Inspection on 25/09/08 for Quiet Waters

This inspection was carried out on 25th September 2008.

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

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

Other inspections for this house

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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: Quiet Waters 8, Thorndon Avenue West Horndon Brentwood CM13 3TT 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: Bernadette Little Date: 2 5 0 9 2 0 0 8 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 33 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2008) 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Quiet Waters 8, Thorndon Avenue West Horndon Brentwood CM13 3TT 01277812466 TBC Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Voyage Ltd Name of registered manager (if applicable) Miss Shani Titcombe Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 6 0 care home 6 learning disability Additional conditions: The registered person may provide the following category of service: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability not falling into any other category - Code LD The maximum number of service users who can be accommodated is 6 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 33 A bit about the care home Quiet Waters was registered in February 2008 to provide care and accommodation to six people who have a learning disability. The home is positioned just off the A127 in West Horndon, and there is a train station, local bus route and shops nearby in the village. The service provides its own transport to support residents to access the community. The home consists of six single bedrooms spread over two floors, all of which are ensuite. On the ground floor there is a large lounge, dining room, activities room, kitchen and separate laundry utility room. There is a downstairs cloakroom and a separate bathroom available on the first floor. The large secure garden to the rear of the premises is accessible to residents. To the front of the property there is parking for approximately ten cars. All doors to the outside are alarmed. A statement of purpose and service user guide are available. The manager advised at this site visit that the core base charge is £1860 per week. This then varies dependent on the individually assessed and agreed package for each person, including for example agreed one to one staff hours. The agreed fees include the use of the homes vehicle. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: One star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 33 How we did our inspection: This is what the inspector did when they were at the care home One inspector spent seven and a half hours at the home as part of the first key inspection of Quiet Waters since it was registered. Time was spent with residents, relatives and staff who were at home at times during the day. The things they told us about the home are included in this report. The home is owned by a company called Voyage. As the registered manager is on leave, a person from Voyage filled in and sent us their Annual Quality Assurance Assessment (AQAA) as we asked them to, before we went to the home. This is their assessment of what they do well, what could be done better and what improvement they are planning. This information was looked at as part of the inspection process and is part of the report. Before the site visit, the manager was sent surveys to give out to residents, staff, care managers and health professionals, so we could ask them what they thought about Quiet Waters. We got reply from a resident and two staff and information and comments are included as part of the report. Care Homes for Adults (18-65 years) Page 7 of 33 We looked at all parts of the home as well as at some policies and procedures. These have information that show how the manager and staff are to do certain things. During the day at Quiet Waters, we talked with the manager about the things we found so they could ask any questions and be clear about what we would say in this report. We appreciate the help given to us by all the people would took part in this inspection. What the care home does well Voyage makes sure that a full assessment is done for any person thinking of coming to live at the home. This means they gather all the information about the person so they can be sure that their needs can be met at Quiet Waters and that it will be the right place for them to live. Even though staff felt they have not had full support from management, they have worked together so that the residents get good care outcomes. Comments from staff surveys said the senior and support staff work well as a team and we give a good quality of care to our service users and I have had support from senior members of staff and other support workers and advised on ways to do things. I feel we work well together to provide a good service. Care Homes for Adults (18-65 years) Page 8 of 33 People living at the home are helped to access a range of activities both at home and in the community, and to make choices and decisions in their lives, so that they have an active and meaningful lifestyle. Residents spoken with said that they like living there. A relative spoken with said that they are satisfied with the level of care and support provided. Quiet Waters is clean and comfortably furnished and gives the residents a nice place to live. The garden is also well looked after and gives residents another place to spend their time. Each person has their own bedroom and ensuite bath/shower room that gives them privacy. The registered provider has undertaken audits and checks of the home. When they found that it was not running as it should in some areas, they have put an experienced manager in place who has a written plan to work through to put things right. Care Homes for Adults (18-65 years) Page 9 of 33 What has got better from the last inspection What the care home could do better Records need to show clearly that all the required information, references and checks have been gathered about staff before they start working with residents. There also needs to be clearer records about residents money. These will help to ensure that residents are safeguarded. There needs to be better evidence of good induction training for staff to show that staff have training when they start working Quiet Waters. Induction training helps staff to understand all areas of peoples care needs and how to meet them. A comment from a staff survey was I have been here for x weeks. However I have not been shown/given any training or shown ways in which to work. Care Homes for Adults (18-65 years) Page 10 of 33 The improvements seen and planned in the management systems at the home needs to continue to ensure best quality outcomes for residents in all areas. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Bernadette Little CSCI CPC1, Capital Business Park Cambridge CB21 5XE 01223 771300 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 11 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People thinking of living at Quiet Waters will have enough information about the home to help them make a decision about living there and will have a full assessment of their needs to make sure that the home is the right place for them. Evidence: The AQAA identifies that the service has a comprehensive and detailed service user guide and statement of purpose available and that they are located in the front entrance area and in each bedroom. These would then be readily available to prospective residents during planned transition visits to Quiet Waters. This was seen in practice. A resident confirmed in a survey that they had enough information about the home before they moved in to decide if it was the right place for them. A relative spoken with also confirmed that they felt they had received adequate information about the home prior to their relatives admission. The AQAA identifies that the organisation has an allocated senior care planner whose responsibility it is to identify and match potential service users with potential services. The manager confirmed that detailed assessments are undertaken prior to admission that include the prospective service user, other carers and care managers. This gives Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: opportunity to obtain as much information as possible to make an accurate assessment of the ability of Quiet Waters to meet the persons support needs, wishes and aspirations. A detailed assessment of needs was viewed on a residents file and had been undertaken prior to their admission. Staff spoken with explained that one member of staff had spent several days in another region of the country visiting a prospective resident in their previous care environment as part of the assessment process. As part of the assessment process, a transition plan is drawn up tailored to the individual needs of the prospective resident. The AQAA identifies that this level of familiarisation may not be appropriate for some people who have conditions where long transitions and changes may cause confusion and distress. A resident and relative spoken with confirmed opportunity to visit the home prior to admission. Care Homes for Adults (18-65 years) Page 14 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at Quiet Waters can expect to have their support needs clearly identified and met by staff in a consistent and safe way that supports their right to make decisions. Evidence: The AQAA states that each resident has their own individual support to plan file that covers every aspect of their lives and each section is accompanied by relevant risk assessments and guidelines to ensure individual needs are identified and attended to. The manager advised that information that forms the care plans had been contained in five different places. The manager stated that they had begun working through the care plans to produce one document that includes the views of residents and relatives and will be easier for staff to use every day to meet residents needs. A relative spoken with confirmed that this was in progress. The new care plan sampled was almost complete and identified the persons strengths, support needs and long and short-term goals so that staff had clear information on how each person was to be supported in everyday practice. The care plans were Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: written with the words my and I and were person centered. Areas covered included physical health, communication, personal care, mobility, social skills, finance, relationships, activities, living skills, behaviour, cultural/spiritual expression, medication, ageing/illness/death and decision-making. Staff spoken with demonstrated encouragement and respect for residents right to make their own decisions. The manager confirmed that advocacy services had been accessed for most residents so they have access to independent information and support. This will be extended to all residents. The manager stated that they were no specific limitations in place for residents currently. It was noted positively that where a care plan showed a resident was to be supported to maintain appropriate physical boundaries and personal space with others, this was seen to be operated in practice in a respectful and dignified way. A range of individual risk assessments were in place to support resident safety, for example with physical care issues there were risk assessments to support shaving or bathing, depending on individual persons need. Other risk assessments were in place to show residents had opportunities to experience everyday activities and associated risks such as holidays and social outings, using public transport, making decisions, using the kitchen area and cooking. Care Homes for Adults (18-65 years) Page 16 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at Quiet Waters can expect opportunity and support to experience a range of interesting activities and meals of their choice to meet their individual needs. Evidence: The AQAA states that as they get to know individuals, they aim to encourage people to be more independent in daily living skills and access a range of educational links. At the time of the site visit, residents were out undertaking a range of occupations including attendance at college or going for a pub lunch. Residents spoken with confirmed that they went shopping, bowling, to college and out to eat. Two residents spoken with confirmed that they liked living at Quiet Waters. Residents were seen to be able to choose to spend time alone in their own room or with others in the communal areas and were confident and calm in the use of the space. A resident advised that they had been shopping to choose new clothes. Observation indicated that residents dressed in individual styles appropriate to their age group. Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: Quiet Waters has its own vehicle to help transport residents to their chosen activities and family visits. The AQAA confirms that where relevant, residents also access public transport in and around the local community. Discussion with a relative confirmed that relationships are encouraged and that they always feel welcome to visit or have the resident visit them at their home. Records and anecdotal discussions with staff indicated that residents are also supported to continue relationships and spend time with their families including regular weekend visits. Throughout the day interactions between staff and residents were noted as positive and respectful. Each person has a weekly planner in place that identifies activities both inside and outside the home such as baking, helping to make dinner, bringing laundry down to be washed as well as walks in the park and listening to music. Outside activities for a resident were noted to included advocacy opportunity, going to a evening social club, and college attendance for arts and crafts, life skills and music and movement. At the time of the site visit one resident was involved in cleaning and tidying their bedroom with staff support as identified in their care plan. They were happy to show their room, confirmed they had brought some of their own things with them and had a key to their bedroom to support their privacy. Staff were seen to knock at residents bedroom doors and wait to be invited in, so promoting privacy and dignity for residents. A resident spoken with said that the food is good at Quiet Waters and advised of the choices that they can make. It was noted that the resident made a distinct choice at lunchtime to have a fried egg sandwich. Each residents file notes a list of their food likes and dislikes and a record is maintained of what each resident has eaten and drunk each day to support nutritional monitoring. This also evidenced that choice was available. Ample food stocks were seen and were appropriately stored. Care Homes for Adults (18-65 years) Page 18 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents at Quiet Waters can expect can expect to receive good health and personal support that meets their needs and overall to have their medication managed safely. Evidence: Each resident has an allocated key worker to support consistency and continuity of care. The manager confirmed that there will be monthly key worker meetings as well as regular routine meetings with relatives or professionals to review the developing aspirations and needs of the person. There was clarity within the care plan sampled of encouraging and prompting people to maintain their own personal hygiene and independence. Discussion with staff showed an awareness of individual resident needs and preferences in the way their personal support should be provided. Staff spoke of individual residents care needs and planned care packages and how these were to be met in practice, for example one person enjoyed a bath where others preferred showers. None of the current residents require mobility support equipment. The manager advised however that all staff will be attending full moving and handling training in the near future. The AQAA confirms that specific health issues relating to individual people were identified in the initial assessment process and would be followed through into a Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: support plan as to how these were to be met. The care plan sampled contained a health action plan which the manager advised was currently being devised. A separate record demonstrates that the resident had had an appointment to meet their new GP. Records show that staff had monitored the persons health and well-being. There was evidence that a medication review had been sought for a resident and the additional support of a behavioural therapist accessed. A medication care plan was in place. A monitored dosage system for medication had just been introduced and was in its first week of use. The manager confirmed that no controlled drugs were currently prescribed for residents at Quiet Waters. Medication Administration Records (MAR) did not yet contain photographs of residents to support identification and it was stated that these were still on the old files. Where a medication had been given from the old, rather than the new system supply, the reason was recorded in the communication book, but not on the back of the MAR as appropriate. Protocols were not in place to support administration of medications prescribed on an as required basis to ensure these were administered consistently and so support effective monitoring. Staff had access to the organisations policy and procedure are medications as well as the copy of the Royal Pharmaceutical Society Guidelines on the management of medications in care homes. The AQAA confirms that staff receive accredited training on the principles of administration medication via the companys electronic learning program, as well as specific training on the use of the monitored dosage system. Staff spoken with confirmed that they had had recent training on medication. Care Homes for Adults (18-65 years) Page 20 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People using the service may not easily be able to raise concerns or be fully safeguarded by appropriate procedures and staff knowledge. Evidence: Information on the compliments and complaints procedure is included in detail in the statement of purpose and also contained in the service user guide. The AQAA states recognition of a need to provide a complaints procedure in a more user-friendly format. The manager confirmed that, although this would have been appropriate, no spoken word version was available or planned, but that this will now be considered. The Commission has not received any complaints about this service. The manager advised that one complaint had been received and this confirms the information in the AQAA. This related to a complaint from a relative regarding a homely remedy medication. The manager provided evidence that they had written to the complainant to advise them of the actions taken but was recommended to record the detail of their investigation and the formal outcome reached. Appropriate actions had been put into place including the introduction of a homely remedy policy, discussion with staff in a staff meeting, the introduction of a monitored dosage medication system and the completion of a written and practice assessment in medication competence for all staff. A relative spoken with confirmed that they felt able to raise any issues and that they would be listened to. In