Inspection on 07/04/09 for Percy Hedley Foundation

This inspection was carried out on 7th April 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Percy Hedley Foundation 27/05/09

Percy Hedley Foundation 10/04/07

Percy Hedley Foundation 28/02/06

Percy Hedley Foundation 07/12/05

Percy Hedley Foundation 25/09/04

Percy Hedley Foundation 15/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Percy Hedley Foundation Chipchase House & Ferndene Station Road Forest Hall Newcastle Upon Tyne NE12 9NQ     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: Elaine Charlton     Date: 1 5 0 4 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 32 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 32 Information about the care home Name of care home: Address: Percy Hedley Foundation Chipchase House & Ferndene Station Road Forest Hall Newcastle Upon Tyne NE12 9NQ 01912381300 01912701290 sarahmccormick@percyhedley.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Percy Hedley Foundation care home 50 Number of places (if applicable): Under 65 Over 65 0 physical disability Additional conditions: 50 The maximum number of service users who can be accommodated is: 50 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Physical disability Code PD, maximum number of places: 50 Date of last inspection Brief description of the care home The Percy Hedley Foundation is a registered charity caring for people with cerebral palsy and related physical disabilities. The Foundation also runs a school where there are boarding facilities for children. Both share the same management and administrative team. Accommodation at the home is made up of 34 single bedrooms and a three bed roomed self-contained flat, housing two people, in the main building. Four single selfcontained bed-sits and 10 self-contained bungalows are located separately in the grounds of the home. Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home The bungalows are found within a covered street known as Ferndene. There is a dining room on the ground floor of the main building attached to the main kitchen. Meals are prepared here for people who do not wish to make their own. At the entrance to the home there is a day centre that many people who live at Chipchase and Ferndene use. It has a separate lounge/dining area, and includes a bar that people from both residential and day care services use. Chipchase House is in a quiet residential area of Forest Hall close to a metro station and bus routes. Nursing care is not provided but staff are trained to carry out some delegated nursing tasks. Fees start at £691.69 per week, and increase dependant on individual need. The home has a Residents Handbook that gives information about the support and care anyone living at Chipchase or Ferndene can expect. Copies of inspection reports are available in the home. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star, this means that the people who use this service experience adequate quality outcomes. An unannounced visit was made on the 7 April 2009, with a follow up visit on the 15 April. A total of 6 1/2 hours were spent in the service. The deputy manager was present throughout the inspection. Before the visit we looked at Information we have received since the last visit on the 10 April 2007. The Annual Quality Assurance Assessment (AQAA) that gives CQC evidence to support what the Care Homes for Adults (18-65 years) Page 6 of 32 service says it does well, and gives them an opportunity to say what they feel they could do better and what their future plans are. How the service has dealt with any complaints and concerns since our last visit. The providers view of how well they care for people, and the views of people who use the service, their relatives, staff and other professionals who visit the service. We have also reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. During the visit we Talked with people who use the service, staff and the manager. Looked at information about the people who use the service and how well their needs are met. Other records which must be kept. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. We looked around the building/parts of the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since our last visit. We told the deputy manager what we found. What the care home does well: What has improved since the last inspection? What they could do better: Make sure that all records are fully complete, dated and signed. This includes care plans, accident and fire records. Make sure that staff get the training, support and supervision they need to do their job and to help them keep people who live in the home safe and well. Review staffing levels to make sure they are sufficient to meet the changing/diverse Care Homes for Adults (18-65 years) Page 8 of 32 needs of people who live in the home, and promote quality time and chances to get out and about in the community. Complete the updating of residents care plans, archiving unnecessary records along the way. Make sure that staff training in the protection of vulnerable adults is up to date and that people understand what is expected of them if someone raises a concern or makes an allegation. Health care professionals and staff felt the service could improve by employing more staff and therefore having more time to spend with individual residents. Staff also said they would like more meetings and felt they could be listened to more. