Inspection on 24/08/09 for Peddars Way

This inspection was carried out on 24th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Peddars Way 18/09/07

Peddars Way 19/09/06

Peddars Way 09/02/06

Peddars Way 11/08/05

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Peddars Way 5a Peddars Court Peddars Way Lowestoft Suffolk NR32 4TT     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: Julie Small     Date: 2 4 0 8 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 33 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 33 Information about the care home Name of care home: Address: Peddars Way 5a Peddars Court Peddars Way Lowestoft Suffolk NR32 4TT 01502538746 F/P01502538746 Mike.Ullah@mencap.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Royal Society of Mentally Handicapped Children and Adults care home 3 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: 1 The care home for adults is able to accommodate three young adults in the age range 16-25 years. Date of last inspection Brief description of the care home 5a Peddars Court is a home for young adults, registered to provide care, accommodation and support for three service users with profound learning and physical disabilities. Due to the complex nature of their disabilities, these service users are unable to be cared for at their family home. Each service user requires very significant care staff input in relation to meet their health; physical, and emotional and social care needs. The families of the three service users have unrestricted contact. 5a Peddars Court is a bungalow, built as part of a residential housing development in Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 3 Brief description of the care home North Lowestoft. As such, it is attached to neighbouring properties, and the small development has been built in courtyard style, with neighbours on three sides. The home is located close to a range of community services including local shops and public transport. Due to the very significant levels of disability, the service users living at this home are transported using the homes own adapted minibus. The home is run by Mencap, a Voluntary Agency specialising in services for people with learning disabilities. At the last key inspection the homes manager informed the inspector that charges were £1,754.27 per week. Care Homes for Adults (18-65 years) Page 5 of 33 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 unannounced inspection took place on Monday 24th August 2009 from 13:10 to 18:40. The inspection was a key inspection which focussed on the core standards relating to adults and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. During the inspection a tour of the building and observation of work practice was undertaken. Three people who lived at the home were met and three staff members were spoken with. Records viewed included the care records of three people that lived at the home, staff training records and the recruitment records of three staff members. Further records viewed are detailed in the main body of this report. Prior to the inspection an annual quality assurance assessment (AQAA) was sent to the home, which was completed and returned to us. Surveys were also sent to the home Care Homes for Adults (18-65 years) Page 6 of 33 and we received completed surveys from two people who lived at the home, three relatives of people that lived at the home and three staff members. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 33 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 use this service can expect to have their needs assessed prior to moving into the home and to have their needs met. Evidence: There had been no changes in the people that lived at the home since the last key inspection. Each person had their needs assessed prior to moving into the home. The care records of three people that lived at the home were viewed and each held detailed care plans, which identified the support that people needed and preferred to meet their assessed needs. The AQAA stated as a Mencap service we are continuing to review and evaluate the service users needs, their support plans and risk assessments. The support plans are ongoing and live documents which identify needs. We did not inspect Standard 1 regarding the homes Statement of Purpose during this key inspection. However, due to changes in the management structure we checked that the document had been amended to show the current management Care Homes for Adults (18-65 years) Page 10 of 33 Evidence: arrangements of the home. We viewed the Statement of Purpose and it was noted that the document had been updated to show the changes to ensure that people were provided with up to date information about the home. Care Homes for Adults (18-65 years) Page 11 of 33 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 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 this service can expect to have their needs and preferences set out in an individual care plan and to have the risks in their daily lives assessed. They cannot be assured that their care records are regularly updated to reflect how their individual choices were made and changes in their circumstances. Evidence: The care records of three people who lived at the home were viewed and each included detailed care plans which identified the support that they needed and required to meet their assessed needs. The care plans included areas such as personal care, mobility and communication. The records also provided the support that people needed to use their mobility aids and the specific support that they needed in areas such as eating and during the night, which included photographs of how their mobility equipment was used and an explanation was provided to support the photographs in text format. The records needed updating to reflect the changing circumstances of people, for example one of the people had left their educational establishment and the care plan had not been updated to reflect this. A staff member was spoken with about Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: the need to update the care plans and they told us that they had planned to address the issue the day after the inspection. Two staff members that were spoken with told us that the care plans provided them with the information that they needed to meet peoples needs. The staff showed a good understanding of peoples needs and how they were met. Three staff surveys said that they were always provided with enough information about the needs of the people that they supported and that the ways that they passed on information about people always worked well. The relative survey asked if their relatives needs were met and that they were provided with the support and care that they expected or agreed, one answered always, one answered usually and