Inspection on 02/12/09 for Penn House

This inspection was carried out on 2nd December 2009.

CQC found this care home to be providing an Poor 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 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Penn House 11/12/08

Penn House 19/12/07

Penn House 20/12/06

Penn House 11/01/06

Penn House 19/10/05

Penn House 09/11/04

Penn House 01/03/04

Penn House 01/03/04

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

Key inspection report Care homes for adults (18-65 years) Name: Address: Penn House The National Society For Epilepsy Chesham Lane Chalfont St Peter Gerrards Cross Bucks SL9 0RJ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Maureen Richards     Date: 0 3 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 46 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 46 Information about the care home Name of care home: Address: Penn House The National Society For Epilepsy Chesham Lane Chalfont St Peter Gerrards Cross Bucks SL9 0RJ 01494601435 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.epilepsysociety.org.uk The National Society for Epilepsy care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users to be accommodated is 22 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Physical disability (PD) Date of last inspection Brief description of the care home Penn House is one of a number of homes situated on the Chalfont Centre for Epilepsy. The home is registered to provide residential care to for up to twenty two adults with a physical disability, including one relief bed. 1 1 1 2 2 0 0 8 22 Over 65 0 The home provides care and support to individuals with a range of personal care needs. The home is made up of five flats each with their own kitchen, sitting area and shower. Downstairs is wheelchair accessible. Care Homes for Adults (18-65 years) Page 4 of 46 Brief description of the care home The Centre provides on site work placements which a number of service users from Penn house access. Alongside this there is an internet cafe, a shop and restaurant. There is access to public transport and the home is accessible to Chalfont St Peter Village, which allows for access to the towns of Amersham, High Wycombe, Uxbridge and Slough. Please contact the provider for the current range of fees. Care Homes for Adults (18-65 years) Page 5 of 46 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: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over two days and covered all of the key National Minimum Standards for younger adults. Prior to the inspection, a detailed self assessment questionnaire known as the Annual Quality Assurance Assessment document was sent to the manager for completion and comment cards were sent to a selection of people living at the home, relatives, staff and visiting professionals. Any replies that were received have helped to form judgements about the service and their responses have been included under the relevant sections of the report. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with the some staff and service users, examination of some of the homes required records, observation of practice and a tour of the premises. An expert by experience was involved as part of this inspection. He had discussions with two service users and observed practices. His observations and feedback are included within the body of the report. Care Homes for Adults (18-65 years) Page 6 of 46 Feedback on the inspection findings and areas needing improvement was given to the Deputy Director of Services and manager at the end of the inspection. The staff and service users are thanked for their co-operation and hospitality during this unannounced visit. Nine requirements from the previous inspection have not been complied with and enforcement action is now being considered to address those areas of non compliance. This inspection has resulted in a number of further requirements to improve practice and outcomes for service users. Care Homes for Adults (18-65 years) Page 7 of 46 What the care home does well: What has improved since the last inspection? What they could do better: Service users to the home must be fully assessed with records of assessments in place to support this to ensure that the home can meet identified needs and have considered compatibility with other service users. Contracts must be completed in ink and signed to safeguard service users. Service users care plans must be developed to clearly and specifically outline care needs including service users ability to make choices and decisions. These must be kept up to date and reviewed to promote continuity of care. Care Homes for Adults (18-65 years) Page 8 of 46 Service users care plans must outline up to date information of who is supporting a service user with their finances to safeguard service users. Service user plans must include up to date risk assessments which address all identified individual risks, including moving and handling. These must be kept up to date and reviewed to promote service users safety. Opportunities for leisure activities must be improved to enable service users to have access to a wide range of activities. Accurate records should be maintained to reflect the activities that have taken place. Opportunities must be made available to enable service users to develop their independence and take a more active role in the day-to-day running of the home. Staff should ensure that visitors to the home knock or ring the door bell prior to entering to promote service users privacy. The choice of meals on offer must be increased and evidence provided that service users are given more options and that they take an active role in making choices. The registered person must ensure that all events, which affect the well being of service users is reported to the Commission. Improvements must be made to medication practices to safeguard service users. All complaints received must be logged, investigated and responded to in a timely fashion to safeguard service users. Staff must be appropriately trained to recognise when a situation is a potential safeguarding situation and report to the relevant bodies to safeguard service users. Staff must be inducted into the home and suitably recruited with records maintained to evidence this to safeguard service users. Staff must have the required mandatory and specialist training to enable them to meet service users needs in a safe and consistent way and to fulfill their roles. Staff must be formally supervised and appropriately supported to safeguard service users. The registered person must ensure that this service is being effectively managed and monitored to ensure that requirements are complied with to improve practice and to safeguard service users. The registered person must ensure that the records required for Regulation are well maintained, accessible and up to date. The registered person must ensure that the use of free standing radiators do not pose risks to service users. Care Homes for Adults (18-65 years) Page 9 of 46 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 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 10 of 46 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 11 of 46 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users are provided with the key information on the home however respite admissions are not reassessed to ensure that the home is aware and can meet their current needs with contracts not being completed which potentially put service users at risk. Evidence: At the previous inspection a requirement was made that the registered person must ensure that an up to date service users guide is in place and made available to service users. The service user files viewed included a copy of an up to date copy of the service user guide. This requirement is assessed as being complied with. The Annual Quality Assurance assessment document tells us that they ensure that prospective service users have the necessary information to make a decision about moving to the home. They have an assessment tool in place to carry out assessments on prospective service users which includes a comprehensive assessment questionnaire, transition meetings, day visits, overnight stays and weekend stays. It indicates that they ensure all assessments for long term care and respite care are well Care Homes for Adults (18-65 years) Page 12 of 46 Evidence: documented and comprehensive. The Annual Quality Assurance assessment document tells us that the home has had no admissions since the previous inspection. The acting manager had carried out a recent assessment on a prospective service user using the above mentioned assessment tool. This completed assessment was found to be