Inspection on 18/08/09 for Roman Court (1)

This inspection was carried out on 18th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Roman Court (1) 02/08/07

Roman Court (1) 12/07/06

Roman Court (1) 01/03/06

Roman Court (1) 20/09/05

Roman Court (1) 17/03/05

Roman Court (1) 14/10/04

Roman Court (1) 23/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

Key inspection report Care homes for adults (18-65 years) Name: Address: Roman Court (1) 1 Roman Court Broadfields Pewsey Wiltshire SN9 5DS     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: Pauline Lintern     Date: 1 8 0 8 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 33 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 33 Information about the care home Name of care home: Address: Roman Court (1) 1 Roman Court Broadfields Pewsey Wiltshire SN9 5DS 01672564412 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Steven@StevenAbbott.wanadoo.co.uk Mrs Jane Abbott care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Valued Lives is a private organisation, which operates five care homes for adults with a learning disability. All are small establishments, intended to offer a normal domestic lifestyle. The main lead for the organisation is taken by one of the registered person, Mrs Jane Abbott. She is supported by other senior colleagues, including family members. Each of the Valued Lives homes is situated in Pewsey, or nearby small villages. Pewsey itself offers a range of amenities. The market towns of Marlborough or Devizes are within 15 minutes? drive. Slightly further afield, there are the larger centres of Salisbury and Swindon. The organisation has a number of vehicles used to transport people, who contribute towards the costs of these. Most people now cared for by the organisation have been with them for a number of years. People may have lived in more than one of the homes that Valued Lives operates. Roman Court is on a housing estate in Pewsey. The home cares for up to three people. Each person has a single room. There is an upstairs bathroom, and a separate toilet downstairs. There is also a living room, dining area and kitchen downstairs. There is an enclosed garden Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 3 Brief description of the care home area at the back of the house. The current fees range from #636 to #745. 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 peterchart Poor Adequate Good Excellent How we did our inspection: This service was last inspected on 5th September 2007. The unannounced inspection took place on 18/08/2009. At the time of our visit the two people who live at the home were at their day services and therefore we were unable to obtain their views on the service. The registered manager, Mrs. Carole Bottoms was available to assist us at the home. The staff member on duty was supporting the two people, who use the service at their day services. We were therefore unable to meet with them. Surveys were sent out to both people who use the service and staff members to complete if they wished to do so. We received 1 response from a member of staff. We sent Mrs. Bottoms an Annual Quality Assurance Assessment (AQAA) to complete. Care Homes for Adults (18-65 years) Page 6 of 33 This was the homes own assessment of how well they are performing would provide us with information about their future plans. At the time of writing this report CQC had not received the completed AQAA. We reviewed the information that we had received about the home since the last inspection. We looked around the home and read a number of records, including care plans, risk assessments, health and safety procedures. The judgments contained in this report have been made from all the evidence gathered during the inspection; including the visit to the service and takes into account the views and experiences of people using the service. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: At the last visit to the service, three good practice recommendations were made, which all related to care planning. Although one recommendation has been addressed the remaining two have not. We noted that care plans are not being signed and dated by the person who completed them. Care plans should evidence that the person being Care Homes for Adults (18-65 years) Page 8 of 33 supported or their representatives were involved in their development. We noted that although individual files contain documentation relating to person centred planning, they have not been completed. This includes health action plans and communication dictionaries. Completion of the plans will help to ensure that they reflect a person centred approach and provide better information about peoples diverse needs. Behavioural management plans need to be reviewed and updated. Where an individual may need physical intervention a risk assessment must be in place to support this. The community nurse needs to agree these, to ensure they are appropriate for the people who use the service. When a persons behaviour may challenge, if new staff or visitors are in the home, a risk assessment should be completed. If individuals are to visit staff members homes this should also be risk assessed. The home must keep a complaints log at the home. This will ensure that any complaints are monitored for patterns and trends, which may emerge. If accidents/incidents are recorded on the incident chart by a tick, further information relating to this must be recorded within the incident/accident record sheet. All expenditure of peoples personal money must be recorded on the financial record sheets and be accompanied by the appropriate receipt. All transactions must be signed by a staff member. An audit of all money transactions must take place. The home must be able to evidence that staff training is taking place and refresher courses are attended. There should be a training matrix held at the home. This will enable the manager to monitor staff members training needs. The people living at the home should have the opportunity to meet with staff members and the manager to discuss issues relating to the service. All meetings/discussions should be recorded. The registered manager of the home must complete the relevant qualifications necessary for her role. The registered manager must ensure that a Quality Assurance audit is completed annually. This should include the views of all stakeholders and should be instrumental in the homes development plan. The registered provider must complete monthly audits of the service. Records must be available for inspection. We will be asking Mrs. Bottoms to provide us with an Improvement Plan in relation to matters arising from this inspection. 