Inspection on 29/09/09 for Randolph Avenue, 248

This inspection was carried out on 29th September 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Randolph Avenue, 248 06/11/07

Randolph Avenue, 248 18/12/06

Randolph Avenue, 248 06/02/06

Randolph Avenue, 248 18/07/05

Randolph Avenue, 248 11/01/05

Randolph Avenue, 248 26/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Randolph Avenue, 248 248 Randolph Avenue London W9 1PF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ann Gavin     Date: 0 5 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Randolph Avenue, 248 248 Randolph Avenue London W9 1PF 02076258975 02076248948 randolphavenue@together-uk.org www.together-uk.org Together Working for Wellbeing care home 12 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) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 12 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Male whose primary care needs on admission to the home are within the following categories Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Randolph Avenue is a home for up to 12 service users with a mental health disorder. The aim of the project is to provide a structured, rehabilitative accommodation for a maximum period of two years. The home is managed by Together Working for Wellbeing and Octavia Housing Association is responsible for maintenance. The home is situated in Maida Vale with good transport links and access to community services. Each service user has their own single bedroom and have access to communal areas. The home has a lounge equipped with TV, video and hi-fi. There is a kitchen on the lower ground floor, which opens into a spacious garden. There is also a quiet room on the lower ground floor equipped with a computer printer and TV. The weekly fee for the service is #537.54. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 12 Brief description of the care home Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place on two days 29th September and 5th October 2009. Time was spent talking with the people who lived in the project, three members of staff and the Manager. The care of three of the people who live in the project was tracked through talking with them, staff, looking at their care plans and other documentation. There were seven questionnaires returned from people who live in the project and five from staff. The information provided by the Manager in their Annual Quality Assurance Assessment (AQAA) was also drawn on to inform the inspection and report. Care Homes for Adults (18-65 years) Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 7 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person has a full assessment of their needs and aspirations prior to admission. Evidence: We carry out full assessments for all prospective service users, the assessments are informed by information provided in the care management assessment, CPA minutes, Social Services care plan and risk assessment. All prospective service users visit the home prior to an assessment, where they have an opportunity to meet other service users and staff, we avoid emergency admissions. Quote from Annual Quality Assurance Assessment (AQAA) completed by the Manager. The care of three people who live in the project was tracked through discussions with two of the people, their care workers, observation of interaction with staff and looking at documentation related to their care. All referrals to the project come via Westminster Social Services who provide good information. The project then collates all information and carries out their own Care Homes for Adults (18-65 years) Page 9 of 32 Evidence: assessment to ensure that they can meet peoples needs and aspirations. The Manager explained how they have recently updated their assessment process following on from feedback from the people living at the project who said they had found the process quite daunting as it had involved answering many formal questions within a long interview. People are now assessed over a couple of visits to the project with more opportunity to get to know the community. The project allocate a key worker to each prospective resident.The feedback from this more informative assessment has been positive. Randolph Avenue also complete placement recommendations which are specific to the person who is offered a place and focus on the level of support required to help people achieve their goals. One person was observed visiting the project. It was their second visit and they stayed for an afternoon and supper. The Manager said in their AQAA that they were in the process of reviewing and updating the information given to people prior to visiting the project to enable them to make more of an informed choice. Care Homes for Adults (18-65 years) Page 10 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in creating their plan of care. Care plans and one to one key working sessions need to be developed further to identify agreed, clear, achievable goals. The project must ensure that every person has a risk management plan in place. Evidence: Each person in the project has input into creating a plan of their care and support needs. The project has recently introduced the Recovery Star Plans which is a model of care planning where both the person and their support worker charts their progress in different area and scores where they feel they are and plan which areas to develop. This type of care planning is much more goal specific and person centred. All staff have received training. Of the four care plans seen two had completed and begun to start to work with Recovery Star and two had not. Like the previous way of working the support plans would be outlined in the weekly one to one key working sessions that the project aims Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: at. To gain a view of how the project worked the care of three people was tracked and four care plans reviewed. The care plans seen varied in the depth of information and level of