a survey, a resident confirmed that they would know who to speak to if they were not happy, identifying my support workers and that the carers Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: listen and act on what they said, but indicated that they would not know how to make a complaint. Policies and procedures on abuse and safeguarding vulnerable people were readily available in the home. The manager stated that all staff are trained on protecting vulnerable adults through the electronic training programme. One staff member spoken with who is currently undertaking this program confirmed a clear understanding of safeguarding people and whistleblowing. Another staff member was also able to demonstrate appropriate knowledge. Surveys received from staff who were asked if they knew what to do if somebody had concerns about the home stated that they knew where the complaints procedure was and that they would refer to it if this occurred, but did not show awareness of safeguarding or whistleblowing. The manager was clearly able to identify ways in which abuse could occur in practice and demonstrated both knowledge and confidence in reporting this appropriately. The manager was recommended to obtain a copy of the local multidisciplinary guidance and protocols on safeguarding vulnerable people. Staff recruitment procedures did not demonstrate an effective system to safeguard residents. This is discussed further in the Staffing section of this report. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents live in a pleasant, well maintained and clean environment that meets their needs. Evidence: The premises is maintained to a high standard having recently been completely refurbished and redecorated as part of their registration application. Furniture is of good quality, modern and appropriate to the age group of people living at Quiet Waters. Residents have access to a range of communal spaces including a large lounge, separate dining room, an activity room, a kitchen and a large, accessible and well maintained garden with seating. Individual resident bedrooms are spacious, comfortably furnished and individual in taste. Residents had been able to choose to bring much of their own furniture, such as beds, chairs etc. and this was confirmed in a discussion with a resident. Each person had their own ensuite, either shower type wetrooms or a bathroom, depending on the persons preference and the agreed care package. Cleaning schedules are in place, which the manager monitors closely. The premises presented as clean and was free from odours. This was confirmed in a resident survey Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: and also in discussion with a relative. Staff spoken with were aware of appropriate infection control management procedures for example in relation to laundry and management of clinical waste. Staff also confirmed that appropriate protective clothing and equipment was readily available to them. No health and safety issues were noted. Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents of Quiet Waters may not have enough well-trained staff available to meet their needs and may not be safeguarded by the recruitment procedures. Evidence: The AQAA advises that all staff will work through an induction, complete their Learning Disability Qualification and then move onto National Vocational Qualifications at a level appropriate to their role and responsibilities. The manager stated that currently, two staff have achieved NVQ level 2 or above. The manager stated that the home is fully staffed to meet the needs and agreed care packages for the current residents. There has been recent recruitment in preparation for future admissions and prospective staff are currently undergoing all the appropriate checks. Recruitment files were sampled for two previously recruited staff. These did not show all the required evidence of robust recruitment including for example, a full employment history or exploration of gaps, a declaration of offences, references received some weeks after the person was employed (and after residents had visited or were admitted to the home), no photograph and no evidence of identity. Additionally Povafirst checks were received after the person had started working in the home. Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: Staff at Quiet Waters undergo training through an electronic learning programme. This was demonstrated by a member of staff currently undergoing induction training, who felt it was informative and clear. The system was able to demonstrate the training the staff member had undertaken to date, for example in safeguarding vulnerable people. Training files for two staff sampled showed that they had completed the electronic learning program in a range of basic subjects such as infection control, food hygiene, moving and handling and safeguarding as well as service user focused issues including sensory impairments, autism, epilepsy, communication and non-violent crisis intervention. A staff member spoken with said that their induction had been bitty and not effective. Staff surveys received indicated that some staff had not had a satisfactory induction with comments with no previous experience of care work I have not been shown any handling, restraint etc. I have not been given any induction or told what each service user is here for and Induction - was told to read policies and procedures and understand and raise any queries we had. Staff surveys held different views of the training with one person feeling they had not had any appropriate training and another while being given some training added the comment we have had service users come in with difficult disabilities and no training to handle them correctly has been given. Staff surveys indicated that staff have not been given appropriate management supervision to offer them support and discuss how they are working. Staff files sampled indicated that supervision had been provided initially to staff when the home was registered but there had been no further sessions until very recently undertaken by the current manager. Supervision notes indicated an identified need for more induction training, that staffing levels had been poor, there has been pressure on staff to work long shifts and that it has been a stressful period for the staff group. Staff surveys show that staff feel that there are only sometimes enough staff to meet the individual needs of the people who use the service, for example there has been times when there is not enough