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. Care Homes for Adults (18-65 years) Page 9 of 33 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 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 11 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 receive an assessment so that their needs can be met Evidence: There have been no admissions to the home since the last inspection. Two people are currently living at the home. Both people at Roman Court have lived within Valued Lives for a number of years. They therefore have established routines and their individual and varied needs have been assessed over time. At the last key inspection, this outcome was judged as good. There has been no information to conflict with this view. Based on this, we have made a judgment, that the assessment process would ensure the service could meet the persons needs. Care Homes for Adults (18-65 years) Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples assessed needs are reflected in the individual plans however, information about peoples personal goals, and how they will achieve these, is not yet included in the plans. This information will help to ensure that the plans reflect a person centred approach. People are able to make choices about how they live their lives. People are supported to take risks, though not all risks are fully reflected in the care plan. Evidence: Each person has a care plan in place, which has been kept under review. Little action has been taken to address the good practice recommendation we made that people living at the home or their representative sign the care plan to show that they have been involved in its development. We noted that care plans have also not been signed by the person who completed them. Staff sign to confirm that they have read each section of the care plan. We saw that person centred plans are in place; however they have not been completed. Mrs. Bottoms reported that all staff have attended person centred planning training. Files contained communication dictionaries and health action plans. Communication dictionaries had not been completed. One key worker Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: had made a start on a health action plan, although it was far from completed. The other health action plan had no entries completed. It is important that a person centred approach is adopted by the home to ensure that people are treated as individuals and their goals and aspirations are considered. We noted that care plans detail all aspects of the persons life such as disposition, comprehension, behaviours, mobility, health needs, spiritual; needs, medication, personal hygiene, personal care and dietary needs. Care plans identify preferred activities, contact details for friends and family and social graces. Within the file we saw that tick charts are kept to record any incidents or accidents that have taken place. We saw that an incident had taken place on 12/8/09, however this had not been recorded on the incident/accident record to provide further detail on what had happened and the outcome. We require that a clear audit trail of all incidents/accidents is maintained. Mrs. Bottoms confirmed that both of the people using the service are able to make decisions and choices within their daily life. We noted that in one persons care plan it states that they have a tendency to stay up late writing so may need some encouragement to go to bed. People can choose the food they eat as the menu is flexible. As part of the inspection process we sampled individual risk assessments. We saw that not all risks are fully reflected in the care plan. For example we saw an entry in a care plan which states that one person may need physical intervention when behaviours are displayed, however there was no risk assessment in place to ensure the safety and protection of the person or the staff involved. Within the daily records we saw that one person using the service had lunch at a staff members home. We told Mrs. Bottoms that staff should not be entertaining service a user in their own home without an assessment of risks and that it had been agreed within their care plan. Mrs. Bottoms told us that one person living at the home might become agitated when people visit the home or if new staff are on duty. There was not risk assessment in place to safeguard people in this situation. We asked Mrs. Bottoms to complete a risk assessment to minimise any potential risks. We saw that individual risk assessments have been reviewed on 5th June 2009. Care Homes for Adults (18-65 years) Page 14 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. This judgment has been made using available evidence including a visit to the service. People have access to a variety of activities within the local and wider community. Links with families and friends are maintained. People have established routines and choice making is promoted. Menus are flexible and varied. Evidence: Each person using the service has a weekly activity plan. Plans are in a pictorial format. Activities include bingo, personal household tasks, community activities such as shopping, library, band rehearsal, tea dances and group discussions. Both of the people living at the home attend day services at Harlequins, The Secret Garden and the farm. All of these services are run by Valued Lives. Staff from the home support people to attend. Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: Mrs. Bottoms reported that one person enjoys accessing the local PACT centre. This is an internet cafe. Mrs. Bottoms added that the person is hoping to purchaser a lap top, which they can use at home. Daily reports show that people have the opportunity to attend the local church. Specific services are arranged for people living in Valued Live homes. People attend the Gateway club in the evening. Mrs. Bottoms told us that one person living in another local home, owned by Mrs. Abbott will often visit and sometimes stay overnight. We asked that this situation be risk assessed. People are able to take advantage of the homes static caravan which is near Bournemouth. One of the people living at the home has relatives living abroad and they visit them independently, without staff support. Daily records show that people are supported to visit their family and friends when they wish to do so. Within the activity plan it states the day when people are supported to telephone their family regularly. We saw that people have established routines at the home. Mrs. Bottoms confirmed that each person takes on some responsibility for household tasks. She added that one person will help with meal preparation, while the other person prefers to do other tasks. We looked at the four weekly menus. Mrs. Bottoms reported that the menus are very flexible, as people often change their mind on the day. People using the service take an active role in food shopping for the home. We saw that there is a good variety of food offered, such as fish, chicken, pasta, vegetables and fruit. People eat their main meal in the evening and take a packed lunch to their day services. Care Homes for Adults (18-65 years) Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgment has been made using available evidence including a visit to the service. Care plans do not always fully reflect how peoples personal care needs should be met. People have access to healthcare professionals when required. However, relevant prefessionals should be consulted when management plans are put in place. There are safe systems of administration of medication for service users. Evidence: Care plans record how the person using the service wishes to have their personal care support provided. One care plan states that the person is able to dress themselves, however they need support with washing their hair. They are able to shave themselves with staff supervision. Plans do not always reflect peoples personal goals and aspirations. Within daily and weekly records we saw that people have access to various healthcare professionals when they are required. This includes speech and language therapists, physiologists, opticians and chiropodists. When a need has been identified for a health referral to be made this has been actioned. As mentioned earlier in this report Mrs. Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: Bottoms confirmed that they are waiting for behavioural management plans to be updated by the relevant person. As mentioned previously in this report people have a Health Action Plan within their individual files. However, they have yet to be fully completed. We noted that people living at the home have had a review of their medication and a letter from the GP is kept on file, which confirms that homely medication can be administered. At the time of our visit to the home only one person was receiving medication. We sampled medication administration records and saw that medication was managed satisfactorily. Staff members receive medication training. Care plans contained clear protocols for the use of as required medication. We saw that records are kept of when medication is taken home with people. Family members sign to say they have received the medication. The home did not have a medication cabinet which complied with the current requirements for the storage of controlled drugs. This meant that, although no controlled drugs were being kept at the time of our visit, the home would not be able to store these safely if they were prescribed in the future. Care Homes for Adults (18-65 years) Page 18 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. This judgment has been made using available evidence including a visit to the service. Policies and procedures are in place to enable people to raise concerns or make a complaint. Generally, people are protected from abuse, neglect and self harm. However, some people may still be at risk of harm because the plans to manage their behaviour have not been agreed with the relevant professionals. Greater care must be taken when handling service users money transactions to ensure that their finances are safeguarded. Evidence: There is a complaints procedure in place; however the home does not have a complaints log. We asked Mrs. Bottoms to develop a complaints log which is kept at the home. This will enable her to identify any emerging trends or patterns. There have been no complaints made to the organisation and no complaints received by CQC since the last inspection. Mrs. Bottoms reported that all staff have received training in Protection Of Vulnerable Adults (POVA). As there were no training records at the home we were unable to confirm this. Mrs. Bottoms explained that the training is delivered over two days, which ensures that all staff is able to attend. Staff have access to a DVD, which provides refresher training on POVA, while they are working at the day services. Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: Staff members are provided with a copy of the local protocols No Secrets in Swindon and Wiltshire. There have been no allegations of abuse since our last visit to the service. We saw that one person had a behavioural management plan in place, which had been devised by the community nurse on 25/10/06. Mrs. Bottoms told us that each person living at the home is on a waiting list to have their plan reviewed. We saw that Mrs. Abbott and Mrs. Bottoms had reviewed the behaviour plan themselves in June 2009. We noted that the plan had not been signed by the person who completed it. It was identified that the plan be reviewed every six months. The community nurse needs to agree these, to ensure they are appropriate for the people who use the service. Mrs. Bottoms reported that Mrs. Abbott has arranged for a company to provide training for staff on the use of physical intervention on September 18th 2009. One of the two days training will be spent looking at the specific needs of the people in the home. As part of the inspection process we sampled finance records of monies held by the home on behalf of the people living there. We noted that one persons finance sheet did not balance with the cash held. There was a shortfall of £33. Mrs. Bottoms told us