic and auditory services, where necessary specalist services are also accessed, speech therapy, behavioural therapist, psychology and the community learning disability team have been involved. The medication is currently in a lockable kitchen cupboard. Changes to current guidance states that this is not a suitable storage facility. We have asked the provider to provide a more suitable facility and the service also provides suitable storage for controlled drugs. Each person has a medication profile in their records. There is a very good record of stock control, and we were able to undertake a clear audit trail with all the medication we looked at. We saw that records of administration are signed properly and where medication is not administered an explanation is also recorded on the medication administration record(MAR). We saw instruction for an, as required medication that did not give clear instruction for when the medication should be given, we discussed this and have recommended that a protocol for its use is agreed with the prescriber to ensure that staff know under what circumstances it should be given and are therefore consistent in this. We saw that on two occasions, records show that a prescribed treatment had not been administered because, there is no female staff trained to administer medication on duty. We spoke to the acting manager about this and are concerned that the person using the service did not receive the treatment they had been prescribed. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 can be confident that the service will listen to any complaints they have and act upon them but cannot be confident that they are protected from the risk of abuse. Evidence: The service told us in the AQAA that, A copy of the organisations complaints policy is displayed in the hallway at New Lodge. This ensures easy access for relatives and visitors to the home. This has recently been updated and a copy sent to clients families. It is a user-friendly format and is pictorial. There is a complaints procedure on display in the the home and is also included in the service user guide in a pictorial format, that people can more easily understand. We looked at the record of complaints received by the home and noted that none have been received since the last visit. We can also confirm that we have not received any complaints about the service in the same period. We have received 3 staff surveys, 2/3 of the staff say they know what to do if concerns are raised about the care provided. One person said, I would inform the home managers straight away with any concerns they may have. Document all that has been said in relevant paper work. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: Records show that staff have received safeguarding training and we interviewed one member of staff who gave an account of the action she would take if she suspected abuse. We have received notification of eight incidents and accidents in the home since the last inspection site visit. Of these five have been incidents between people using the service. We understand that no serious injuries have occured and the service has acted to support all people using the service. But clearly there are concerns that people should not be subject to assault in their own home. It is recommended that any further incidents should be reported under safeguarding procedures. It is accepted that the service has sought support and advice from health professionals and has implemented positive intervention plans for the support and management of the people who display challenging behaviour. From recruitment records we saw that in two examples there is no evidence in the home that pre employment checks have been carried out. This means that from the information avaiable to us we cannot been sure that the recruitment procedures are robust. This potentially places people at risk. We have sent relatives surveys to the service to ascertain their views. At the time of writing we have not received any comments. Records show that staff have received safeguarding training and we interviewed one member of staff who gave an account of the action she would take if she suspected abuse. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have a home that is in keeping with other residential properties in the area and generally enjoy an environment that meets their needs, but further work is necessary to ensure that the home is comfortable, well presented and well maintained Evidence: The service told us in the AQAA that, New Lodge is a detached house situated in a rural area, five minutes walk to the country side. The homes environment has been improved quite dramatically with refurbishment/redecoration of all main communal rooms,lounge, kitchen, bathrooms. Since the last inspection the organisation has ensured that improvements have been made to the bathing and toilet faciliites for the benefit of people using the service. Further thought should be given to how the service can make these rooms more homely in appearance. We also recommend that toilet tissue is made available in the first floor bathroom. Despite the reported improvements to the service we saw that an area of the carpet in the lounge is threadbare, we saw that there are no light shades in the lounge, we saw Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: one arm chair is badly torn on the arm and that the edges of curtains are frayed. We would recommend that the services plan for continual improvement includes action to address these matters. We saw that the kitchen has been completely refitted and retiled, with the flooring being replaced. But staff told us that the fridge is not maintaining a suitable temperature, this has been reported but has not yet been resolved, which has meant that some food has had to be thrown away. Again it is recommended that the organisation takes action to ensure the safe storage of food stuffs. Each person using the service has their own bedroom, with a bedroom door lock that can be easily overridden from the inside. We did not look at any of the bedrooms during this visit. We saw the service is clean and tidy, saw evidence that infection control systems are in place but understand from the records we have been provided with, that only three staff have completed infection control training. Other staff must receive this training we have discussed this in the staffing section of this report. Care Homes for Adults (18-65 years) Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service need to be sure that staff are well trained and are provided in sufficient numbers to meet their needs. Evidence: The service told us in the AQAA that, Three members of staff have NVQ 3, two have NVQ 2, two are working towards NVQ 2, and two are waiting to hear if they can commence their level 2. All staff have completed the LDQ induction although some are still waiting for their completed work to be returned from the assessors. We saw records of staff training and supervision, these show that there are some gaps in the training records of staff, for example 8/16 have been trained in manual handling, 11/16 health and safety, 8/16 food hygeine, 15/16 fire training, 7/16 NVCI, 4/16 epilepsy, 11/16 autism 7/16 challenging behaviour, 2/16 diversity, 3/16 infection control, 1/16 makaton . The records show that 6/16 staff have trained to NVQ level 2 or above this is lower than the recommended 50 of the workforce. We saw in staff surveys that 2/3 said that the induction had provided all the Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: information they needed and to provide people with the care they are assessed as requiring. We observed a staff handover at the change of shift during