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 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 are given good information to help them decide about moving into the home. Their diverse needs and wishes are assessed before they move in but documents are not always up to date which could place people at risk. Evidence: The Percy Hedley Foundation has policies and procedures in place to make sure that people are properly assessed before they move into the home and that their care and support needs can be met. There is a waiting list of people who want to move into the home and strong links are maintained with school and day services. The Residents Handbook tells people what they can expect from living at Chipchase House or Ferndene. We saw records for one person who had moved into the home since the last Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: inspection. The new resident moved into the home in May 2008, but there was still no photograph on their file, their contract with the Foundation had not been signed, risk assessments were not signed and the weekly personal file audit sheet had not been regularly completed. Information about the persons care and support needs were good and they had been given a chance to come to the home, with their own one to one support, before making a decision about a permanent move. People who sent back our questionnaires said, I was happy to move into Percy Hedley as most of my friends come here or live here as I have been with the Foundation for many years as I attended Percy Hedley School. I also knew most of the care staff at Chipchase House before I move in so it was nice that I knew most people and it helped settle in. About information we were told, I knew most things as I attended the day services as a daily for many years before becoming a resident. Other people said, I am happy I came here, My Mam found this place for me. I think its super. The home does not provide nursing or intermediate care. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are involved in planning their care, making choices and decisions about what they want to do, and are helped to be independent in their personal care and daily life, but records to support these decisions are not always well kept. Evidence: People who sent back our questionnaires told us that staff treated them well, listened to what they said and acted upon it. Staff said that communication usually worked well but that they did not always feel they had up to date information. People who live in the home are involved in putting their care plans together, they make decisions about what they want to do and who they want to provide their personal care. They have an Essential Life Plan as well as their care plans. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: Regular reviews are carried out and recorded. These involve the resident and, where appropriate, day services staff. Care plan evaluations are not always carried out on a monthly basis, and entries are not always outcome focused. Records show where people who live in the home are taking personal responsiblity for areas of their daily life. For example, renewal of blue badge, medication, finances. We also saw agreements for staff to open a persons mail and act on it if they were in hospital. Only eight residents files have been changed into the new format in the last 12 months. Files that have not been changed were messy, had loose sheets in them and were difficult to use. Records are not being regularly archived. Audit sheets have not been regularly completed and entries in residents files were not always signed by the staff member making them. The home uses occurrence sheets instead of daily records. These are completed when there is an event/incident or something that all staff need to be aware of. An entry is also put in the staff handover book to make sure that people know to look at the sheets. One entry on the occurrence sheet said staff to observe but there were no further entries to say whether this had been done or if the situation had changed. Each person has a range of care plans, depending on their needs, that clearly set out how they want their personal care to be provided, what they need to be given time to do, what upsets them and how they like to be treated. Residents, staff and healthcare professionals told us that privacy, dignity and equality issues were always dealt with in a respectful and sensitive way. Care Homes for Adults (18-65 years) Page 14 of 32 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 living in the home are encouraged to be as independent as they wish. They access educational and social opportunities within the home and the wider community. Choices and rights are promoted as well as healthy living. Evidence: People who live in the home and returned our questionnaires said they always made decisions about what they did each day. People we saw and spoke to during the inspection also said they made their own choices and they were seen coming and going as they wanted. Residents said I do whatever I like, I also go out when I like and return when I like, only if staff are available to assist, when I wish to go out 1-1 with a carer I only have to request it and I always get the member of staff I have asked for. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: Activities and social events are displayed on the noticeboard on the ground floor in Chipchase House. There had recently been a 40th birthday party and Easter bonnet and egg painting competition (with drinks, nibbles and surprises). Posters were displayed for a Percy Hedley Foundation event at the Federation Brewery, New Year event at the Civic Centre and tour of Newcastle Uniteds ground. People continue to be as independent as they wish and go out unaccompanied if they want and are able. We talked to people as they moved around the home, and during their comings and goings. Some people have very structured programmes of activities, day centre and college attendance. Lives are as flexible as personal routines allow. Routines for getting up and going to bed are only determined by appointments and/or regular commitments like day services, work or college. People are encouraged and