Inspection on 16/06/09 for Prospect Place

This inspection was carried out on 16th June 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

Prospect Place 20/06/07

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Prospect Place 19-21 Prospect Place Cirencester Gloucestershire GL7 1EZ     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: Adam Parker     Date: 2 9 0 6 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 35 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 35 Information about the care home Name of care home: Address: Prospect Place 19-21 Prospect Place Cirencester Gloucestershire GL7 1EZ 01285640520 01285640520 claire.mcgovern@brandontrust.org 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) : The Brandon Trust care home 5 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: 5 5 The maximum number of service users who can be accommodated is 5. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability (Code LD) Physical disability (Code PD) Date of last inspection Brief description of the care home Prospect Place is a home for five people with profound learning disabilities and physical disabilities. The home is situated in Cirencester in a quiet location and is close to local amenities. Each person has a single room which they can furnish and decorate as they wish and there are bath, shower and toilet facilities. There is a lounge/dining area which is comfortable and spacious, a conservatory and a kitchen which is domestic in style. There is a separate laundry room. The grounds are well managed and are accessible to people who live in the home. A variety of garden furniture is provided as well as a summerhouse. Information about the home is available in a statement of purpose and service user guide. Information about the fees can also be obtained from Care Homes for Adults (18-65 years) Page 4 of 35 Brief description of the care home the home. Inspection reports are available from the home and our website, www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We asked the home to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how they were performing. It also gave us information about what has happened during the last year, and about their plans for the future. We sent out surveys so that these could be completed by the people who lived in the home and by the staff. We had a survey back from one staff member. We visited the home on the 16th and 17th of June 2009. The lead inspector was Elaine Barber. We talked to the deputy manager and four members of staff. We looked at some of the homes records. We met with three people who lived in the home and asked them about their experience of living in the home. Care Homes for Adults (18-65 years) Page 6 of 35 The judgments contained in this report have been made from all the evidence gathered during the inspection, including the visit. The last inspection of the home was on 20th and 22nd June 2007. What the care home does well: What has improved since the last inspection? We made requirements at the last inspection that several areas must receive attention. Some of these had been addressed. The carpet in the front hall had been replaced but was again showing signs of wear and tear. Some of the bedroom carpets had been replaced with non-slip flooring. Some of the bedrooms and the corridors had been Care Homes for Adults (18-65 years) Page 8 of 35 redecorated but these needed to be done again. Some scratch plates had been put on the doors in the corridors which had become scuffed. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 35 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 35 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 and their representatives had most of the information that they needed to make an informed decision about whether the home was the right place for them. Peoples needs were assessed when they moved into the home so that their needs would be met. Evidence: We looked at the statement of purpose and service user guide. We saw that these were detailed and contained all the required information. Both were written in simple language and had pictures. It was not clear from this information who was the current manager of the home and this needs to be clarified. The address for contacting the Care Quality Commission also needs to be updated. We looked at the files of three people. They had had lived in the home for several years and their needs had been assessed when they moved in. One person had assessment information completed by the home in their file. A second person had a community care review and psychology assessment several years before. The third Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: person had a community care assessment and care plan when they moved into the home. Care Homes for Adults (18-65 years) Page 12 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each persons assessed needs were reflected in care and support plans so that their needs would be met. However, these were not always being reviewed and changed as necessary. People were assisted to make decisions about their lives. People were supported to take risks to promote their independence however, some information about risk taking had not been reviewed to make sure it was up to date and people were kept safe. Evidence: We looked at the records of three people. One person had recently moved into the home. They had a care plan from their previous home. The deputy told us that now this person had become a permanent resident and they planned to produce an up to date care plan. Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: The deputy told us that because of staff shortages the staff had not been doing the six monthly care plan updates and annual reviews. A second person had a person centred plan which had been reviewed in February 2009. This was in the same format as the plan they had in their previous home. A member of staff told us that they were in the process of reviewing this plan and putting it into the same format as the other plans. A third person had an essential life style plan produced in August 2008. They had other care plans for bathing routines, key working routines, an evening routine and a morning routine, hairdressers visits, communication needs, guidelines for money and guidelines for laundry. These had been reviewed in March 2009. A member of staff told us that the reviews for two people had been done but the reviews for the other people who lived in the home had not been done. When we looked at the care plans we found that these were not consistent and the three people had different types of care plans. The deputy and a member of staff told us that they were trying to transfer all the plans into the new format but there were not enough staff to do this. The care plans showed the decisions that people were able to make about their lives for example whether to have a newspaper or to do their own laundry. We observed people choosing where to spend their time. For example one person sat in the kitchen watching while the staff cooked, one person sat in the conservatory doing puzzles and one person chose to sit in the garden. A member of staff told us that people were able to make decisions on a daily basis, for example, what to wear, to do a puzzle, to read, to go out and whether or not to go to college. The staff member said that if a person was not able to make a decision they would hold a meeting of professionals and representatives to discuss what was in their best interests. When we looked in one persons file we saw the notes made by a member of staff who was organising a best interests meeting for that person. When we looked at the files we saw that each person had a series of individual risk assessments. These included risks associated with sitting in a chair, trying to stand from the wheelchair, using the bath, accessing the community, eyesight and health, safe eating, epilepsy, finance, medication, kitchen safety and accessing the hairdressers. The risk assessments focused on promoting independence. One persons risk assessments had been reviewed in May 2009. The others had not been reviewed recently. Three different staff told us that there were not enough permanent members of staff. This meant that they had to give priority to caring tasks and they did not have enough Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: time to devote to writing and reviewing care plans and risk assessments. Care Homes for Adults (18-65 years) Page 15 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had opportunities to access various social activities both inside and outside of the home but these were limited because of staff shortages. Links with families and friends were maintained, where possible. Peoples rights were respected and promoted. People were offered a varied diet and could choose their meals. Evidence: The manager told us in the AQAA that there had been a reduction in staff when the house next door cancelled their registration and they had had to request more staff to support this service. They also said that there had been further problems because one permanent member of the team was absent from work with long term illness. They said that this had impacted on the service provided and had meant that some activities for people had been reduced. It had also meant a high use of Bank and agency staff. Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: When we looked at the care records we saw that peoples day time activities were recorded in their files. Two people attended a day service. The third person had been living in the home on a trial basis and had just decided to move in permanently. They had home based activities and liked to do puzzles. The records said that they also liked to go out for coffee and a member of staff confirmed this. Two people, who went to a day service also went to hydrotherapy. A staff member told us that one of them had not been able to go for some time because of staff shortages and they had had some problems with stiffness. They had started to go again more recently and this had improved. A member of staff and the deputy told us that there were not always enough staff on duty to take people out. They said that the deputy and the manager spent a lot of time trying to find bank staff to cover shifts. The deputy said that there were four fewer staff than there were before the home next door, which was also a registered service, cancelled their registration and moved to a supported living arrangement. The deputy and the member of staff said that it was difficult to take people out at weekends because it needed two staff to take people out in the vehicle and two staff to stay at home with other people. The deputy said that it was harder to get bank staff to cover weekends and they needed more permanent members of staff. A member of staff told us that each person had a key worker who would take them personal shopping, take them out for coffee or a meal and help them to tidy their room. One person told us that they went shopping on their day off from their day service. They said that staff would take them out but this depended on whether there were enough staff on duty and they could not always go. Two staff members told us that they tried to take people out at the weekends and the manager aimed to put two staff on duty at weekends so that people could go out but people could not always go because they were short staffed. The staff told us that the outings were recorded in the house diary. We checked this for May and June. We saw that on the first weekend of May people went out for coffee and for a walk in the park. On the second weekend they went to the butterfly farm. On the third weekend two people went to Butts Farm and three people went for a walk into town. On the fourth weekend in May people went to Wychwood festival and for a pub lunch. On 13th June two people went to Butts farm and two people went to Birdland. People also had leisure activities at home. We observed people listening to music and one person dong puzzles. On the first day of our visit it was sunny and people were sitting in the garden. This was arranged so that there were many points of interest including mobiles, several areas with different plants, a summerhouse with lights and a water feature. Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: We saw records in the personal files which showed that people had contact with family and friends. One person had no family contact, a second person had contact with their sister and the third person saw their mother and sister. This person told us that they saw their sister sometimes on a Friday. When we talked to this person they were peeling the vegetables for the evening meal The told us that they did this every day except at Christmas. They also told us that they were involved in cooking by stirring the pans and they also folded the washing. A staff member said that they always had people in the kitchen with them to involve them in the cooking. We saw one person in the kitchen with the staff when they were cooking. One staff member said that they involved people in making cakes. Two staff members told us that people tidied their own rooms on their key worker days. When we looked at the menu it showed that a variety of meals was being served. However, it was not recorded in enough detail to show whether a nutritious diet was being served, for example, whether people were having five portions of fruit and vegetables per day. A member of staff told us that they chose the meals with people every Thursday evening. They also said that if a person does not want the meal that is planned on a particular day they will be offered an alternative. One person told us that they chose their meals. On the evening of one of our visits liver and onions with cauliflower and broccoli were served and we saw everyone enjoying their meal. Care Homes for Adults (18-65 years) Page 18 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People received support in ways that they preferred. Peoples health care needs were not being fully met. People were generally protected by the medication practices. Evidence: When we looked at the records we saw that each person had information about their preferred routines such as their morning and evening routines. These provided information about how people liked to be supported. The manager told us in the AQAA that each person had a health action plan. When we looked at the records we found that one person had a health action plan from their previous home and this had been reviewed in February 2009. Another person had a health assessment which was not fully completed and an OK health check dated 2007. A third person had a health assessment completed in Mar 2009. Two people also had an epilepsy risk assessment and a management plan, they had seizure records and a care plan for taking epilepsy medication. We saw that appointments with health care professionals were recorded with Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: information about the outcome. People saw the GP, community nurse, physiotherapist, occupational therapist, continence nurse, consultant psychiatrist, ophthalmologist, dietician and optician. The deputy and a member of staff told us that staff shortages were preventing people from having their needs fully met. They told us that one person had had a specialist assessment because they were suffering additional pain and taking more as required medication than usual. They also said that this was correlated with times when the person was not able to attend hydrotherapy sessions because of staff shortages. The assessor recommended that the person attended their twice weekly hydrotherapy session. The also concluded that their distress occurred when they were expressing a need for staff to do something for them. The assessor recommended that the person should have adequate staffing to meet all their needs for activities to be able to take place when they were timetabled and also at additional times. They also recommended a programme of exercises to maintain their flexibility. A member of staff told us that this person and another person had not been having their physiotherapy exercises because staff were too busy. There was a medication policy and guidelines for giving medication. Medication was stored in a locked cupboard. One of these cupboards had an inner cupboard. A staff member said that no-one was taking controlled drugs. A monitored dosage system was used. There were printed medication administration (MAR) sheets provided by the pharmacist. These were used to record medicines received into the home and administered to people. These were on the whole well maintained. We saw that some medicines were recorded with instructions as directed with no information about what this meant. We also saw that some handwritten additions had been made to the MAR sheets which were signed by two members of staff but not dated. This meant that it was not possible to cross reference them with instructions given by the prescriber who had initiated the change. All medicines were prescribed. People had individual protocols for the administration of as required medication. There were records of stock control and medicines disposed of and returned to the pharmacist. Care Homes for Adults (18-65 years) Page 20 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples concerns were taken seriously and acted upon. People were protected from abuse and harm. Evidence: We saw that there was