one answered sometimes. The AQAA stated we support people to take a lead in their support planning and help them to arrange individual meetings on a regular basis to review these plans, as Mencap service we ensure that service users can expect that their needs are reflected in their support plans and service users are also supported to take risks as set out in their risk assessments. Each care plan included risk assessments which identified how the assessed risks in peoples lives were minimised in areas such as medication, mobility and personal care. There were risk assessments and care plans which showed the support that people were provided with regarding access to their bank accounts, including withdrawals and transactions. However, the records needed to be updated to show how peoples finances were safeguarded. The records stated that staff who had left the service were the appointee and trustees for two peoples finances. The records did not reflect the changes in the appointee and trustee arrangements and there was no indication to show how the arrangements were reviewed, how the decisions were made, who was involved in making the decisions, where alternative arrangements, such as appointed persons other than those employed by the service had been considered and methods of ensuring that safeguarding checks were undertaken by a person not employed by the service. There was a statement of peoples lack of capacity to make decisions regarding their finances, which was undertaken by the homes previous registered manager. However, there was no indication of a formal Mental Capacity assessment or the involvement of an independent advocate to ensure that the arrangements were made in peoples best interests which safeguarded them or for the convenience of the home. Peoples spending money was kept in a secure cupboard in their bedroom and there were detailed records of all transactions and receipts were in place. Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: The daily records that were maintained regarding each person showed the support that people had been provided with, the staff observations of their well being and how they had made choices in their lives. The records of circle meetings were viewed which showed that people and their representatives, friends and family were included in the decisions about their daily living. Two service user surveys said that they always made decisions about what they did each day and that the staff always listened to what they said. The interaction between staff and people that lived at the home was observed to be caring, attentive and professional. The staff included people in all their discussions. Two service user surveys said that the staff always treated them well. The relative survey asked if their relatives were supported to live the life they chose, two answered always and one did not answer. Care Homes for Adults (18-65 years) Page 14 of 33 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. People who use this service can expect to be provided with activities which are of interest to them, to maintain their chosen contacts, to be treated with respect and to be provided with a balanced diet. Evidence: The care plans of three people that lived at the home were viewed and they identified the educational support that they were provided with. However, they needed to be updated to show the current arrangements. A staff member who was spoken with explained the arrangements for each person, which included college attendance, which was to commence when the summer holidays had ended. Peoples care plans identified the activities that people participated in on a daily basis, which included swimming, horse riding, going out for a drive, going to football matches, shopping and visiting local coastal towns. On the morning of the inspection Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: all three people had been to a local park to enjoy the nice weather. There were activities plans in place which showed that people were provided with the opportunity to participate in activities each day. Since the last key inspection the garden room in the home had been made into a sensory room, which provided comfortable seating, lighting, sounds and items to feel and touch. Peoples daily records and activities plans showed that they regularly used to sensory room. A staff member told us that people enjoyed using the room and that they were relaxed after they had used it. The AQAA stated Mencap aims to enable and support people who use the service to actively engage with and participate in their local community and to develop and lead lifestyles that enable them to achieve the things that matter to them. Two service users surveys said that they could always make decisions about what they wanted to do each day. However, one commented sometimes there are not three staff on duty so I cannot go out. A staff member was spoken with and told us that there were three new staff who were due to start working at the home the week after the inspection. They said that there were usually three staff on duty, however, there had been times when two staff worked so if all three people present in the home then they could not go out to an activity. The staff rota was viewed and showed that there were three staff working at the home for the majority of the time. Three staff surveys said that there were usually enough staff to meet peoples needs. A relative survey commented I dont believe my (the person) has the opportunity to do activities or outings at Peddars any more. Peoples care plans showed the arrangements that were in place for maintaining contacts with their family and friends, which included visits. The daily records showed where people had maintained contacts. A staff member was spoken with and showed us a communication book, which had been developed for the use of a persons relative to ensure that they were informed of issues regarding the person and they could also write comments in the book for the attention of the staff when the person returned from home leave. The AQAA stated Mencaps families charter encourages and guides our staff in supporting people to maintain and strengthen family connections that are important to them. All staff receive training in this. The relative survey asked if their relative was supported to keep in touch with them, two answered always and one answered never. The survey asked if they were kept up to date with important issues affecting their relative, one answered always, one answered usually and one answered sometimes. Comments included my (the person) Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: seems happy and well looked after at the home, so feel they are looking after (the person) to which (the person) is contented and happy to be there and we have circle meetings which