helped to maintain relationships with family and friends and to meet new people. Difficulties arise when relatives live some distance away and residents do not have their own transport. The home needs to consider how relationships and visits can be maintained as both residents and their relatives get older and need more support to see each other. At a Food Forum meeting in March it was decided to invite chef to residents meetings so that food choices/issues and the needs of people with swallow problems could be regularly raised. The Better Lives steering group also met in March. Concerns were raised by residents who said they were feeling rushed to get ready, and felt there were constraints around when they could have a bath. It was felt this was as a result of two staff having to be involved in all transfers where a hoist is used. Residents commented on beautiful lunch for Mothers Day. Two people we spoke to told us about a planned holiday that they were taking independently. Other people go away with family. Destinations for holidays have been in this country and hotter climates abroad. We visited the kitchen and spoke to Chef. There is a weekly menu with choices at breakfast, lunch and teatime. We also saw that 16 out of 40 residents regularly have a different choice to the planned menu. These Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: alternatives are usually selected at the start of the week and are recorded on a separate menu sheet but people can still ask for something different on a daily basis. Mealtimes are flexible but also have to fit in with everyones activities. Breakfast is available from 08:00 to 09:30, but a continental breakfast is available all morning. Lunch is 12:00 to 13:00 hours, and the evening meal 17:00 to 18:00. Chef has access to dietician reports to help with meal planning. Some people prepare their own food or choose to have the occasional take-away. Two Better Lives Advocates have been appointed. One for the day centre who will look at employment opportunities for people and another for the home. Pictures and contact details for both advocates are displayed on the homes noticeboard. People also have access to information about, and use, independent advocates of their choice. Care Homes for Adults (18-65 years) Page 17 of 32 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 living in the home are asked how they wish their personal care to be provided and by whom. They are supported and helped to be independent with medication and can see health care professionals as they need. Evidence: Two health care professionals who sent back our questionnaires said the home always seeks advice, meets individual needs, respects privacy and dignity and supports people to self medicate. We carried out a random check of the medication system and medicines held in the home. Twelve people who live in the home take responsibility for their own medication and at least one person goes to the chemist to collect their prescription as well. All medication is recorded as it is brought into the home. This includes the medicines for people who self medicate. They then sign to take them away. People have secure facilities in their bedrooms where they can keep medication or other items. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: We looked at current and previous Medication Administration Record (MAR) sheets. All had been properly and fully completed. Separate records are kept for medication that people take on an as and when required basis. Controlled drugs are securely stored within a second cabinet in the treatment room. We checked the register and stock of controlled drugs which were both correct. All unused medication is regularly returned to the pharmacist. Each medication returned is recorded in a returns book and is signed for by the pharmacist. Each resident has a separate section in the stock cupboard for any medication not currently in use. People who live in the home use different systems of communication. One person was due to have a second trail of a new electronic communication system. Following an unsuccessful first trial adaptations were being made to the standard equipment before the second trail. Care plans are detailed and individual about how people want their care and support to be provided. Areas that might cause problems are identified. For example, there was clear information about how staff support a person, who suffers from unexpected spasms, when cleaning their teeth and at meal times so that the resident and staff are kept safe. People continue to see a wide range of health care professionals as and when they need. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The views of people who live in the home are listened to. They are protected from harm through policies and procedures and staff training. Residents are also encouraged to join in staff training to help them understand what happens when complaints, concerns and allegations are made. Evidence: Residents told us through questionnaires and discussion that they knew who to speak to if they were unhappy or wanted to make a complaint. The complaints procedure is displayed on the noticeboard in Chipchase House and is included in the Residents Handbook. People are also told about independent advocates and how they can make contact with them if they want. A healthcare professional said about complaints and concerns - I feel the residents themselves may have a different opinion from a member of staff whether or not the care service has responded appropriately to their needs. The staff training matrix indicated that all staff may not have received or be up to date with protection of vulnerable adults training. During the inspection certificates arrived to evidence that staff had completed this training. Residents also have the chance to be a