information about how to make a complaint in the statement of purpose and service user guide. The manager told us in the AQAA that there was a complaints procedure with stages and timescales. They also said that people were supported to express concerns and concerns of people with complex needs were monitored monthly. There had been no complaints since the last inspection. We saw a procedure about safeguarding adults in the office. A member of staff told us that there are procedures and they knew how to report if an allegation of abuse was made. They said that they would contact the manager, the deputy or the on-call manager. The member of staff who completed a survey said that they knew what to do if someone had concerns about the home. When we looked at the staff records we saw that most of the staff had training about protection from abuse in February 2007. A member of staff told us that this was going to be updated in June and July this year. Staff handled money on behalf of people. We saw that each persons money was kept Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: in their own purse. Records were kept when money was spent. Two staff signed the record when money was withdrawn for someone to spend. Care Homes for Adults (18-65 years) Page 22 of 35 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 accommodation was spacious but some areas were not easily accessible to people and otherw were in need of redecoration. Each person had their own room which was individually decorated and furnished. There were not sufficient bathroom facilities to meet everyones needs. The home was clean and hygienic. Evidence: We looked at all of the accommodation. We made requirements at the last inspection that several areas must receive attention. Some of these had been addressed. The carpet in the front hall had been replaced but was again showing signs of wear and tear. Some of the bedroom carpets had been replaced with non-slip flooring. Some of the bedrooms and the corridors had been redecorated but these needed to be done again. Some scratch plates had been put on the doors in the corridors which had become scuffed. These were again very scratched from wheelchairs passing through. The deputy showed us that these were too narrow to accommodate a wheelchair easily. He told us that one person, who was independently mobile, had injured their ankle and had been using a wheelchair. However, they had not been able to move around the corridors without assistance because the door ways were too narrow for them to get through without scraping their hands. When we looked at the doorways Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: we saw that they were too narrow to get a hand operated wheelchair through. They prevented independent mobility. We looked at the living areas which included a large sitting and dining room and a conservatory. We saw that some parts of these rooms were in need of redecoration. The bedrooms were individually decorated and furnished although some needed some repainting. They all had specialist equipment including ceiling hoists. There were two bathrooms with ceiling hoists and special baths. However, we saw that these were arranged so that there was a lot of wasted space. There was no separate shower for those people who preferred a shower. The deputy told us that one person who did not like baths was having strip washes. There was a separate utility room that was well organised. The doorways to this room had been moved so that laundry could be carried straight in through the corridor and did not pass through areas where food was prepared or eaten. There were infection control guidelines. On the first day of our visit it was sunny and people were sitting out in the garden. This had been arranged with different areas of interest created by different types of planting and garden features including a pond, water feature, bower and summerhouse. One person spent a lot of time in the summerhouse which had music and lighting. There were mobiles and wind chimes in the garden. Care Homes for Adults (18-65 years) Page 24 of 35 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 were supported by a permanent team of staff who were qualified, experienced, trained and committed to meeting their needs. However, there were not enough staff to meet all of peoples needs. People were protected from being cared for by unsuitable staff by the recruitment practices. Evidence: The manager told us in the AQAA The home has a a staff team of 12.38 FTE (full time equivalent) which includes a manager, 1 senior, administrator, 1 domestic, 10 care staff to meet service users needs 24 hours a day. Staff are usually able to support service users uninterrupted to complete allocated tasks such as personal care, sensory work, outside activities. All care staff have at least 3 hours administration time a month. The manager works mainly Monday to Friday 9-5 and the two seniors have 2-3 days a week administration time. The skill mix and number of staff usually allows for the day to day running of the home and the management of emergencies. The home uses regular bank staff and agency staff who are known to the home to cover absences or short fall in staff numbers. Sickness levels are slightly higher due to 1 staff being on long term sick leave. All absence levels are monitored by management on a weekly basis and return to work interviews are always completed. Any particular concerns are monitored through supervision. Regular bank staff and agency staff have Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: been used during these periods. There is a low rate of turnover. During our visit the deputy and two members of staff told us that since Brandon Trust cancelled the registration of the house next door and changed it to a supported living model there had not been sufficient