staff to handle service uses needs. Surveys indicate that staff feel they work together as a team to provide a good service and support each other. Care Homes for Adults (18-65 years) Page 26 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents of Quiet Waters can expect to be listened to and to benefit from the improving management systems and practices at the home. Evidence: The registered manager is currently on leave. Following quality audit, it was recognised by the organisation that the interim support systems to manage the home were not satisfactory and a temporary, well qualified and experienced manager has recently been allocated to Quiet Waters. An action plan has been produced, the manager is currently working through this and improvements are already noted. There had been a lack of effective management, for example in relation to management of the staff rotas where, on occasion, no female staff were booked on duty or no senior staff to provide medication. The current manager will cover the shifts and a new system is to be implemented for the future. This report has also identified that all staff have not received appropriate support and training and robust recruitment procedures were not evidenced. These issues are included in the management plan. The organisation has a quality assurance director who has undertaken quality audits at the home. Contrary to the information in the AQAA, reports as required under Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: regulation 26 were not available on request. The AQAA identifies that a letting us know what you think procedure is in place as part of the service user guide so that residents know how their views will be listened to and acted on accordingly. When the home approaches one year old, an annual service review will seek feedback and responses from all stakeholders. The outcomes of this review will form the basis of an annual development plan for the service as a whole. Records of the management of residents money were reviewed. In one case withdrawals were signed by both the staff member and the resident, which is positive. In another, staff will consider whether the relative receiving money on behalf of the resident could sign for its receipt. Receipts were generally available, but not for one withdrawal. Additional money was also available for a resident but with no record of its existence or where it came from. Guidance was provided on recording all money looked after for residents and maintaining records to explain particular preferences by residents, these could be included in the plan of care. The manager advised that they will be a review of all records relating to residents money at the end of each month and these will be sent to head office for monitoring. Aspects of health and safety were reviewed. General risk assessments were in place relating to safe working practices, including for example management of cross infection and control of substances hazardous to health. There was evidence of monthly health and safety audits and daily checks on some items such as fridge and freezer temperatures and water outlets. Cold water temperatures were regularly recorded by staff at above the recommended maximum, however no action had been taken to report or manage this. The fire risk assessment and fire emergency plan had been reviewed and a recent letter from Essex Fire and Rescue Service confirmed a satisfactory level of fire safety. A record of fire drills was maintained that should include the time of the event. This did not evidence that all staff had been included in fire drills. Safety inspection certificates for gas, fire alarm and emergency lighting sampled were current. Care Homes for Adults (18-65 years) Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 33 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description 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 Description Timescale for action 1 34 19 Ensure that all required pre- 15/11/2008 employment information, checks and references are undertaken and available for all staff. To safeguard residents. 2 35 18 Ensure that all staff are 15/11/2008 provided with training appropriate to the work they are to perform including structured and supervised induction training. To support staff to competently meet the needs of the people using the service. 3 37 10 Ensure that the home is managed competently and effectively. 15/11/2008 To safeguard residents and Care Homes for Adults (18-65 years) Page 30 of 33 ensure that the home is run in their best interests. 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 20 Current medication Administration records should contain a photograph of the resident to support accurate identification. To support consistency and effective monitoring, protocols should be available for all the medications administered on an as required basis. To ensure effective auditing and medication management, any medication not administered as prescribed should be recorded on the back of the current medication administration record. To evidence openess and assist clarity, the manager was recommended to record the full details of all aspects of complaint investigations. So that residents have access to full information, the complaints procedure should be available to them in a format that is appropriate to their needs and abilities. The manager is recommended to access a copy of the local multidisciplinary protocols guidance on safeguarding vulnerable adults. At least 50 percent of staff should achieve NVQ training. The manager should monitor and review the staffing levels to ensure they continue to meet residents individual needs. The manager should ensure staff are provided with appropriate supervision, at least six times annually, to support them in their role and to meet the needs of residents. So that evidence is available to demonstrate effective monitoring of the service by the registered person, reports as required under regulation 26 to be available in the home. Ensure effective monitoring and delivery of appropriate water temperatures to promote the safety and well-being 2 20 3 20 4 22 5 22 6 23 7 8 9 32 33 36 10 39 11 42 Care Homes for Adults (18-65 years) Page 31 of 33 of residents. 12 42 Ensure that all staff are involved in regular fire drills and practices to promote the safety and well-being of residents and staff. Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk We want people to be able to access this information. 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