intervention of the support workers. Three of the care plans held good descriptive profiles of the person including of their mental health and background. One had neither a profile nor a photograph of the person.All held an equality and diversity form which highlighted any cultural religious or other needs of people. Only one care plan was fully working with the Star Recovery plan. This was clearer in terms of joint working and areas to develop but like all the other care plans seen it lacked specific short term goals with details of how they would be achieved and the expectations of the person and staff member. There was also a lack of any workable link from the care plan to the weekly sessions. The weekly sessions are recorded and signed by the person and their key worker. The sessions have set headings covering areas from mental and physical health to daily programme and activities, personal hygiene, cooking and menu planning. The weekly sessions seen on one person, whose mental health had seen a gradual decline, were repetitive with no direction, plans or goals to achieve. With the exception of the last session there was no mention or challenge to this persons perception of their mental health. One session referred to making an appointment to follow up a course, however no note was left in the diary and this person was not on duty on that specific day therefore no action was taken. One persons care plan did hold goals with regard to moving towards practising their cooking and self catering skills which the person was achieving. Three of the key working sessions lacked short term goals or any action points. The Manager said he is working trying to develop staff to work SMART (specific,measurable, agreed,realistic, timely). Staff must make sure that both peoples care plans and their weekly support sessions have agreed, clear, achievable goals and action points. People are encouraged to make their own decisions and choices, this was observed throughout the time spent at the project. Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: The project has a good system for managing risks. There are detailed risk assessments which identify warning signs,risk factors and actions to be taken. Three care plans had good risk management plans one had none at all. One of the plans although good with clear risk indicators the action plan did not appear to have been followed fully nor the the risk assessment updated. The Manager had suggested a course of action to take yet the key worker had not followed it through. One of the care plans seen was of a person who had moved into the project three months ago. Apart from having neither a profile, photograph or risk assessment no care plan had been undertaken. This was raised with the Manager who explained that the role of risk assessment had historically been that of the senior workers though the managers had undertaken it. Now it has been placed again with senior workers who have received training but are still adapting to the system. Assessments of risks need to be kept under review. Staff must make sure that every person who lives in the home has an assessment and action plan of any risk factors. Care Homes for Adults (18-65 years) Page 13 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity for both structured activities and free time. The level of support offered to people in gaining life skills must be further developed. There should be a greater emphasis on developing more nutritional balanced and varied menus to maximise peoples enjoyment of food and its nutritional benefit. Evidence: As part of placement recommendations, we encourage service users to work with us in finding meaningful activities for the day, and to take part in an external programme three times a week (college, voluntary work placements, local resources, day centers, etc). The placement will not work without this commitment, and this becomes a key focus of key working sessions. Service users are also supported, encouraged and enabled to accessed community resources such as libraries, shops, pubs, cafes, leisure centres etc Quote from AQAA completed by the Manager. Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: The staff are good at cooking, they keep us company and make us feel welcome and deal with issues. We could do with more activities, better cleanliness, for the staff to spend more time in groups and for us to have internet access in the downstairs lounge Quote from questionnaire of someone who lives in the project The home could provide more funding Staff questionnaire A number of people at the project have been involved in structured activities. One of the men is involved in voluntary work as a step into work. Some are attending college, others workshops at local centres. Routines at the project are flexible, people are free to do what they want during the day. Everyone has a day which they help with the cleaning, or chose, shop and cook the main evening meal. People are also responsible for cleaning their rooms and doing their laundry. Whilst this is noted in peoples care plans the planning and support around these activities could be more specific with clearer goals and ways to achieve them. Two people from the project had left that week to move into their own accommodation which they had been planning with staff for some time. The Manager has identified a member of staff to take the lead in activities. They have a very limited budget and so are trying to source free activities as people are reluctant to pay for outside activities. The Manager says that staff can approach peoples individual care managers for specific expenses.There are a selection of board games and music.The project recently received an Nintendo Wii computer game console which people have enjoyed. The area of monitoring and providing good nutrition is one which the project needs to focus on. There is a main meal each evening which one person and a member of staff cooks. The menu is currently created piecemeal. Weekend