comprehensive and informative in outlining the individuals needs. On the day prior to the inspection a service user was admitted for respite care. This individual had not been reassessed to establish if their needs had changed and was not formally admitted by a doctor as is the procedure within the organisation. Their care plan was not updated to reflect their change in circumstances since the last admission and there was no record on the daily record sheet of their admission. The first entry in that individuals daily record was by the night staff to record a seizure. This is unsafe practice which potentially put the service user at risk. A requirement was made at the previous inspection that the registered person must ensure that service users to the home are assessed with records of assessments in place to support this. This requirement is assessed as not being complied with and will be referred to the enforcement team for their consideration. The home has a referral and assessment policy which was updated in July 2005. This does not outline the procedure for admissions into respite care. At the previous inspection a recommendation was made that service users contracts should be completed in ink and signed off by staff as outlined on the contract. The contracts viewed at this inspection were completed in pencil, some were unsigned and still included details of the previous manager. This has not been addressed and a requirement will be made to address this to safeguard service users. Written feedback from service users confirm that twelve out of fourteen were asked if they wanted to move into the home and was given enough information about the home before they decided if it was the right place for them. One service user indicated they could not remember if they were asked if they wanted to move into the home and if they were given enough information to decide if it was the right place for them and one service user indicated they were not asked if they wanted to move into the home and was not given enough information about the home before they decided if it was the right place for them. Written feedback from relatives confirm that one relative always get enough information about the care service to help them make decisions and four relatives usually get enough information about the care service to help them make decisions Care Homes for Adults (18-65 years) Page 13 of 46 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users plans lack detail and are not specific as to how identified needs are to met, risk assessments are not in place for all known risks, kept up to date and reviewed which potentially puts service users at risk. Evidence: Four service user care plans were viewed. Care plans contained a photograph and a personal details information sheet. They outlined significant important dates and a pen picture on how best to support the individual. Care plans identified needs associated with epilepsy, medication, behaviours, eating and drinking, finances, social skills, personal care, mobility, communication, cultural and religious preferences, general health, family and friendships and health appointments. The care plans viewed showed evidence of being reviewed and service users involvement. The care plans viewed were not detailed and specific as to how service users needs were to be met. One service users care plan made reference to prompting a service user with their personal care, however it does not outline how they are to be promoted or frequency. One service users care plan outlined that the service user was able to communicate Care Homes for Adults (18-65 years) Page 14 of 46 Evidence: their needs however a recent investigation indicated that they were unable to communicate their health needs but the care plan was not updated to reflect this. One service users care plan indicated that they suffered from high muscle tension however there was no explanation as to how this affected the service user and staff on duty were unable to explain what it was. One service users care plan outlined that they had difficulty in swallowing. It did not clearly outline what those difficulties were and there was no risk assessment in place to address potential risks associated with this. Care plans outlined behaviours pre and post seizure but the care plan did not outline how those behaviours were to be managed. One service users care plan made reference to a protocol being in place in relation to the management of challenging behaviour however there was no protocol included in the care plan and staff on duty were not aware of its existence. This is unsafe practice which potentially put the service user, other service users and staff at risk. As outlined under standard 3 the care plan in place for the service user admitted prior to the day of the inspection was out of date and did not reflect their current circumstances with the daily records not completed to indicate this individual was admitted. The Annual Quality Assurance assessment document tells us that comprehensive careplans are in place for every service user which was not assessed as being the case in the sample of care plans viewed. The care plans viewed made no reference as to how service users are to be supported in making choices and decisions except for one care plan that made reference to choosing meals. A requirement was made at the previous inspection that the registered person must ensure that service user care plans are developed which clearly and specifically outline care needs including their ability to make choices and decisions. This requirement is assessed as not being complied with and will be referred to the enforcement team for their consideration. A recommendation was made at the previous inspection that service user plans should accurately reflect the service users religion. The care plans viewed included service users religious preferences and indicated if they required support to meet their religious needs. A recommendation was made at the previous inspection that service user files should be reorganised and made, more accessible. The information was made more accessible but lacked the details as outlined above. Care plans makes reference to communication needs but as outlined above does not outline how service users were being supported and empowered to make choices and decisions. Changing lifestyle meetings have been taking place with service users and families to discuss the closure of this service in 2011 and the acting manager confirmed that she had started one to one meetings with service users to discuss their future options and obtain their views on what type of accommodation they would like Care Homes for Adults (18-65 years) Page 15 of 46 Evidence: to move to. The Annual Quality Assurance Assessment document tells us monthly resident meetings take place. Minutes seen confirm that a residents meetings took place on the 17th November with previous minutes on file for meetings that took place on the 10th August and the 25th October 2009. This should be developed on with meetings take place on a more regular basis to enable service users to raise issues which affect them. Written feedback from service users confirm that nine out of fourteen service users always make decisions about what they do each day. Two service users fed back that they usually make decisions about what they do each day, two service users fed back that they sometimes make decisions about what they do each day and one service user did not answer this question. Service user plans included money management risk assessments and care plans outlined the support required with finances. In one file viewed the money management risk assessment indicated that the service user required someone to act on their behalf to manage their money however the care plan did not outline who was supporting this individual and staff on duty were unaware of the arrangements for this individuals finances. The Annual Quality Assurance assessment document tells us that the local funding authority had taken responsibility for this individuals money however during the inspection it was clarified that this was not the case. This is unsafe practice in relation to the recording of information which potentially put service users at risk of financial abuse. At the previous inspection some service users had restricted access to their cigarettes and snacks. A requirement was made that the registered person must ensure that restrictions imposed on individuals are within an individual risk assessment framework that does not impact on other service users. Service user plans viewed included protocols on the management of cigarettes. However two of the three protocols viewed were