that it was probably that the most recent transaction had not been recorded on the sheet yet. We told Mrs. Bottoms that all transactions must be recorded straight away and accompanied by receipts to safeguard people using the service. Care Homes for Adults (18-65 years) Page 20 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. This judgment has been made using available evidence including a visit to the service. The home provides a clean, comfortable and safe environment for people to live in. Evidence: Roman Court is a modern semi-detached house, in a residential estate in Pewsey. It is a short walk from the centre of the village, and all local amenities. The home is domestic in scale and in keeping with other houses in the street. It is attractively decorated and furnished. As part of the inspection process we toured the premises and found bedrooms to be personalised with photographs, ornaments and mementos. As there are currently only two people living at the home, the third bedroom is used as a sleeping in room for staff. Mrs. Bottoms told us that since the last inspection, there has been nor redecoration within the home. There is a small but well maintained garden to the rear of the home. There are seats Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: and a table for people to use. On the ground floor there is a comfortable lounge, a small dining room and a kitchen. The laundry facilities are domestic in style. The washing machine is in the kitchen and the drier is situated in the garage. Mrs. Bottoms told us that they no longer have a cleaning company to clean the house. Staff members are now responsible for this task. At the time of our visit we found the home to be clean, hygienic and fresh. Care Homes for Adults (18-65 years) Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgment has been made using available evidence including a visit to the service. People are supported by an effective staff team who has a sound underpinning knowledge of their needs. There has been no new staff since the previous inspection when the standard about recruitment was met. Training records were not available during our visit. Evidence: Each shift has one staff member supporting the people living at the home. One member of staff sleeps in to provide supervision and support throughout the night. Mrs. Bottoms confirmed that the home does employ agency staff to cover staff illness and annual leave. She added that they mainly use two agencies. This ensures a consistency of agency staff. Mrs. Bottoms confirmed that the agency staff used knows the service users well. The standard about recruitment was met at the last inspection and no new staff have been recruited since. No recruitment records were held at the home. At the time of our visit training records were not available for inspection. Mrs. Bottoms Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: told us that Mrs. Abbott was in the process of developing a training matrix. We requested that a copy of the matrix be forwarded to CQC as soon as possible. At the time of writing this report, we had not received this document. Mrs. Bottoms reported that the service had recently started to use training workbooks by an outside training provider. These are certificated courses in 12 subjects including health and safety, diet and nutrition, principles of risk assessments, safeguarding, medication, manual handling, basic food hygiene and infection control. We saw an example of the workbooks completed by staff members awaiting accreditation. Mrs. Bottoms confirmed that specific training is also provided in subjects such as Epilepsy, Downs Syndrome, Dementia and Mental Health. Mrs. Bottoms told us that all staff receive mandatory training and attend refresher courses. However, due to no records being kept at the home we were unable to evidence this. We require that all staff training records are made available for future inspections. Care Homes for Adults (18-65 years) Page 24 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. This judgment has been made using available evidence including a visit to the service. The manager should obtain the relevant qualification to ensure that people benefit from a well run service. Quality assurance remains under developed. People must feel their views are reflected in the homes development plans. Systems are in place to protect and promote peoples health and welfare. Evidence: Mrs. Jane Abbot is the registered owner of Roman Court. Mrs. Bottoms is the registered manager of Roman Court. Mrs. Bottoms also manages another service owned by Mrs. Abbott. She spends her time working across both homes and at the day services. Mrs. Bottoms told us that she was working towards her Registered Managers Award (RMA) however the training company ceased trading. Mrs. Bottoms reported that she would be starting the Leadership and Management qualification in the near future. As registered manager of the home it is important that Mrs. Bottoms commences this training as soon as possible. Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: Mrs. Bottoms reported that she attends all of the training that staff members attend. She added that managers within Valued Lives regularly meet with Mrs. Abbot for peer support and to discuss new policies and procedures, work practices and any changes to legislation. At the previous inspection two requirements were made in relation to quality assurance for the home. One requirement asked that the registered person supply to the Commission a copy of the report about quality assurance survey and make a copy available to service users. The initial timescale for this requirement was 30/09/06, which was extended at the next visit to 31/12/07. During our visit to the service Mrs. Abbott confirmed that this had not yet been addressed. She instructed Mrs. Bottoms to provide us with a copy of the last review. We noted that this was for the years 2004/ 5/ 6. The review appeared to be generic and was not specific to Roman Court. The quality review should be specific to the service and form the basis of the annual development plan. We told Mrs. Abbott that we expect a quality audit to take place annually and not every three years. The second requirement made required that the registered manager implement an effective