staff ask individuals what they wish to cook and put together the menu. The menus are then planned and displayed for a two week period. However the menus lack variety and nutritional balance. The Manager is aware of this and said it would be addressed at the house meeting. During the time spent at the project people were observed in the lounge on the ground floor where there a small kitchen area. One person was making a sandwich and another person asked to have some of their supplies. The fridge was empty except for a small quantity of milk. The cupboards had some breakfast cereal, a few Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: packet of noodles but little else. The fridges and freezer downstairs were locked and no food was available in the cupboards. People were observed asking staff for bread and cheese to make a sandwich. These foods the staff kept in a small fridge in the office. Discussions on how the project manages breakfast and lunch have been noted in the last inspection and there appears to have been no progress made. It is unacceptable for people to need to ask for bread and provisions to make a snack or breakfast. This was discussed with the Manager and the reason for keeping the food in the office was that food was wasted and also people would eat all the weeks supplies in a day or two. On returning to the project for the second half of the inspection the following week there were supplies in the fridge of cheese and ham with bread also available. The Manager said that he was planning to discuss food provision at the house meeting that evening.He also plans to develop the role of one of the staff with one of the people in the project to be responsible for food supplies and nutrition. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good procedures in place for administering and monitoring medication. The majority of people are supported with medication but people are also supported to administer their own medication. Evidence: The care plans seen included an assessment of peoples needs for social, spiritual, and personal support. The project works closely with the local care management team, the community psychiatric nurse(CPN ) and other healthcare professionals. Everyone is registered with a local General Practitioner and are referred to other health care services if required. The project has clear procedures regarding medication. There are clear pathways for people to follow to become self medicating and safety nets in place if people do not manage. People are encouraged to be compliant with their medication and this is closely monitored. Staff were clear what action to take and who to involve if someone does not want to comply. Medication is kept locked in the office in dossett boxes if possible. People sign for their Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: medication and staff will note when someone refused or was not present. Staff need to be consistent in the system they use to record missed or refused medication to ensure correct monitoring and for the safety of the people in the project. The Manager plans to build up closer links with the local pharmacist. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the project know what to do if they are unhappy. The project has policies enabling people to make complaints and to safeguard vulnerable Adults. Evidence: The project has a complaints policy in place. There was also a suggestions book available in the hallway. Neither of these are used much as people would talk to their key worker or the Manager if they were unhappy at something or would raise it in a house meeting so that it could be resolved. The Manager said that most situations were talked through and action taken to resolve. Situations which were more likely to occur were disagreements between people. All parties would gather together to talk through and resolve. This was confirmed talking with people who lived in the project. The project has a policy for the safeguarding of vulnerable adults from abuse. All staff receive appropriate training. The project works closely with Health and Social Services and any concerns would be raised immediately. Care Homes for Adults (18-65 years) Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The project provides a safe environment which could be made more homely with the level of cleanliness increased. There is an urgent need to review the staff sleep in arrangements so as to sustain the support they offer to people who live in the project. Evidence: We will discuss with service users their views on making the project more homely, warmer and more welcoming.We will explore opening an account with a local domestic appliance provider enabling us to replace domestic appliances in a timely manner when needed. Review the staffs sleeping in area Quote from AQAA completed by the Manager We got a new sofa thats nice. We used to have someone who did the garden but there is no money now Quote from someone who lives in the project The environment can be less institutional and more homely Quote from staff questionnaire Randolph Avenue is a large, terraced, five-storey Victorian building situated close to the local amenities of Maida Vale. The communal areas were seen. There is a lounge on the ground floor equipped with a small kitchen area. People were observed to be Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: spending time in there watching TV, and socialising. This appears to be the main area people use to have their breakfast and lunch.The Manager said they have recently replaced the settee in the lounge. The project has the main kitchen dining room downstairs with an a small quiet lounge with a TV and computer. The small lounge is often used for weekly sessions.This downstairs area had a surplus of fridges and equipment which arrived from another project which need to either replace current equipment or be moved. The project has three bathrooms all of which lack any personalization. They are all white with old