overdue for review. These should now be further developed to enable service users to start taking some responsibility in preparation for their discharge from the service. Service user plans included risk assessments in relation to fire, smoking, use of kettle, transport, money management risk assessments and medication risk assessments but only for service users who were self medicating. Two of the three money management risk assessments viewed were completed in 2006 and were not reviewed or updated following the changes within the organisation in relation to the management of service users finances. Some of the risks assessments viewed were overdue for review. None of the files viewed included risks assessments in relation to the management of challenging behaviours, behaviours pre and post seizure and risks associated with individuals medical conditions and disabilities. There were no risk assessments on file Care Homes for Adults (18-65 years) Page 16 of 46 Evidence: for the service user admitted the day prior to the inspection. Service user plans included a moving and handling care plan but there was no moving and handling risk assessment in place to support the care plan. A requirement was made at the previous inspection that the registered person must ensure that up to date risk assessments are in place to address all identified individual risks, including moving and handling. These must be kept up to date and reviewed. This requirement is assessed as not being complied with and enforcement action is now being considered by the Commission to address this non compliance. Written feedback from relatives indicate that four relatives feel the care service usually meets the needs of their relative and one relative indicated that they always meets the needs of their relative. Written feedback from relatives indicates that three relatives feel they usually support people to live the life they choose, one relative indicated they always support people to live the life they choose and one relative indicated they sometimes support people to live the life they choose. Written feedback from staff confirms that four staff indicated they are always given up to date information about the needs of the people they support. Three staff indicated they are usually given enough information about the people they support and one staff member did not answer this question. Care Homes for Adults (18-65 years) Page 17 of 46 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users do not have access to a range of leisure activities, their independence is not promoted and they have limited choice of meals provided which does not benefit service users. Evidence: The Annual Quality Assurance assessment document tells us that the organisation provide office based work for service users and is actively helping and supporting some service users to find work in the community. The Organisation has put together a business plan for a Horticultural Social Enterprise Project and some service users have commenced work on this project. Some service users work on other projects on site and some service users attend college. Service user plans included a weekly timetable of activities with a record maintained in daily records of what individuals participated in. One service user fed back to the expert by experience that they were currently improving their literacy skills with the aid of another service user which was Care Homes for Adults (18-65 years) Page 18 of 46 Evidence: their choice as the option of going to college would be too stressful. The Annual Quality Assurance Assessment document tells us that what has improved in the service is that they provide more regular social and recreational trips out and provide social events as part of a centre wide rota system. They have photographic evidence depicting trips, holidays and activities with written reports included in service users daily reports. A recommendation was made at the previous inspection that accessible records should be maintained to evidence that leisure activities takes place with a requirement made that the registered provider must ensure that opportunities are made available to enable service users to access a range of leisure activities. During the two day inspection no leisure activities were observed to take place or be organised. A weekly record of activities was put in place as recommended but was not being completed to evidence that service users have access to a range of leisure activities and there was no time during the inspection to go through individuals daily records to establish if this is the case. Therefore from the evidence provided on the day of the inspection it is assessed that this requirement has not been complied with and enforcement action is now being considered. The Annual Quality Assurance assessment document tells us that service users have access to an annual holiday with care plans indicating that this was a goal for some individuals. Care plans outline significant people involved in service users lifes and the care plans outline the support required in maintaining those relationships. Feedback from service users confirms that their relatives and friends are made to feel welcome. A requirement was made at the previous inspection that the registered person must ensure that opportunities are made available to enable service users to develop their independence and take a more active role in the day to day running of the home. Care plans viewed do not evidence that service users are promoted to develop their independence and this was not evident in practices during the inspection. This requirement is assessed as not been complied with and enforcement action is now being considered by the Commission to address this non compliance with a regulation. A recommendation was made at the previous inspection that service user plans should outline support required with post and a risk assessment should be in place to indicate why an individual do not have a key to the front door of the home. The care plans viewed included a risk assessment on the management of post with one of the three risk assessments viewed overdue for review. Care plans indicated that staff entered service users bedrooms at night to check on individuals to promote their safety and service users have a key to the front door. During the inspection it was noted that the maintenance man and builder entered the home without knocking or ringing the bell. This is unacceptable practice and intrusion into the service users home which as a good practice recommendation should be addressed. Care plans outline service users Care Homes for Adults (18-65 years) Page 19 of 46 Evidence: preferred form of address and service users can choose when to be alone or in company. During the inspection service users who were not involved in work or college spent the majority of the day in their bedrooms with little engagement noted with staff. Staff feedback that they were discouraged from sitting talking to service users as this was seen as them not doing anything. Service users were not observed to be involved in housekeeping tasks apart from setting the table for meals. One care plan viewed made reference to staff supporting that individual with spring cleaning their bedroom. The service is due to close in 2011 and is set up with groups of four or five service users living together sharing a sitting room and small kitchen which is ideal for supporting and enabling service users to develop some life skills. This must now be developed on. The staff team meeting minutes of the 24th November include discussions on involving residents more in household tasks. One service user fed back to the expert by experience that they liked to be independent with most aspects of their life and this is promoted. However the expert by experience did not witness any other practices which promoted independence and enabled service users but observed more of a culture of looking after service users. Service users are provided with three meals a day. Four service users make their breakfasts in their own kitchenette whilst the others have their breakfast in the dining room. The majority of service users have their lunch and evening meal in the dining room. All of the meals are now catered for in the home which the service users indicated was an improvement and they indicated that the meals provided were good. Staff take full responsibility for the meals with no evidence of service users being involved in the planning, shopping, cooking or serving of meals. The home has a four week menu with the weeks menu plan displayed on the notice board in the dining room. The four week menu plan does not evidence service users