brings us up to date with things that are happening to our (the person) or are going to happen. The interaction between staff and people that lived at the home was observed to be friendly, respectful and professional. Staff were observed to be attentive to peoples needs and they included people in their discussions. Staff were observed to knock on bedroom doors before they entered them, which ensured that peoples privacy was respected. Two service user surveys said that the staff always treated them well. People were provided with a balanced diet and their care plans clearly showed the specific support that they required with eating and diet. A record of what each person had eaten and drank each day was maintained in their care plans. A staff member was spoken with and explained the dietary needs of the people that lived at the home and they told us that they had been provided with training to ensure that they supported a person who used a peg feed appropriately, this was confirmed in the training records that were viewed. During the inspection people were provided with chicken curry and rice for their evening meal, which looked appetising. People who required support to eat their meal were provided with one to one support from staff, who were patient and remained with them until they had finished their meal. The AQAA stated as part of a person centred approach to support planning we actively encourage the people we support to be health aware and provide support in healthy eating and lifestyles particularly where someone has identified a need or wish to improve their health. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be provided with personal support in the ways that they prefer, to have their health care needs met and to be protected by the homes medication procedures. Evidence: The care plans of three people were viewed and each held detailed information of how they were provided with personal care to meet with their assessed needs and preferences. The care plans detailed the support that people were provided with such as with eating, their appearance, personal hygiene, bedtime routines and mobility. The plans were provided in photograph and text format, which clearly showed how people should be supported in areas such as using mobility aids. The daily records that were viewed showed the personal care support that people had been provided with to meet with their needs and preferences. During the inspection it was noted that people were well presented with regards to their appearance and staff were observed to be attentive to peoples personal care needs throughout. A relative survey stated that they had concerns about the personal care support that their relative was provided with at the home, such as (the person) looks decidedly scruffy Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: and three times in a row when (the person) came home (the time of the home visits) (the person) had odd socks on. Staff that were spoken with had a good understanding of their roles and responsibilities and peoples individual needs regarding the personal care support that they were provided with. The AQAA stated we use the person centre support with an individual in line with their preferences and beliefs. The care records of three people that were viewed clearly showed the health care support that people had been provided with and the outcomes of physical and emotional healthcare treatment that they had received, such as from their doctor. The daily records showed that the staff observed the well being of people and changes in their condition were promptly addressed and reported, such as when people had seizures and in their behaviour. Staff that were spoken with had a good knowledge of each persons condition and the healthcare support that they were regularly provided with. The AQAA stated each service user has a health action plan in place which is reviewed regularly and information recorded after each medical professional visit. The plan is taken by the service user for each medical visit. The medication procedures were viewed and the document identified the methods for the safe handling, administration and storage of medication. Peoples care records that were viewed included a medication profile, which identified the administration arrangements, their prescribed medication, the reasons for the prescription and the possible side effects. There was PRN (as required) guidance where people had been prescribed PRN medication. The care records detailed when there had been changes in medication. The AQAA stated our policies and procedures around medication actively encourage our staff to demonstrate safe working practices and to fully involve the person in taking as much control as possible over their medication. The MAR (medication administration record) charts were viewed for three people and each were recorded appropriately to show when medication had been administered and the appropriate codes were used when people had not taken their medication, for example when they were on home leave. Issues with the administration of medication were clearly recorded, for example a tablet had been dropped onto the floor, it was disposed of and the person was provided with another tablet. Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: Medication was stored in a secured medication cabinet in each persons bedroom and stocks of medication were stored in a secured medication cabinet in the homes office. The AQAA stated that there had been no controlled drugs stored in the home in the last twelve months. A staff member who was spoken with told us that there was no controlled medication stored at the home. We pointed out that a medication profile stated that one person had a prescribed PRN medication which was a controlled drug and the staff member said that the medication was not stored at the home and that the person only had the medication for example when in hospital. They agreed that they would check with their pharmacy that their current medication storage meets with the regulation regarding the storage of controlled drugs, should the need for controlled drugs to be kept in the home arise. Staff that were spoken with told us that they had been provided with medication training and this was confirmed in the training records that were viewed. Three staff surveys said that they were provided with training which gave them enough knowledge about health care and medication. Care Homes for Adults (18-65 years) Page 20 of 33 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 this service can expect to be protected from abuse and to have their complaints listened to and acted upon. They cannot be assured that that they are fully protected by the arrangements in place to safeguard their finances. Evidence: Staff the were spoken with told us that they had