shower curtains and are very basic. They are in need of an upgrade or at least redecoration to create a less institutional feel and make the experience of the people who use them more relaxing,welcoming and hygienic. The AQAA completed by the Manager stated that staff regularly monitor the environment and carry out frequent room checks to ensure that all fittings and fixtures and facilities are in good working order. The communal areas of the project were in need of being fresher and cleaner. The fridges and cupboards in particular required cleaning. The project are currently advertising for a part time cleaner as their previous person had just retired. They are using an agency worker who work Monday, Wednesday and Fridays. The garden was used by people who live in the project and the Manager said the person who liked gardening was just moving out into their own accommodation.The garden was also in need of attention. The Manager said that they have just allocated a staff member and a person who lives in the house to oversee the garden. The general cleanliness of the home must be improved both inside and outside. All surfaces, fittings must be cleaned. The kitchen and fridges need to be kept clean and hygienic. The staff use the office as a sleep in room. There is a drop down bed and a sink. Staff need to go through the project to access the communal bathrooms. The project does not afford any quiet or time out space for the staff. The current sleep in arrangements are far from satisfactory as they do not afford the staff privacy and dignity. The sleep in facilities for staff need to be urgently reviewed especially in the light of the project receiving referrals from people with greater support needs. Care Homes for Adults (18-65 years) Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The project has good recruitment practices that involve the people who use the service. There are always sufficient staff on duty though the hours worked need to be reviewed. Evidence: The project could offer more training on risk assessments and Recovery Star Plan The project could improve with residents care The project could give more time for residents. Quotes from staff questionnaires The project has experienced a number of staff change over the last year. They are currently in the process of interviewing for a social care worker, two relief care workers and a part time cleaner. The current vacancies are being covered by the either the projects own staff or the organisations bank staff. Looking at staff rotas highlighted that in the recent past staff were doing continual bank work resulting in working for seven days in a row. Documentation showed that Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: the Manager discussed this with staff and ensured that staff have two days off a week. The staff were seen to be working very long shifts.This must be addressed to ensure that the people who live in the project are supported by staff who are able to respond to their needs and not tired from long hours. One of the rotas showed people doing 9 am to 9 pm. It is difficult to see how staff can maintain concentration and energy to relate to people in the way they need. The Manager has addressed this and has insisted that staff return to the normal shifts patterns. The shift patterns ensure that there are two members of staff on duty at all times during the day. From 10 pm to 8 am there is one staff member who sleeps in the building in case of emergencies. The shift pattern of the sleep in member of staff has has been determined because of the lack of appropriate sleep in facilities. It is 11 am through to 10 pm sleep in then 8 am to 12 midday. This shift and the sleep in facilities need to be addressed urgently. Eleven hour shifts in a project which has no facilities for staff to take time out is inappropriate and could impact on the quality of the support offered. The project has an on call service at all times and an overlap of staff to ensure a daily handover. Each day the staff work from a handover sheet which outlines the key appointments, areas to be met, concerns that need to be monitored as well as cleaning, laundry, the evening menu and medication overview. Three staff were spoken with, one being the most recent recruit. They confirmed that they had all the appropriate checks, Criminal Record Bureau (CRB), and references before starting. They said that received good induction which included a period of shadowing different members of staff. The project works with the organisations headquarters in the recruitment process. The regional office carry out all the pre employment checks, checks on references. Interviews are normally in the project and involve the people who live in the project. The last interview held in the home the prospective workers first met and were interviewed by the people who lived in the project who fed back their views to staff. The Manager said that there was consistency with both the people who live in the project and the staffs views of the candidates.The Manager was planning to meet with two people who live in the project to discuss the forthcoming interviews and their involvement. The Manager has allocated specific tasks to each staff member to ensure that all areas Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: of work are covered and to further develop the team.There have also been team development days. Staff said they receive frequent training. Much is provided in house and also Westminster Social Services training is also accessed. In the AQAA completed by the Manager three of the five permanent staff have National Vocational Qualification (NVQ) level 2 or above. The Manager must review staff training and development in view of the inadequate weekly one to one sessions and care planning so that each person in the project receives the consistent support they require Staff spoken with have had supervision and these sessions are recorded with action plans. The manager says this is also