involvement in choosing the meals, it does not indicate service users likes or dislikes and no alternative choices are recorded as being provided. Staff advised that they do cater for a vegetarian meal choice and that they do provide alternatives for service users who do not like what is on the menu. This is not recorded to evidence that it takes place. Service users have a choice of snack type meals in the evening and this is recorded. The acting manager has recently completed a questionnaire with service users in an attempt to improve meals and the feedback from those is to be incorporated into menu plans. Resident meeting minutes of the 17th November and staff meeting minutes of the 24th November include discussions on developing self catering for service users who want to with the plan being for this to be introduced in the new year. This will be a positive move in preparing service users for when the service closes. The expert by experience observed a meal time. He found that service users were served large portions of one meal choice, with a lot of waste on the day of the inspection. Service users were served the meals by staff and there was little Care Homes for Adults (18-65 years) Page 20 of 46 Evidence: interaction or engagement between staff and service users or each other. Written feedback from service users confirm that twelve out of fourteen service users can do what they want during the day, in the evening and at the weekend. Two people did not answer this question. Service users commented under what the home does well good meals and good menu, they help us to cook and cook my dinner, day trips and holidays. Service users commented under what the home could do better is more food, self catering, provide more outings and easier access to shops. Written feedback from three relatives indicates that the home always helps their relative keep in touch with them, two relatives indicated they usually help their relative keep in touch with them. One relative commented that when they visit they are always made welcome and it is a happy atmosphere. One relative commented under what the home does well is provide food to a good standard. One relative commented under what the home could do better is activities, off centre activities have recently been shelved, courses such as art and crafts, cookery have stopped. Weekends seem to be a dead area as far as organised activities go. One relative commented that their relative has a full programme of activities and they are helped to be as independent as possible. Staff commented under what the home could better is to improve the service by having their own vehicle enabling them to take service users not only on day trips but to the local shops and external services and appointments. Care Homes for Adults (18-65 years) Page 21 of 46 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. Service users health and personal care needs are met although care plans need to be more specific as to the support required to ensure all needs are met in safe and consistent way. Improvements are required to medication practices to safeguard service users. Evidence: Service users plans makes reference to the support required with personal care although as outlined under standard 7 this was not detailed and specific enough to ensure that all staff were consistent in the care being provided. Service users plans included moving and handling care plans with no moving and handling risk assessment in place to support the care plan. Times for getting and going to bed are flexible with service users being encouraged to get up to attend work placements and colleges during the week. Care plans do not indicate if service users make their own choice of clothes and hairstyles. The Annual Quality Assurance assessment document tells us that service users have access to a range of specialist health professionals with records maintained of appointments with health professionals. Staff act as key workers to service users. Some staff spoken with were unclear as to what that role entailed and confirmed they were responsible for developing care plans and risk Care Homes for Adults (18-65 years) Page 22 of 46 Evidence: assessments but had no formal training in this area. This must be addressed to improve the quality of care plans. Some service users spoken with knew who their key worker was whilst others did not. Service users plans did not outline service users preferred routines, likes and dislikes. The Annual Quality Assurance assessment document tells us that service users have access to specialist epilepsy medical services 24 hours per day which include Epilepsy Nurses, On call Doctor and the Neurologist. It tells us that service users can also access the psychology,psychiatry and physiotherapy departments, pharmacy, dentist and General Practitioner. Service user plans outlined the support required with accessing the dentist, chiropodist and optician and in meeting health needs although this was not specific as to the support required specifically when the service user was unable to communicate their needs. A recent safeguarding of vulnerable adults investigation concluded that an individuals health needs were not met. The records viewed would indicate that service users have access to a range of health professionals and their health needs are met however accurate records are not maintained of concerns raised by relatives which potentially could result in their concerns relating to health needs not being addressed in a timely fashion. At the time of this inspection seven of the sixteen service users were self medicating. Care plans made reference to the support required with medication and for service users who were self medicating there was a medication assessment in place. In one care plan viewed this was due for review in Sept 2009 with no evidence of it being reviewed.For service users who were being supported with their medication there was no indication on file as to how this judgement was made. As a good practice recommendation this should be addressed and reviewed to ensure that service users who may be able to develop those skills can. The home has designated staff who are trained to administer medication. Staff confirmed that they undergo medication training and nine assessments prior to being signed off to administer medication. Copies of completed medication competency assessments are not kept on staff files to evidence this and a part completed one was seen which did not include the page as evidence of being signed off by the manager. As a good practice recommendation this should be addressed with copies kept on file to support practices. Permanent staff are responsible for the ordering, receipt, storage, administration and disposal of medications with a record maintained to evidence this. The home has individual medication records with a photograph, which includes a General Practitioner prescription medication administration record and a Consultant medication administration record. All medications administered are prescribed including homely remedies. The records viewed showed gaps in administration of medication for three service users, one which included signing off to say a service user had been given Care Homes for Adults (18-65 years) Page 23 of 46 Evidence: their weeks supply of medication to self medicate. The service user who was admitted the day prior to the inspection was administered their supply of medication they brought to the home with them. This was administered following advice from the first line nurse on duty without the service user being seen by a Doctor and without an up to date medication administration record in place for the staff member administering the medication to record it as being administered. No record was maintained on the service users daily record of the medication administered and there was no evidence on file to indicate that it had been established with the service users General Practitioner or family that this was their current prescription. This practice is not in line with the Organisations procedures and medication policy and must be addressed to safeguard service users. Service users records include a seizure description sheet and a protocol for administration of their as required emergency medication. A medication management incident report is completed for all medication errors, and there was one on file since the previous inspection which was not reported to the Commission. There was seven accident/incident reports on file involving service users which was also not reported to the Commission. A requirement was made at the previous inspection that the registered person must ensure that all events, which affect the well being