been provided with safeguarding training and they were aware of their roles and responsibilities regarding the protection of people that lived at the home and reporting concerns of their well being. The staff training records that were viewed confirmed that they had been provided with safeguarding training and the AQAA said that staff were provided with the training on a yearly basis. Staff were further provided with information about safeguarding in the local authority safeguarding guidelines and the homes safeguarding and whistle blowing procedures, all of which were available in the homes office for reference. The AQAA said that there had been no safeguarding alerts made in the last twelve months and stated we recognise that the people we support are very vulnerable and who may also have difficulty in expressing their feelings and fears, that the awareness and vigilance of staff is key to protecting people from harm. The storage and recording of the transactions of peoples spending money that was kept in the home was viewed and it was noted that all transactions were clearly Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: recorded. However, there were risk assessments and care plans which showed the support that people were provided with regarding access to their bank accounts, including withdrawals and transactions. The records needed to be updated to show how peoples finances were safeguarded. The records stated that the previous homes registered manager was the appointee for two peoples finances and that the previous registered manager and the previous deputy manager were trustees for two peoples finances, both had left the service. The records did not reflect the changes in the appointee and trustee arrangements and there was no indication to show how the arrangements were reviewed, how the decisions were made, who was involved in making the decisions, where alternative arrangements, such as appointed persons other than those employed by the service had been considered and methods of ensuring that safeguarding checks were undertaken by a person not employed by the service. We could not be assured at the time of the inspection that their bank accounts were appropriately safeguarded. A staff member was spoken with and told us that they thought that the acting manager was the current appointee for two peoples finances. They told us that peoples spending, such as the purchase of a car and bath was discussed in their circle meetings. We told the staff member that we would be available for discussion the day after the inspection, should someone wish to contact us with further information about how the access to peoples bank accounts had been decided upon. We were not contacted. The acting manager telephoned us 14th October 2009 and advised that the records had been updated 24th April 2009 which were present in peoples records and that they were filed underneath other records. However, staff were asked if the records had been updated and they had not provided them at the time of the inspection. The homes complaints procedure was viewed and identified the ways that people could make complaints about the service that was provided at the home and the actions that they could expect to be taken to address their complaints. The procedure needed to be updated to show the contact details of CQC, should people wish to contact us. The AQAA stated we have a robust complaints procedure in place and we believe that the people who use our services should be able to comment or complain if any aspect of our services or activities do not meet the high standards that they have a right to expect. Two service user surveys said that they knew who to speak to if they were not happy and how to make a complaint. Two relative surveys said that they knew how to make Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: a complaint and one did not answer. The relative survey asked if the service had responded appropriately if they had raised concerns, one answered always, one answered usually and one answered sometimes. Three staff surveys said that they knew what actions to take if a person wished to make a complaint about the service that was provided at the home. The complaints book was viewed and it was noted that there had been no complaints received since the last inspection, this was confirmed in the AQAA. Informal concerns and how they were addressed were recorded in peoples care records and/or in the homes communication book. Care Homes for Adults (18-65 years) Page 23 of 33 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. People who use this service can expect to be provided with a clean, homely and well maintained home to live in. Evidence: A previous repeat requirement was made which stated that the bathroom should be refurbished to ensure that it could be used safely by a person that lived at the home. Since the last key inspection one of the bathrooms in the home had been refurbished. The bathroom was large and provided an assisted bath, shower and hoist facilities to enable the staff to support the people who lived at the home with their personal care in a safe and effective manner. A staff member who was spoken with told us that the bathroom provided good facilities. There was a second bathroom in the home which provided a toilet, bath and hand wash basin. Peoples bedrooms were viewed and each held peoples personal items of memorabilia and a staff member told us that the people had chosen the decor and furnishings in their bedrooms. Each bedroom reflected peoples choices and individuality. The communal areas in the home were clean, comfortable and well maintained and it was noted that there were no unpleasant odours. There was an open plan lounge, dining room and kitchen. A staff member told us that the communal areas had been Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: redecorated since the last key inspection. The garden room had been refurbished and provided a sensory room, which provided sensory facilities, such as lights and sounds, in which people could relax in. Two service user surveys said that the home was always fresh and clean. The AQAA stated we aim to provide an environment that is capable of meeting individual needs, is safe, secure and promotes the well being of the individual. The laundry was viewed and provided a washing machine, a drying machine and hand wash facilities. The laundry, bathrooms and kitchen provided hand washing facilities which included hand wash liquid and disposable paper towels to minimise the risk of cross infection and there was a stock of protective aprons and gloves for the use of staff when supporting people with personal care. Staff that were spoken with had a knowledge of their responsibilities regarding infection control and they were observed using good infection control practices