where staffs personal development and training needs are identified. Staff supervision was undertaken by the Manager and Deputy Manager. The Deputy Manager left in May 2009 and their post is not being replaced. The organisation is still in the process of restructuring and it is envisaged that a Senior Manager will be spending approximately one day a week in the project. The organisation must be sure that there is sufficient management in place to ensure that staff receive regular supervision. Care Homes for Adults (18-65 years) Page 24 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the project have their views listened to and are involved in the running of the project. Regular health and safety checks are carried out. The current management arrangements need to be clarified. Evidence: The Registered Manager is on maternity leave which has been further extended. The acting Manager has been in post since though has had a period of illness. They are currently in the process of registering as Manager with the Commission. They are an experienced Manager who has a clear knowledge of the service its aims and is focused on the needs of the people in the project. The Manager is awaiting the final details of how the restructuring will impact on the support needed to both run the project, support the people who live in it and the staff. The manager was struggling to develop the service without the support of a deputy and being left unsure as to how the role and tasks undertaken by them were going to be met. The organisation must finalize and inform the Commission of the full management arrangement to ensure that the appropriate management support is in Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: place. Their are regular house meetings where people who live in the project can share their views and input ideas and suggestions. There are annual questionnaires sent to the people who live in the project, staff, health and social care professionals. The organisation has failed to address the previous requirements to provide monthly unannounced visits to the project. These must be put in place to support and monitor the project. The health and safety records checked during the site visit showed that these are carried out regularly. There was a routine check of the fire points and records showed the statutory fire drills had been carried out. Care Homes for Adults (18-65 years) Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 39 26 1 2 3 4 The visits on behalf of the registered provider must be undertaken monthly and unannounced by a person that is not directly involved with the project as per the regulations. Original timescale of 01/03/07 not met, this is a repeat requirement. 01/01/2008 Care Homes for Adults (18-65 years) Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Staff must make sure that both peoples care plans and their weekly support sessions have agreed, clear, achievable goals and action points so that the people who live in the home are able to develop their life skills and attain their aspirations. 30/11/2009 2 9 13 Staff must make sure that every person who lives in the home has an assessment and action plan of any risk factors to ensure the safety of every person in the home 30/10/2009 3 11 12 Staff must further develop 30/11/2009 the level of support offered to people who live in the home in the area of life skills to enable people to further develop their skills. Care Homes for Adults (18-65 years) Page 28 of 32 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 4 17 16 The project must encourage and develop more nutritional,balanced and varied menus with more provision of fresh foods, fruits ensuring that peoples nutrition is monitored to maximise peoples enjoyment of food and its nutritional benefit. 30/11/2009 5 24 23 The general cleanliness of the project must be improved both inside and outside. All surfaces, fittings must be cleaned. The kitchen and fridges need to be kept clean and hygienic. to ensure that people live in a homely and hygienic environment 30/11/2009 6 27 23 The bathrooms are in need of an upgrade or redecoration to create a more homely environment and enhance peoples quality of life. 31/01/2010 7 28 28 The sleep in facilities for staff need to be urgently reviewed to afford the staff privacy and dignity and sustain the support they offer to people who live in the project 31/12/2009 Care Homes for Adults (18-65 years) Page 29 of 32 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 8 32 18 The Manager must review staff training and development in view of the inadequate weekly one to one sessions and care planning so that each person in the project receives the consistent support they require The Manager must review staff the staff shift hours and rotas to ensure that the needs of the people who live in the project can be fully met at all times. 30/11/2009 9 33 18 30/11/2009 10 36 18 The Organisation must ensure that there is sufficient management in place to supervise staff so that people who use the service are supported by staff who practice is developed and supported. 30/11/2009 11 37 8 The Manager must complete their registration with the Commission 31/12/2009 12 38 18 The organisation must detail 30/11/2009 and finalize the management arrangements of the project Care Homes for Adults (18-65 years) Page 30 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action to ensure the people in the project benefit from clear well supported management. 13 39 26 The organisation must address their continued failure to provide monthly unannounced visits to the project. These must be put in place to support and monitor the project 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 31/10/2009 1 20 Staff need to be consistent in the system they use to record missed or refused medication to ensure correct monitoring and for the safety of the people in the project. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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