of service users is reported to the Commission. This has not been complied with. A pharmacy audit was carried out in October 2009 with a report on file to outline the actions required which related mainly to disposing of out of date medication. Three service users commented under what the home does well is look after us when we are ill, another service user commented that they help me when I have a seizure and help me with hygiene. One service user commented under what the home could do better was help with problems but did not give their name or any examples of what assistance they felt they were not getting to enable this feedback to be followed up on. Two service users expressed anxiety regarding the future closure of this service and this was also fed back to the expert by experience during his visit. Written feedback from relatives indicates that four relatives are always kept up to date with important issues affecting their relative and one relative indicated they are usually kept up to date with important issues affecting their relative. Three relatives indicated that the care service always give the support and care that they expect or agreed. Two relatives indicates that the care service usually give the support and care that they expect or agreed. Four relatives indicate that the service usually responds to the different needs of individuals and one relative indicates that they sometimes respond to the different needs of individuals. Relatives commented under what the service does well that medical care is excellent, they make life as normal as possible and generate a good family Care Homes for Adults (18-65 years) Page 24 of 46 Evidence: orientated environment. They ensure medical and physical needs are met but also provide the peripheral extras that make life individual and pleasant. They have met my relatives needs very well indeed, there is good medical help on site. My relative feels safe and that is everything as it keeps their state of mind stable. One person commented that we are so grateful at the way our relative is looked after and hope it can continue as our relative is very settled. One relative commented under what the home does well is keep their relative warm and take care of the washing. They commented under what the home could do better is as needs change there needs to be greater understanding and tolerance of the restrictions they have to live under. Staff commented under what the home does well is support service user in all areas of care, including the management of challenging behaviour and they provide a caring and homely environment at the home. Feedback received from two Social and health care professional indicated they were generally happy with the care provided. They commented that what the service does well is inform clients about their medication, manages complex mental health issues, encourages knowledge of epilepsy and how to manage the condition. They commented under what the service could do better is ensure health needs are fully met, not only those related to epilepsy. Provide a more positive path for those moving on by encouraging and promoting independence. The accommodation feels very institutional and there is need for more person centred support. Service users fed back to the expert by experience that staff are quick to respond to call bells and deal with medical issues. Care Homes for Adults (18-65 years) Page 25 of 46 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place to safeguard service users however practices, recording and lack of training potentially put service users at risk. Evidence: The Organisation has a complaints procedure in place, which was reviewed in March 2009. A summary of the complaints procedure is displayed on the notice board in the dining room and includes the Commissions up to date contact details. A requirement was made at the previous inspection that the complaints procedure must be updated with the correct contact details of the Commission, which has been complied with. The Annual Quality Assurance assessment document tells us that the home has one complaint which was dealt with within 28 days. The complaints log included two complaints, one from a service user in relation to meals which was not investigated and responded to and one from a relative received by the Commission which was sent to the organisation to deal with. This complaint did not include the outcome and was not dealt with within 28 days as the complainant came back to the Commission to follow up on a response. The Regulation 26 report dated the 29th July 2009 makes reference to a complaint from a relative which was not logged in the complaints log and this was not followed up at subsequent Regulation 26 visits so there is no evidence to indicate if this was dealt with. This must be addressed with accurate records maintained of all complaints received which include the outcome of the investigation into the complaint. Written feedback from service users confirm that thirteen out of fourteen service users that responded know who to speak to if they are Care Homes for Adults (18-65 years) Page 26 of 46 Evidence: not happy and fourteen know how to make a complaint. Written feedback from relatives confirm that four relatives know how to make a complaint and the home always responds appropriately to concerns raised. One relative indicated they did not know how to make a complaint and the home usually responds appropriately to concerns raised. Written feedback from staff confirms that they all know what to do if someone has concerns about the home. The Organisation has a vulnerable adults and whistle blowing policy in place. The whistle blowing policy was reviewed and updated in March 2008. The abuse policy was last updated in March 2004. The home has had one safeguarding of vulnerable adults referral and investigation. The outcome of this investigation was that the allegation was upheld. The accident and incident reports viewed included incidents between service users which should have been reported to the Commission and the safeguarding of vulnerable adults team. The Deputy Director of Services agreed after the inspection for the acting manager to review all of the accident and incident reports on file and make safeguarding of vulnerable adults referrals in retrospect of incidences which were assessed as safeguarding. Staff spoken with confirmed their responsibility to report bad practice and abuse however the lack of reporting of potential safeguarding of vulnerable incidents would indicate that staff do not fully understand what is a potential safeguarding situation and this must be addressed. A requirement was made at the previous inspection that the registered person must ensure that all staff including night staff have up to date safeguarding of vulnerable adults training, and all other mandatory training as required. The training records supplied evidences that four out of the ten permanent staff team members have up to date safeguarding of vulnerable adults training with five staff overdue updates in this training and one staff not having had this training. The update for some staff members had been booked and cancelled by them with no explanation as to why it was cancelled and not rescheduled. This requirement is assessed as not been complied with and enforcement action is now being considered to address this non compliance. The service has some service users with challenging behaviours. The Annual Quality Assurance assessment document tells us staff attend mandatory challenging behaviour training to ensure that service users who present with this type of behaviour are treated safely and appropriately.It tells us that behavioural guidelines are developed to support service users emotional needs and behavioural guidelines are reviewed quarterly, or sooner if required, with the Psychiatrist.The care plans Care Homes for Adults (18-65 years) Page 27 of 46 Evidence: viewed did not include behavioural guidelines where this was required and the training records evidence that five out of the ten staff do not have challenging behaviour training. A requirement was made at the previous inspection that the registered person must ensure that all staff have access to a range of specialist training to support them in their roles including challenging behaviour training. This requirement is assessed as not being complied with and enforcement action is now being considered to address this non compliance. Service user plans made reference to support required with finances but as outlined under standard 7 for one service user the care plan did not actually reflect the current practices as to how that individuals money was being managed. Three service