this visit and listened to the discussions. We are reasonably confident that sufficient information is passed on between shifts to ensure that people care needs can be met. Staffing issues have improved since the last visit, in that fewer agency staff are being used, 14 hours in the last month. The usual staff deployment is for 4/3 staff. We interviewed one member of staff who said that the staffing levels did restrict the spontaneous opportunities people using the service have and limited access to community facilities applies because of this. The manager said that she has asked all placing authorities to review the care needs of people they support to ensure that they are receiving an appropriate level of care. The manager feels that some people require more 1:1 hours than they are currently contracted to receive. We looked at a sample of four recruitment records and were disappointed to see that we could not find evidence of POVA CRB of written references in two examples. We have agreed that the organisation maintains the original recruitment records at their headquarters. But as part of this agreement the organisation have agreed to maintain a proforma for each individual which shows that they have had the appropriate checks carried out. The evidence at this visits is that people using the service may have been put at risk because we could not evidence that pre employment checks have been carried out for two members of staff. Care Homes for Adults (18-65 years) Page 24 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service need to be sure that the manager of the service is registered and approved to manage their home. Evidence: The service told us in the AQQA that, A Manager has been recruited (started midOctober), and will be applying for registration with CSCI. The Manager has NVQ 4 Registered Managers Award. The Acting Manager holds NVQ4/RMA, and has 18 years experience in care settings, over 12 as a Registered Manager. We have spoken to the acting manager about applying to us to be registered and have been assured that the application will be submitted as soon as possible. We are concerned that this happens quickly as at the last inspection the service had recruited a new manager and we required that an application was submitted to us but it wasnt. That manager has since left the service. This means the service has not had a registered and approved manager in post for over 12 months, this situation is not acceptable, and potentially places people at risk. The organisation must recognise its responsibility to ensure that the service is managed by a person who is registered and approved to do so. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: We saw that the service carries out regular fire safety checks and staff are involved in fire drills, records slao show that the 15/16 staff have received fire training. We saw that the organisation has made arrangments for quality audits to be carried out and saw the report from the last one. There is evidence from the information we saw that the organisation takes its responsibility to continually improve the quality of service seriously. The service has kept us informed of accidents and incidents in the home and from this information we have calculated that since the last inspection site visit the service has notified us of seven incidents five of which have been incidents between people who use the service. We also saw that during the visit that the service records any near misses and evaluates the incidence of accidents and incidents in the home. Care Homes for Adults (18-65 years) Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 35 9 That the new manager applies for registration with the Commission. 29/04/2008 Care Homes for Adults (18-65 years) Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 The service must provide a suitable medication cupboard. To be sure that medication is stored safely. 30/04/2009 2 23 13 The provider must ensure 17/04/2009 that pre employment checks are carried out and the evidence that they have is maintained in the service. To be sure that people using the service can be confident that they are not at risk from poor recruitment practice and record keeping. 3 24 13 The service must take action 01/04/2009 to repair or replace the fridge currently not maintaining its temperature. To be sure that food is stored at a safe temperature. 4 32 13 All staff must receive training in manual handling. 09/05/2009 Care Homes for Adults (18-65 years) Page 28 of 31 So that people using the service are confident staff have the knowledge and skills they need. 5 32 13 All staff must receive mandatory training in respect of infection control. So that people using the service are confident that staff have the knowledge they need. 6 37 9 The provider must ensure that the current manager applies to us for approval and registration. So that people using the service can be confident that the service is properly managed. 30/04/2009 09/05/2009 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 2 3 4 6 6 6 12 The service should make further efforts to ensure that the communication passports are effective. The service should consider how it can ensure that the care documention is more easily acccessible to staff. The service should consider how it can more easily involve people using the service in their support planning. The service should continue to seek a varied range of social, recreational and leisure opportunties for people using the servcie. The service should make further efforts to ensure that people using the service participate in community events and intergate in the local community. Staff deployment should be fluid to ensure that people have 5 13 6 14 Care Homes for Adults (18-65 years) Page 29 of 31 opportunities to make spontaneous choices in terms of the activity they are involved in out of the home. 7 14 Discuss the circumstances under which the computer was first purchased at the persons next review to determine how the decision to purchase the computer was made. All staff involved in food preparation and cooking should be trained in basic food hygeine. The service should ensure that the communication tools it has introduced to promote peoples choices are implemented. The service should ensure that people using the service receive the medication/treatment they are prescribed. The service should provide a suitable controlled drugs cupboard. To be sure that any future controlled medication is stored safely. The service should ensure that instructions for as required medication is clearly recorded to be certain that all staff are clear about the circumstances under which it is given. The provider should ensure that it seeks advice from the Local Authority if there are any other incidents where people are potentially at risk. The service should ensure that the programme of refurbishment is continued. So that people using the service have a well maintained environment in which to live. Toilet tissue should be made available in the first floor bathroom. So that people using the service, staff and visitors dont have to ask for it. The first floor bathroom would benefit from some homely touches, to provide people using the service with a pleasant and attractive place to bathe. 50 of the workforce should be trained to NVQ level 2 or above, so that people using the service are supported by a well trained staff team. All staff should be trained in basic food hygeine, to ensure that they are aware of best practice. 8 9 17 17 10 11 20 20 12 20 13 23 14 24 15 27 16 27 17 32 18 32 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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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