cycle of quality assurance and ensure that the views of all stakeholders were represented. We could see little evidence of this taking place, although two questionnaires for the people using the service and one member of staff had been completed. Mrs. Bottoms told us that Mrs. Abbott was in the process of developing an effective quality assurance system. We saw a copy of the new quality assurance form; however it had not yet been completed. We discussed how the views of the people living at the home are canvassed. Mrs. Bottoms reported that usually informal discussions took place within the home. We asked that this be further developed and recorded to evidence that people are participating to the day to day running of the home. We noted that there was no evidence of monthly management audits being completed by Mrs. Abbott. We require under Regulation 26 that audits of the service are completed by the registered provider on a monthly basis and records are made available for inspection. As mentioned in the summary of this report, Mrs. Bottoms failed to return the completed AQAA to CQC as requested. We were therefore unable to include this self audit within the contents of this report. We will be writing to Mrs. Bottoms about the failure to return the AQAA which is a statutory requirement under the Care Homes Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: Regulations Daily checklists are completed by staff members at the beginning and end of each shift. We saw that environmental risk assessments are in place and have been kept under review. Mrs. Bottoms told us that the people living at the home are aware of the dangers of toxic materials and therefore they have assessed that they do not pose a risk by being kept in the kitchen. Manual handling assessments have been completed. We noted that hot water temperatures are checked monthly. Fridge and freezer temperatures are checked regularly. There was a fire risk assessment dated 01/09/08, which was reviewed 17/02/09. Small electrical appliances were last checked on 30/07/09. Mrs. Bottoms reported that she was waiting for the company to get back to her with a date to visit. We observed Mrs. Bottoms contacting the company during our visit. The Environmental Health Officer visited the service on 24/02/2009 and the home was awarded 5 stars for food safety. Care Homes for Adults (18-65 years) Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 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 Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 13 You must ensure that any accidents/incidents are fully detailed and recorded. This will provide a clear audit trail. 09/11/2009 2 9 13 You must ensure that where 09/11/2009 physical intervention may be uses, a risk assessment is completed and kept under review. To ensure that people are protected. 3 9 13 You must ensure that a risk 09/11/2009 assessment is completed in relation to visitors/new staff coming into the home and service users visiting staff in their own homes. To ensure that people are protected. Care Homes for Adults (18-65 years) Page 29 of 33 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 22 22 You must have a log to record any complaints/concerns received. This log must be kept within the home. To monitor for patterns or trends. 09/10/2009 5 23 17 You must ensure that all 09/11/2009 financial transactions of money held by the home, on behalf of the person using the service, are recorded straight away and receipts are kept. To safeguard peoples finances. 6 23 13 Strategies for management 09/12/2009 of behavioural needs must contain appropriate guidance, be shared with professionals involved, show who has been involved in devising them, and be kept under regular review. To ensure they are appropriate to the needs of the person. 7 35 18 You must ensure that staff training records are available for inspection. 09/10/2009 Care Homes for Adults (18-65 years) Page 30 of 33 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 that staff members are competent and qualified to carry out their duties. 8 37 9 The registered manager 09/12/2009 must complete management training required for her role. To ensure that the home is run in the best interests of the people who live there. 9 39 24 The registered person must supply to the Commission a copy of the report about quality assurance survey and make a copy of the report available to service users. The timescales previously set have not been met. Some progress has been made in relation to this requirement. The registered person must continue to implement an effective cycle of quality assurance and ensure that the views of all stakeholders are represented. Some progress has been made in relation to this requirement. 09/12/2009 10 39 24 09/12/2009 Care Homes for Adults (18-65 years) Page 31 of 33 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 11 39 26 The registered provider must complete monthly quality audits of the service and keep records for inspection. To comply with Regulation 26 of the Care Homes Regulations. 09/10/2009 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 6 The service user or their representative should sign the care plan to show they have been involved in developing their plan. This recommendation was made at the last inspection and remains unaddressed. Documentation relating to person centred planning should be completed to ensure peoples individual goals and aspirations are being met. Care plans should be signed when they are developed and dated. This recommendation was made at the last inspection and remains unaddressed. That a cupboard that meets the current storage regulations for controlled drugs, the Misuse of Drugs (Safe custody)(Amendment) Regulations 2007 is installed. This is so that any controlled drugs that are prescribed can be stored safely if they need to be kept in the home in the future. That individual health action plans are completed and kept under review. A copy of the staff training matrix should be sent to CQC. Evidence of service users participation in the day to day running of the home should be available. 2 6 3 6 4 20 5 6 7 20 34 39 Care Homes for Adults (18-65 years) Page 32 of 33 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 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!