users money and records were checked and found to be in order. Care Homes for Adults (18-65 years) Page 28 of 46 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, homely and adequately maintained, with some improvements being made to areas of the home to promote a positive environment for service users. Evidence: The home is a detached house situated in the grounds of the Chalfont Centre. The house consists of five flats, each of between three and six bedrooms. There are four flats on the ground floor and one on the first floor. Each flat comprises of single bedrooms, kitchenette, lounge, shower, toilet and storage area. One of the lounges is used as a smoking area as the service users who live in that flat all smoke. The Annual Quality Assurance Assessment document tells us that the smoking room has been refurbished. The expert by experience fed back that this room seemed untidy and did not appear to be cleaned to the same standard as the rest of the home. The home does not have a lift. The ground floor is accessible to a wheelchair user. The home has a bathroom with chairlift for service users who require support. The home has a communal sitting area and main kitchen. Bedrooms are personalised and homely. On the day of the inspection the home was found to be clean and generally well maintained. One of the shower rooms on the ground floor was noted to be damp and this must be addressed. The Annual Quality Assurance Assessment document tells us that the home have employed a housekeeper and this has helped to keep the house clean, tidy and odour free. It has also helped to take the pressure off care staff Care Homes for Adults (18-65 years) Page 29 of 46 Evidence: leaving them with more time to spend with the Service Users. At the time of the inspection the housekeepers post had been changed to a support worker post with all staff being responsible for cleaning. During the tour of the home it was noted that free standing electric heaters were being used to supplement the heating in the home. These were hot to the touch and potentially put service users with seizures at risk. A risk assessment must be completed for each service user and the required action taken to safeguard service users from the potential risk of scalding. The home is scheduled to close in 2011 and whilst the environment is not ideal it is currently adequate in providing a comfortable and homely environment for service users. Written feedback from service users confirm that seven out of fourteen service users think that the home is fresh and clean. Five service users fed back that the home is usually fresh and clean, one service user fed back that the home is sometimes fresh and clean and one service user did not answer this question. Relatives commented that the house is always clean. Care Homes for Adults (18-65 years) Page 30 of 46 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are not suitably inducted, trained, supervised and supported in their roles which potentially put service users at risk. Evidence: Staff on duty during the inspection were found to be approachable and comfortable with service users, although the expert by experience reported that there was a lack of interaction between staff and service users. Staff spoken with fed back that certain members of the management team discourage them from sitting talking with service users. Staff spoken with felt they had the skills and training to do the job required although felt they lacked the training in key working roles, care planning and risk assessments. The training records indicate that all staff have attended specialist training in epilepsy and the majority of staff have attended equality and diversity training. The Annual Quality Assurance Assessment document tells us that six staff have achieved a National Vocational Qualification. At the time of the inspection the home had eleven full time staff which included a deputy, two team leaders, one shift leader and seven support staff. Alongside this there was a deputy from another home who had taken on the role of acting manager as the manager waiting registration was only in the service two to three days a weeks. The acting manager had worked in the service for three weeks prior to the inspection. Care Homes for Adults (18-65 years) Page 31 of 46 Evidence: The rota indicates that there is four staff each shift with two staff at night. During the day time shift there is always a team leader or shift leader on duty. There is back up medical cover 24 hours a day. The manager confirmed that the home has three full time support worker vacancies with interviews planned for the week following the inspection. The home has recruited more staff since the last inspection and still rely on regular bank staff to cover the vacancies with agency staff being used to cover short notice absences. Staff are responsible for the cooking and cleaning and the home has a part time administrator. The manager is not included on the rota and the deputy and acting manager do a mixture of admin days and work on shift. The Annual Quality Assurance Assessment document tells us that three staff have left employment in the last 12 months. Staff meetings take place although minutes of meetings available evidence that meetings took place on ad hoc basis. Since the acting manager has been in post she has facilitated two staff meetings. Three staff recruitment files were viewed. The files viewed included an application form, copies of terms and conditions, job descriptions, pre employment health check, confirmation of Criminal Records bureau check with a further Criminal Bureau check being obtained where there was a gap in employment. Two of the staff files viewed contained copies of two references and in one file there was only one reference, following a break in employment. This must be addressed. Bank and agency staff are managed centrally and there was not time during this inspection to check a sample of those records. The organisation must ensure that the required checks are in place for those individuals. The Annual Quality Assurance Assessment document tells us that house inductions are provided for all staff and comprehensive training and training updates are made available. No induction records were available to evidence that staff are inducted into the home with the assumption made by senior staff on duty that staff must have taken them home with them. Staff spoken with confirmed that they worked alongside existing experienced staff prior to working on their own but none of the three staff spoken with were able to recall if they had completed a written induction and were not informed of what their role entailed other than what they learned from others.This must be addressed with all new staff being properly inducted into the home and records maintained to evidence this. All new staff complete mandatory training as part of their initial induction by the organisation. The training records viewed indicate that a number of staff have infection control training which includes training on COSHH. A requirement was made at the previous inspection that the registered person must ensure that the housekeeper attends health and safety training and COSHH training to support her in her role. The housekeeper role no longer exists and as outlined above a number of staff have attended infection control training. This requirement is assessed Care Homes for Adults (18-65 years) Page 32 of 46 Evidence: as being complied with. The training records viewed evidences that two staff have not got food hygiene training even though staff are responsible for cooking meals. Four staff have not got up to date first aid training, four staff have not got up to date moving and handling training and four staff have not got up to date fire awareness training. As outlined under standard 23 a number of staff do not have up to date safeguarding of vulnerable adults and challenging behaviour training. A requirement was made at the previous inspection that the registered person must ensure that all staff including night staff have up to date safeguarding of vulnerable adults training, and all other mandatory training as required. This requirement is assessed as not being complied with and will be referred to the enforcement team for consideration. A recommendation was made at the previous inspection that the organisation should consider making available to the home confirmation of recruitment checks and training for bank staff used at the home on a regular basis. This has not being actioned and there was not sufficient time during the inspection to go to the human resources department to view those records. It is the organisations responsibility to ensure that the