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Inspection on 18/05/09 for Rough Lee House

Also see our care home review for Rough Lee House for more information

This inspection was carried out on 18th May 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

All the people using the service who were asked said that they liked living at Rough Lee. One person said, "It`s an excellent place, the staff are really nice they will do anything for you." Another person said, "I like the staff." Members of staff were friendly and treated the people using the service with respect. Two members of staff said they enjoyed working at the home. People living at the home could pursue their own interests and hobbies or choose from a range of leisure activities organised by staff and volunteers. Holidays were also arranged for people who wanted to go away for a short break. People were encouraged to be involved with the local community. One person said, "I enjoy working at the charity." All the people asked said the daily routine was flexible. One person said, "I have my breakfast in bed at the weekend."

What has improved since the last inspection?

Action has been taken to comply with two of the requirements made at the last key inspection. Medication is now stored correctly in a locked trolley which is kept in a locked room. Members of staff have received training in fire safety.

What the care home could do better:

Prompt action must be taken to improve the management of medication in order to prevent mistakes being made. A record of all medication received into the home must be kept. To ensure that a person who wants to manage their own medication can do so safely a risk assessment, medication administration record and care plan must be completed. Clear written instructions should be in place for staff to follow to ensure medication prescribed when required is given correctly. Handwritten instructions on medication administration records should be signed and witnessed to check that these have been copied correctly. All containers of medication should be dated when they are opened and the amount of medication left over from the previous month should be recorded on the new medication administration record. This will enable accurate checks to be made to ensure people are given their medication correctly. To promote the safe handling of medication a system must be put in place to regularly check all aspects of the management of medication including staff competence. To ensure all members of staff know exactly what to do if allegations of abuse are made the procedure should be amended to state the correct action they must take. Action must be taken to ensure recruitment procedures are thorough in order to protect people using the service from the employment of unsuitable staff. Two written references and a Protection of Vulnerable Adults first or enhanced Criminal Records Bureau check must be obtained before all new members of staff or volunteers start working at the home.To ensure the manager receives proper support and supervision the responsible person must visit the home every month, talk to people using the service and members of staff and provide a written report for the manager.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Rough Lee House Rough Lee Road Accrington Lancashire BB5 2LR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Hargreaves     Date: 1 8 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Rough Lee House Rough Lee Road Accrington Lancashire BB5 2LR 01254393152 01254393152 ac.buckley@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Alex Group care home 15 Number of places (if applicable): Under 65 Over 65 0 physical disability Additional conditions: 15 The registered person may provide the following category of service only: Care Home only - Code PC To Service Users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD The maximum number of Service Users who can be accommodated is: 15 Date of last inspection Brief description of the care home Rough Lee House offers 24-hour personal care for up to 15 younger adults with physical disabilities. The home is a detached purpose built property with large gardens and a car park. All accommodation and facilities are located on the ground floor. Communal rooms include a conservatory and spacious lounge with dining area. These are suitable for a variety of both individual and group activities. Accommodation is provided in 11 single and 2 twin-bedded rooms. There are no en-suite rooms but bathroom and toilet facilities are close to all rooms. Rough Lee is close to Accrington, local amenities and public transport. The current fees charged at Rough Lee are from £346 to £392.50 per week. Additional charges are payable for transport, toiletries, holidays, trips out and stationary. A statement of purpose and service user guide was available to prospective service users and their relatives on request. Care Homes for Adults (18-65 years) Page 4 of 31 Care Homes for Adults (18-65 years) Page 5 of 31 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: A key or main unannounced inspection, which included a visit to the home, was conducted at Rough Lee House on 19 May 2009. As part of the inspection process we looked at all the information we have received about Rough Lee since the last key which took place on 22 May 2007. This included an Annual Service Review on 22 May 2008. The purpose of this was to assess if the quality of care provided to people living at the home had changed and to make sure the home was being properly managed. Information about the last key inspection and the Annual Service Review can be obtained from Rough Lee House or www.cqc.org.uk The manager completed an annual quality assurance assessment several weeks before this visit to the home. This document is a self-assessment that focuses on how well Care Homes for Adults (18-65 years) Page 6 of 31 outcomes are being met for people who use the service. It also gives us some numerical information about the service. Eight completed surveys were returned from members of staff. At the time of this visit fifteen people were living at the home. A tour of the premises took place and we looked at staff files and care records. We also spoke to members of staff on duty and people who use the service. Discussions also took place with manager and deputy manager regarding issues raised during the inspection. What the care home does well: What has improved since the last inspection? What they could do better: Prompt action must be taken to improve the management of medication in order to prevent mistakes being made. A record of all medication received into the home must be kept. To ensure that a person who wants to manage their own medication can do so safely a risk assessment, medication administration record and care plan must be completed. Clear written instructions should be in place for