staff to meet peoples needs. We have given examples of where needs were not being met in earlier sections of this report. One person told us that they could not always go out if there were not enough staff. A third member of staff said that there were usually four staff in the morning because they were busy then and four staff in the evening. They said that they tried to have four staff in the morning at the weekends but it was not easy to get cover. This member of staff and the deputy said that there was one permanent member of staff on long term sick leave. The deputy also told us that more recently Brandon Trust had provided money for additional hours but it was not always easy to get cover from the bank and agency staff so they needed more permanent staff. We looked at the record of staff cover in the diary for May and June. We saw that there were usually three staff on duty and sometimes four in the morning. There was one waking and one sleeping member of night staff. We looked at the staff cover for weekends and saw that there had been four staff in the mornings seven days out of ten in May and three out of four days in June. One member of staff told us that it was unusual to have a shift when there were all permanent staff on duty and there were sometimes only one member of permanent staff on duty with agency staff. The member of staff who completed a survey said that there were inadequate numbers of contracted staff due to staff sickness and staff shortages. They said that Brandon Trust was using bank staff and staff from two agencies so that people had a lot of different staff supporting them and this was not good for consistency and continuity of care. They also said that the staffing levels did not reflect the needs of the people who live in the home, for example two staff are needed to hoist people and two staff are needed to take the mini-bus out. They told us that a higher staff ratio was needed to take people out for example to hospital appointments or days out as two staff were needed to support the people left at home. The deputy told us that two people had recently moved into the home who had high levels of need so there were not sufficient staff to meet all needs. The manager told us in the AQAA that there were thirteen permanent members of staff and all of them had a National Vocational Qualification at level 2 or level 3. During our visit a member of staff told us that there were eight support staff including the one who was off sick and all but two of them had NVQ level three and these two were hoping to start soon. We looked at the training record. This showed that most staff had an induction and Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: training in manual handling, first aid, food hygiene, medication, fire safety, protection of vulnerable adults and health and safety. Some staff had also had training about the medication system, water safety, risk assessment, control of substances hazardous to health (COSHH), equality and diversity and infection control. We spoke to one member of staff who said that training was brilliant. They said that training needs were discussed in supervision and any identified training was planned in. The told us that more training about protection of vulnerable adults was planned for later in June and they had had an introduction to dementia and more in depth training. We looked at the training records of two staff which showed that they had received a range of training. We also looked at the recruitment records of these two staff. They had each completed an application form which contained a declaration that they had no convictions. They both had a certificate of fitness from occupational health to show that they were physically and mentally fit. They had two written references, protection of vulnerable adults (POVA) checks and Criminal Records Bureau (CRB) checks before they started work. One of these staff had transferred from working for Brandon Trust bank staff and had had their CRB and POVA checks done when they were first employed with the bank. However, they had continued to work for the organisation. A copy of each member of staffs birth certificate and passport had been kept as proof of their identity. Care Homes for Adults (18-65 years) Page 27 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were not benefiting from consistent management of the home. There was a quality assurance system so that any developments were based on peoples views. However, some of the information provided for quality assurance was not entirely accurate. Peoples health, safety and welfare were promoted and protected by the safety measures in place. Evidence: A member of staff told us that the registered manager, Claire McGovern, had left and the new manager was Mike Seend. We had received a notification in January 2009 to say that Claire McGovern had left and Lisa Herbert had been appointed to manage the home. We received a further notification by e-mail in June 2009 that Mike Seend would be managing the service. We have not received an application for him to become the registered manager so he has not been approved as a fit person to manage the service. Mike Seend completed the AQAA and told us that he was the temporary manager and Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: was managing the service three days a week. The member of staff who completed a survey told us that they needed some consistency with regards to a manager and they had had three managers in the last year. They told us that each time they had a new manager they changed the way that the service was run. The manager told us in the AQAA that quality assurance is monitored and reviewed with people through the complaints procedure, person centred plan (PCP) reviews, staff supervisions and service user questionnaires. They told us that a service