bank staff supplied to the home have the required mandatory training. A recommendation was made that training records should be reorganised, made more accessible and kept up to date. This has not been addressed with two systems in place for recording training. The acting manager had attempted to address this and had obtained an up to date copy of training from the training department and had started the process of identifying training that was due and getting it booked. Staff spoken with confirmed that they do not get regular supervision and the required support. The sample of supervision records accessible during the inspection would evidence that staff are not being supervised in line with the contract on supervision which indicates that supervision take place at least 6 weekly. This must be addressed. A requirement was made at the previous inspection that supervision training must be made available to staff undertaking supervision. The training records available do not include external courses and therefore there was no record of supervision training for one of the team leaders. The team leader was on duty and confirmed they had attended this training but had the certificate of training at home as opposed to being kept on file in the home. Feedback from staff indicates that they feel they do not get sufficient support to do their job, they commented that some members of the management team spend their time in the office and do not work alongside them or provide support except in an emergency. They feel they are not treated equally and fairly and some staff felt that they were being bullied and intimidated. Staff feedback that they felt they did not work as a team but that there were clicks within the management team which made their life very difficult when on shift with individuals. This was fed back to the Deputy Director of services who was proactive in dealing with the issues raised and confirmed after the inspection that she had commenced an Care Homes for Adults (18-65 years) Page 33 of 46 Evidence: internal investigation. The outcome of the investigation and actions taken must be reported to the Commission. Written feedback from service users confirm that eight out of fourteen service user feedback that the care staff and managers always treats them well with seven service users indicating that carers always listens and act on what they say. Six service users fed back that the care staff and managers usually treats them well and five service users fed back that care staff and managers usually listens and act on what they say. Two service users fed back that carers sometimes listen and act on what they say. Service users commented under what the home does well that some staff are very good to me. Most staff are helpful. Penn house is peaceful and friendly. They create a friendly house. One service user commented under what the home could do better was understand more. Relatives commented that staff are always helpful, very caring staff who carry on in spite of difficult circumstances at the moment. One relative commented that staff are adequately trained for the purpose of the care home however more training in the needs and requirements of people with other disabilities was needed. Written feedback from staff confirms that they have all had the required recruitment checks carried out on them before commencing work. Five staff indicated that their induction mostly covered everything they needed to know to do the job, two staff indicated that their induction covered everything they needed to know about the job, very well. One person indicated that their induction partly covered everything they needed to know to do the job. Four staff confirmed that they have being given training relevant to their role and that helps them understand and meet service users needs, three staff confirmed that they have been given training that keeps them up to date with new ways of working and gives them enough knowledge about health care and medication. One staff member confirmed they have not been given training that keeps them up to date with new ways of working and that gives them enough knowledge about health care and medication. Four staff did not answer this question. Written feedback from staff confirms that four staff feels the way they share information about the people they support or care for with others and the home manager always works well. Three staff feel the way they share information about the people they support or care for with others and the home manager usually works well and one staff member feel the way they share information about the people they support or care for with others and the home manager sometimes works well. Care Homes for Adults (18-65 years) Page 34 of 46 Evidence: Two staff fed back that there is always enough staff to meet individual needs of service users, five staff fed back that there is usually staff to meet individual needs and one staff member fed back that there is sometimes enough staff to meet individual needs. Five staff feels they always have enough support, experience and knowledge to meet the different needs of people who live at the home. Three staff feels they usually have enough support, experience and knowledge to meet the different needs of people who live at the home. Written feedback from staff commented under what the home does well is provide consistent care to service users, good communication with service users. Written feedback from staff commented under what the home could do better is better staff communication and more input to create a better more relaxed atmosphere, a shift planner, teamwork and all staff should be treated the same, enough staff to meet the individual needs of all the people who use the service and changing needs of service users. Care Homes for Adults (18-65 years) Page 35 of 46 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not been effectively managed and monitored to safeguard service users. Evidence: At the time of the inspection the home was being managed by a registered manager from another service. He has been spending two to three days a week in the home since April 2009 and was due to attend for an interview with the Commission the week following the inspection to become the registered manager of this service with the acting manager being brought in to support this role. At this inspection it was assessed that nine requirements from the previous inspection have not been complied with even though the Annual Quality Assurance assessment document tells us requirements and recommendations are acheived to a high standard which was assessed as not being the case on this inspection. This inspection has resulted in a number of other requirements to improve practice to safeguard service users. Staff confirmed that the manager was approachable and listened but was not proacitve in dealing with issues raised by staff.They confirmed he had been made aware of the issues raised during this inspection but had not acted on them. A requirement was made at the previous inspection that the registered person must consider how this Care Homes for Adults (18-65 years) Page 36 of 46 Evidence: service will be managed to ensure that requirements are complied with to improve practice.The current arrangement of a part time manager was not effective in addressing issues within this service to improve the quality of care being provided and in meeting requirements.Therefore this requirement was assessed as not being met and enforcement action is now being considered to address this non complaince. The Deputy Director of Services confirmed at the end of the inspection that the current management arrangement would cease and she confirmed after the inspection that they had appointed the person who was in the role of acting manager at the time of the inspection to become the reigstered manager of this service on a full time basis. This person has been proactive in introducing positive changes to the home in the short time they have been there. The manager confirmed that there is currently no formal annual quality assurance audit tool in place but this is being developed with the intention being for a quality audit to commence thoroughout the Organisation by the end of December 2009. The progress with this will be assessed at the next key inspection. There is currently a system in place to audit aspects of care including accidents, incidents, seizures, safe guarding referrals, and complaints for the whole organisation as well as a health and safety audit of the service. The home has monthly Regulation 26 visits carried out by a governor with the report for January, March, April, May and Sept 2009 not on file. The Regulation 26 reports