member of the Adult Services Committee and Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: the Executive Committee where all major decisions are taken. They have full voting rights and can put forward the views of other people who use the service. Staff are employed in accordance with the General Social Care Council (GSCC) Code of Conduct and have to have a Criminal Records Bureau (CRB) check carried out at an enhanced level to prove that they are able to work with vulnerable people. Care Homes for Adults (18-65 years) Page 21 of 32 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 live in a homely environment that promotes their independence and the chance to spend time privately. Everywhere is clean and tidy and routines usually promote good infection control. Evidence: People who live in the home and sent back our questionnaires said the home is always fresh and clean. Everyone has their own bedroom, flat or bungalow, but can share if they wish and the accommodation allows this. Alterations on the top floor are now complete and the residents have moved back into their new homes. No other major changes are planned at the moment. We walked around Chipchase House, visiting two of the new flats, several bedrooms, and a couple in their flat. Corridors have been re-painted and staff were see working hard to maintain cleanliness in the home. All areas we saw were fresh and clean. People have access to a wide range of equipment that suits individual needs and helps to keep people independent. We were told that work is to start to introduce tracking Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: systems into the home. The bungalows, flats and uni-flats give people as much independence as they wish, the choice to cook or eat in the home and the space to spend time privately or to entertain guests, family and friends. People who need to use wheelchairs can easily access their bedrooms through an electronic key system. On the ground floor there is a large area where wheelchairs and hoists can be stored and charged. This leads to the laundry. The laundry is well organised but baskets need to be provided for dirty laundry waiting to be washed instead of it being piled on the floor. There are also problems with the concrete floor in this area. Equipment in the laundry includes two washing machines with sluice facilities, two without, three dryers and two hot cupboards for damp items. We looked in all the bathrooms and toilets. The only problem we saw was the need to replace pull cords which were dirty. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are protected through recruitment and selection procedures that are properly followed. Staff are supported through training and supervision to provide the diverse care and support that people need but training may not be up to date. Evidence: The organisations policy and procedures for the recruitment and selection of staff are regularly followed. Staff who returned questionnaires told us that their recruitment had been properly done and a CRB check had been carried out. They also told us that they received training relevant to their role, that helped them to understand needs, kept them up to date with changes and addressed issues of equality and diversity. We were told that communication sometimes works well but there are not always enough staff on duty. Staff felt that the home could do better by listening to staff a little more and having more team meetings. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: The file for one resident showed that they wished to be involved in recruitment interviews for the appointment of their new one to one support following the retirement of their current support. Health care professionals said staff usually have the right skills and experience. We saw planned training for April to June this year that included safeguarding adults, epilepsy and the Mental Health Capacity Act (MHCA). The programme for the rest of the year includes National Vocational Qualifications (NVQ) at levels 2/3/4, all mandatory areas, risk assessment, safe handling of medications, team leadership and supervision. We were given copies of the staff training matrix. There were significant gaps in the records showing that staff needed training and/or refresher sessions in health and safety, first aid, moving and transferring, safeguarding adults and fire safety. Fourteen staff are on duty between the hours of 07:30 and 21:00/22:00 when four staff take over for the night shift. The number of staff on night duty has just recently been increased to four. Care staff are supported by domestic and laundry staff, a caretaker, chefs and kitchen assistants. Staffing levels reduce at the weekend across all areas and both residents and staff feel this is creating problems as there are more people at home needing support and might be wanting to go out. Only 12 care staff are on duty at the weekend and they are also expected to undertake domestic/laundry and food preparation duties. Domestic and laundry staff do not work at the weekend and the chef is only on duty between the hours of 08:00 and 15:30. A large number of staff have achieved an NVQ at a minimum of level 2. Records show that staff are not receiving supervison on a regular basis. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is usually run in a way that benefits the people who live there. They are asked about what goes on in the home through surveys and staff meetings. Policies and procedures promote good health and safety routines but training is not up to date which may put people who live and work in the home at risk. Evidence: The registered manager is on long term sick leave and although staff have been given additional duties and extra support is being provided by the day centre manager, people are feeling the loss of this leadership. The AQAA was provided when we asked for it and was properly completed. The organisation has comprehensive policies and procedures in place that are easily accessible. We checked the fire and accident records. From residents records we saw evidence of two accidents (one to a resident and one to a member of staff) that had not been Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: recorded. An accident record had been completed for a person who was having regular seizures, including a visit to accident and emergency, there was no evidence of what further actions had been taken to manage these events. There was also no evidence to show that records were being monitored by a manager. In the Ferndene fire log there were no recordings of emergency light checks since November 2008, and checks on fire equipment appeared to have not been checked since May 2006. The caretaker was on annual leave so it was not possible to check whether he kept any other records. We saw copies of team meeting minutes held in March/February this year. Care staff had raised the issue of staffing levels only meeting basic care needs, and added that residents who dont need personal care get nothing sometimes because staff are too busy. They also said there was no quality time for residents especially at the weekend. We were told that a member of the staff team is carrying out a time and motions study to look at this. We were told that the quality assurance system is being reviewed to ensure everyone can take part and to make it a more robust process and that an effective and measureable action plan is produced. Maintenance and servicing contracts were reviewed. Everything was up to date and any remedial work that had been identified had been carried out. Changes have taken place to how residents are selected onto the Chipchase House Committee. Half of the committee is now randomly selected from the electoral role. People are then asked by an advocate if they want to take part in the process. Health care professionals, when asked what the service did well said, treats residents as individuals and enables them to live their life as they choose whenever possible. To improve, they suggested, employing more staff and therefore having more time to spend with individual residents. Throughout the inspection we saw records that were untidy, were not fully completed and had not been dated or signed. Care Homes for Adults (18-65 years) Page 27 of 32 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 28 of 32 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 15 Service user plans must be 07/10/2009 brought up to date reflecting the persons needs and wishes. This will make sure that staff know how residents wish to be cared for and what they need assistance with. 2 30 23 The laundry floor should be treated or replaced. This will provide an impervious surface that is easy to clean and promotes good infection control. 07/09/2009 3 33 18 Staffing levels must be reviewed to make sure that there are sufficient staff on duty at all times. This will mean that people in the home are kept safe and well and there are enough staff to provide the care and support they need. 07/07/2009 Care Homes for Adults (18-65 years) Page 29 of 32 4 35 18 Training needs of staff must be reviewed to make sure that they have received all their mandatory training. This will help to support staff to do their job and keep people who live in the home safe and well. 07/09/2009 5 36 18 Staff must receive regular recorded supervision. This will give them the support they need to do their job and a chance to raise any issues they may have. 07/12/2009 6 41 17 Care plans and records 07/08/2009 relating to the health, safety and wellbeing of residents must be fully complete, dated and signed. This will help to show that people who live in the home are being given the care and support they need and kept safe and well. 7 42 23 Fire safety checks must be carried out and recorded regularly. This will mean that the safety of staff and residents is promoted. 07/06/2009 8 42 17 Accident records must be 07/06/2009 regularly completed and include evidence of follow up actions. This will enable proper monitoring of accidents in the home helping to keep Care Homes for Adults (18-65 years) Page 30 of 32 the people who live there safe and well. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 5 Staff should make sure that residents contracts, and all other documents, are properly completed and signed to show that people who live in the home are happy with, and have been involved in the assessment process. Care plans should be evaluated on a monthly basis and entries should be outcome focused showing how the resident had benefitted from the care and support they have received. Audits of records should be regularly carried out, archiving documents as necessary, to make files easier to use. This will mean that staff have access to the most up to date information on people who need care and support. Consideration should be given to how staff can support people to keep in touch with and see their relatives as they both get older. This will mean that people can keep in touch and see people who mean a lot to them. Moving and transferring plans and risk assessments should make it clear to staff whether one or two staff are needed during a transfer. This will mean that residents get the right support and do not feel they are being rushed by staff having to work in pairs. Pull cords in toilets and bathrooms should be replaced to promote good infection control. Containers should be provided in the laundry so that dirty washing is not kept on the floor. This will promote good infection control routines. 2 6 3 6 4 15 5 16 6 7 30 30 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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