users satisfaction survey is carried out. They said that all service users have a PCP which is reviewed at least six monthly and all PCPs have an action plan with goals. We had found this not to be the case in relation to reviews which were not occurring six monthly. The manager said that feedback is actively sort through questionnaires, PCP reviews, house meetings with the help of families and advocates where appropriate. They also said that feedback is sort from families, friends, advocates, other health professionals at PCP reviews where appropriate. During our visit we found that there was a quality assurance file which contained questionnaires which were sent to people who lived in the home and professionals who were working with them. The findings from these questionnaires had been written up in a report and areas for development had been identified. The manager had completed the AQAA when we requested it. It contained very comprehensive information about the service. However, we found that some of the information, for example about the reviews and there being sufficient staff, not to be accurate. The manager told us in the AQAA that a generic health and safety statement has been written by Brandon Trust for the policy, organisation and arrangements for maintaining safe working practices and is read and signed by all staff. We saw a copy of this during our visits. There were risk assessments for all safe working practices. All accidents, injuries, incidents of illness or communicable disease or death of a service user were recorded and reported in the accident book and file. A regulation 37 notification was completed and a copy was sent to the Commission. We found that there were safety procedures such as infection control. The manager told us that all new staff receive induction and foundation training in safe working practices and have regular up dates with existing staff. When we looked at the staff records we saw that staff had training about fire safety, first aid, food hygiene and manual handling. During our visit we saw a staff member doing weekly safety checks. We saw that there were records of weekly, monthly and six monthly safety checks. Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: We saw that there was a fire risk assessment and this was reviewed in April 2009. There were records of fire safety checks and servicing of the fire alarm and emergency lights. Portable appliance electrical tests took place and we saw certificates to show that the hoists, baths, adjustable beds and boiler were serviced. Care Homes for Adults (18-65 years) Page 30 of 35 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 31 of 35 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 1 4 The statement of purpose 30/10/2009 must include the name, address, qualifications and experience of any registered manager. So that people are clear who is responsible for managing the home. 2 6 15 The care plans must be regularly reviewed and revised when needs change. So that there is up to date information for staff and they can support people properly. 28/08/2009 3 13 16 The registered person must 14/08/2009 make sure that people have access to activities, including hydrotherapy where this is an identified need, to promote their fitness. So that the people who require hydrotherapy remain fit and healthy. Care Homes for Adults (18-65 years) Page 32 of 35 4 17 17 The registered person must make sure that a record of food provided for people is made in sufficient detail to tell whether a nutritious diet is being served. So it is possible to tell whether people are receiving recommended nutrients including five portions of fruit and vegetables each day. 14/08/2009 5 19 13 The registered person must make sure that where exercises are recommended by health care professionals these therapies are carried out. To make sure that people remain healthy. 07/08/2009 6 33 18 The registered person must 28/08/2009 make sure that there are, at all times, enough qualified, competent and experienced members of staff on duty to maintain the health and welfare of people who live in the home. So that people receive consistent support and their needs are met. 7 37 9 The registered person must 28/08/2009 make an application to the Commission to register a manager so that they can be approved as a fit person to run the home. Care Homes for Adults (18-65 years) Page 33 of 35 So that people can be assured that the home is being managed by someone who is fit to do so. 8 39 42 The registered person must make sure that information provided in the AQAA is up to date and accurate. So that the Commission and people who live in the home can be assured that the quality of the service is being maintained. 28/05/2010 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 1 1 The statement of purpose should be updated to show who is the current manager and the new address and contact details of the Commission. People should be offered more opportunities for leisure activities and outings. When hand written additions are made to the medication administration records they should be signed by the member of staff making the change and also by another member of staff to witness the change. The record should also be dated so that it can be cross referenced with directions form the prescribing doctor which are written elsewhere. When medicines are prescribed to be taken as directed they should be referred back to the prescribing doctor for full instructions about how they are to be taken. A cupboard that meets the current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007) should be installed so that if controlled drugs are prescribed they can be stored safely. More permanent staff should be recruited and trained to meet peoples needs. 2 3 14 20 4 20 5 20 6 33 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!