during the inspection, such as washing their hands when working with food. Care Homes for Adults (18-65 years) Page 25 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be supported by staff who are competent and trained to meet their needs and to be protected by the homes recruitment procedures. Evidence: The recruitment records of three staff members were viewed and it was noted that the appropriate checks had been undertaken to ensure that people who lived at the home were safeguarded. Checks included identification, their work history which was detailed in their application form, two written references, POVAfirst (protection of vulnerable adults) checks and CRB (Criminal Records Bureau) checks. Three staff surveys said that their employer carried out checks, such as their CRB and references before they started work. The AQAA stated the policies and procedures in place in recruiting and training guide and inform effective recruitment practices that include thorough pre-employment checks, induction and ongoing training to ensure that staff fully understand their responsibilities and how to effectively support people with a learning disability. Three staff surveys said that they were provided with an induction which covered everything that they needed to know to do the job when they started and that they Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: were provided with training which was relevant to their role, helped them to understand and meet peoples needs and that kept them up to date with new ways of working. Staff that were spoken with told us that they were provided with a training programme which provided them with the information that they needed to enable them to meet peoples needs. They told us that they had been provided with a Skills for Care induction programme and that they completed an induction workbook and training such as medication, safeguarding, manual handling and health and safety. Staff training records were viewed, which included a training matrix and certificates, that confirmed that staff were provided with the training that they had told us about and further training such as lone worker, Deprivation of Liberty, food hygiene, fire safety, epilepsy and person centred approach. The home had met the target of 50 staff to have achieved a minimum of NVQ (National Vocational Qualification) level 2 as identified in the National Minimum Standards relating to adults. The AQAA stated that there were ten permanent care workers and seven had achieved an NVQ level 2 or above in care or health and social care. Care Homes for Adults (18-65 years) Page 27 of 33 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 this service can expect to have their heatlh and safety promoted. They cannot be assured that the home is run in their best interests. Evidence: The homes registered manager had left the service in 2008 and an acting manager had been in post until March 2009, however, they had also left the service. The home was currently managed by a registered manager from another Mencap service. The provider had kept us fully informed of the management arrangements in the home. A staff member told us that the manager worked at the home three times a week. They said that the manager post was currently in the process of being advertised for recruitment. A staff member had commenced an acting deputy role on the day of the inspection to assist with the management of the home until a full time manager had been employed. The running of the home was regularly monitored in the Regulation 26 visits, which were undertaken by the homes area manager. The Regulation 26 visit reports were viewed and it was noted that they were undertaken on a monthly basis. The monthly Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: managers compliance checks were viewed, which identified that the areas of issues such as health and safety and record keeping were routinely audited. However, it was noted that the audits that were undertaken had not addressed the issues of outdated care records which identified changes in peoples needs, such as with safeguarding the access to their bank accounts and how their individual choices were made, which is further discussed in the individual needs and choices and concerns, complaints and protection sections of this report. The AQAA stated we have a continuous improvement process in place that sets out how we promoted and assure the quality of the service to the people we support. We have clearly defined processes for gaining feedback from the service users and stakeholders, meeting out compliances, monthly monitoring visits Regulation 26 and annual reviews of the service. Annual satisfaction questionnaires were undertaken which provided people who used the service and their relatives to share their views about the service that was provided at the home. The AQAA stated the home carries out regular health and safety checks. The fire safety records were viewed and they showed that fire safety checks were regularly undertaken. During the inspection we observed a staff member check the fire safety system and record their actions in the fire safety records. It was noted that the fire doors automatically closed when the fire alarm was activated which minimised the risks to people in case of a fire. Environmental risk assessments were viewed, which identified the methods of minimising the assessed risks in the home in areas such fire, manual handling and using the homes vehicle. Records of regular health and safety checks were viewed, which included of the homes vehicle, fridge, freezer and water temperatures and the first aid box contents. Incident and accident reports were viewed and it was noted that the incidents were routinely recorded and addressed where appropriate to ensure that people were safeguarded. Care Homes for Adults (18-65 years) Page 29 of 33 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 30 of 33 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 6 17 Care records must be kept up to date to reflect the changes in peoples needs and preferences To ensure that peoples changing needs are met 30/09/2009 2 7 20 The appointee arrangements 30/09/2009 for peoples finances must be clearly recorded in their care plans and risk assessments. To ensure that peoples finances are appropriately safeguarded. 3 9 20 The arrangements for ensuring that where people lack the capacity to make decisions about their finances, the appropriate assessments must be undertaken to show how decisions were made. To ensure that people are safeguarded 30/09/2009 Care Homes for Adults (18-65 years) Page 31 of 33 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 Care Homes for Adults (18-65 years) Page 32 of 33 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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