were being filed in three different places. The Regulation 26 reports evidences that visits range from 45 minutes up to a maximum of 2 hours. However those monitoring visits have been ineffective in monitoring this service in relation to compliance with regulations and improving the standard of care for service users. The Deputy Director of Services confirmed that they are piloting a new form of Regulation 26 reporting and visits which will include a governor and a manager from another service on site. The progress and impact of this will be assessed at the next key inspection. The Organisation has the required policies and procedures in place, some of those policies are overdue for review with some recently being updated. Some records required for regulation were disorganised, being filed in more than one place, with some records missing. This must be addressed to ensure that records required for regulation are well maintained, up to date and accessible. All staff have not got up to date mandatory training as outlined under standard 35. A requirement was made at the previous key inspection that the registered person must ensure that all substances hazardous to health is stored securely and in approriate labelled containers.This was assessed as being complied with during this Care Homes for Adults (18-65 years) Page 37 of 46 Evidence: inspection. Accident and incident records are completed but are not being reported as required under Regulation 37 and are not being reported to the local safeguarding of vulnerable adults team where this is required. A requirement was made at the previous inspection that the registered person must ensure that all events, which affect the well being of service users is reported to the Commission. This is assessed as not being complied with and enforcement action is now being considered to address this non compliance. As reported on under standard 24 free standing electric heaters were being used which potentially poses risks to service users and must be addressed. The Annual Quality Assurance Assessment document tells us that the maintenance and servicing of equipment is up to date. A sample of health and safety records were viewed and found to be in order. A requirement was made at the previous inspection that the registered person must ensure that the response to the fire alarm and resetting of the fire alarm is in line with the organisations policy and procedure. The fire records viewed evidences that staff are evacuating the home for all fire alarms however fire drills are being recorded in two different places and in different formats. As a good practice recommendation this should be addressed to ensure that staff are working and recording in a consistent way to promote service users safety. Care Homes for Adults (18-65 years) Page 38 of 46 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 2 14 The registered person must ensure that service users to the home are assessed with records of assessments in place to support this. To ensure that prospective service users needs are identified and met. 30/01/2009 2 6 15 The registered person must 28/02/2009 ensure that service user care plans are developed which clearly and specifically outline care needs including their ability to make choices and decisions. To ensure that service users needs are met in a safe and consistent way 3 9 13 The registered person must 28/02/2009 ensure that up to date risk assessments are in place to address all identified individual risks, including moving and handling. These must be kept up to date and reviewed. To promote service users safety 4 13 16 The registered provider must 28/02/2009 ensure that opportunities are made available to enable service users to access a Page 39 of 46 Care Homes for Adults (18-65 years) 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 range of leisure activities. To promote social engagement. 5 16 12 The registered person must 30/03/2009 ensure that opportunities are made available to enable service users to develop their independence and take a more active role in the day to day running of the home. To promote independence. 6 20 37 The registered person must 30/01/2009 ensure that all events, which affect the well being of service users is reported to the Commission. As required under Regulation 37. 7 35 18 The registered person must 28/02/2009 ensure that all staff including night staff have up to date safeguarding of vulnerable adults training, and all other mandatory training as required. To promote service users safety. 8 35 18 The registered person must ensure that all staff have access to a range of specialist training to support them in their roles including challenging behavior training. To promote staff and service 28/02/2009 Care Homes for Adults (18-65 years) Page 40 of 46 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 users safety. 9 37 8 The registered person must 28/02/2009 consider how this service will be managed to ensure that requirements are complied with to improve practice. To ensure that the service is effectively managed and monitored to benefit service users. Care Homes for Adults (18-65 years) Page 41 of 46 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 5 5 The registered person must 28/12/2010 ensure that service users contracts are completed in ink, signed and dated by the relevant people. To safeguard service users. 2 7 13 The registered person must ensure that service user plans clearly and accurately reflect the arrangements in place in relation to who is supporting a service user with their finances, how it is accessed and what support is required from staff. To safeguard service users. 28/02/2010 3 17 16 The registered person must 31/03/2010 ensure that service users become involved in menu planning and choice of meals provided with alternative meal choices and options being made available to suit individuals likes. Care Homes for Adults (18-65 years) Page 42 of 46 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To promote choice. 4 20 13 The registered person must ensure that all medication administered is prescribed and that prescribed medication is given as per the Doctors instructions. To safeguard service users. 5 22 22 The registered person must 28/02/2010 ensure that all complaints are logged, investigated and responded to in a timely fashion. To safeguard service users. 6 23 13 The registered person must ensure that staff are trained to assess whether a situation is a potential safeguarding incident and report accordingly. To safeguard service users. 7 24 13 The registered person must ensure that the use of free standing electric radiators do not pose risks to service users. Individual risk assessments must be in place to confirm this. To safeguard service users. 8 24 23 The dampness in the ground 31/03/2010 floor shower room must be addressed. 31/12/2009 28/02/2010 31/01/2010 Care Homes for Adults (18-65 years) Page 43 of 46 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To provide a warm and comfortable environment for service users. 9 34 19 The registered person must 31/01/2010 ensure that all staff are suitably recruited with all of the required records in place to evidence this. To safeguard service users. 10 35 18 The registered person must ensure that all staff are suitably inducted into the home with records accessible to evidence this. To safeguard service users. 11 35 18 The registered person must 31/03/2010 ensure that staff have training in key working, care planning and risk assessments to support them in their roles. To safeguard service users. 12 36 37 The registered person must 14/03/2010 ensure that the Commission is informed of the outcome of their internal investigation into issues raised by staff. To promote service users well being 31/03/2010 Care Homes for Adults (18-65 years) Page 44 of 46 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 13 36 18 The registered person must ensure that staff are regularly supervised to support them in their role. To safeguard service users. 31/03/2010 14 39 26 The registered person must 31/03/2010 ensure that the service is being effectively monitored with records on file to evidence the monitoring that is taking place. To monitor practices to safeguard service users. 15 41 17 The registered person must ensure that the records required for Regulation are well maintained, accessible and up to date. To ensure that records required for Regulation are accessible and appropriately maintained. 28/02/2010 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 45 of 46 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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. 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