staff to follow to ensure medication prescribed when required is given correctly. Handwritten instructions on medication administration records should be signed and witnessed to check that these have been copied correctly. All containers of medication should be dated when they are opened and the amount of medication left over from the previous month should be recorded on the new medication administration record. This will enable accurate checks to be made to ensure people are given their medication correctly. To promote the safe handling of medication a system must be put in place to regularly check all aspects of the management of medication including staff competence. To ensure all members of staff know exactly what to do if allegations of abuse are made the procedure should be amended to state the correct action they must take. Action must be taken to ensure recruitment procedures are thorough in order to protect people using the service from the employment of unsuitable staff. Two written references and a Protection of Vulnerable Adults first or enhanced Criminal Records Bureau check must be obtained before all new members of staff or volunteers start working at the home. Care Homes for Adults (18-65 years) Page 8 of 31 To ensure the manager receives proper support and supervision the responsible person must visit the home every month, talk to people using the service and members of staff and provide a written report for the manager. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 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. A thorough admissions procedure ensured the social and healthcare needs of of people using the service were identified and met. Evidence: A copy of the statement of purpose and service user guide is available to people who are considering using the service and their relatives on request. These supply information about the care and facilities provided at the home. People who are considering using the service are encouraged to visit the home and meet the other people living there. They are also invited to stay overnight or for a weekend to help them to decide if they would like to live at Rough Lee. Although an assessment of the persons social and healthcare was provided by social services the manager said that during the pre-admission visit further assessments were completed. This process checks that the staff at Rough Lee can fully meet the needs if the person before they are admitted to the home permanently or for respite care. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: We looked at the care records of a person admitted for respite care. A detailed assessment completed by social services was seen in their file. This assessment provided important information for the development of the care plan. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were encouraged and supported to make decisions about their lifestyle and the care they received. Evidence: We looked at the individual care plans of three people who use the service. These plans identified the social and healthcare needs of each person and explained what members of staff needed to do in order to meet these needs. Personal information files, some with illustrations, had also been developed with each person using the service. These files provided information about their individual likes and dislikes and gave clear directions for staff to follow to ensure each person was cared for in the way they preferred. Appropriate risk assessments including ones for falls, nutrition, moving and handling and activities outside the home were in place. Guidance for staff to follow about how to manage identified risks was also included in the care plans. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: A written report about social activities and the care given was usually completed daily. However, the records for one person showed that this had not been done since the beginning of the month. The manager was advised to ensure that a report was written during every shift so that all members of staff had up to date information about each person in order to provide continuity of care. Care plans and risk assessments were reviewed regularly and up dated when the needs of the person changed. Where possible the people using the service were involved in planning their care and signed the care plan to indicate their agreement with the care provided. People using the service were encouraged and supported by members of staff to make decisions about their lifestyle including daily routine and leisure activities. These were recorded in their individual care plans to ensure all members of staff had this information. Eight members of staff completed a survey and in answer to the question Are you given up to date information about the needs of the people you support seven indicated always and one usually. One person wrote, Every service users needs are always in the care plan, needs can changed but the care plan is always up dated. Care Homes for Adults (18-65 years) Page 14 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were supported to have an active and fulfilling lifestyle. meals were wholesome and appetising and people enjoyed them. Evidence: People using the service were encouraged and supported to take advantage of educational and employment opportunities. Two people were doing a computer course at the local college, one person worked for a charity and another person worked at the local college. People using the service could also choose to take part in a variety of leisure activities organised at the home. These included baking, bingo, dominoes and making items to sell at the annual summer fayre. Visits to local amenities were also arranged these included, swimming, shopping, the library and going to the cinema and bowling. Holidays were organised and destinations were decided with people using the service at the residents and friends support group meetings. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: Local clergy regularly visited the home and offered communion to people who wished to practice their faith in that way. A Church choir also visited the home every month. A number of people who used the service regularly attended local Church services. During the visit we saw care workers helping people to do a jigsaw puzzle, look at catalogues and play dominoes. Others were pursuing their own interests, two people were listening to music in the conservatory and some were watching television in the lounge area. During the afternoon of this visit two volunteers organised a game of bingo. People using the service and members of staff said that visitors were welcomed into the home at anytime and offered refreshments. The daily routine was flexible in order to meet the needs and preferences of people using the service. One person said, I dont always want to eat at 5pm so they let me eat later and i have breakfast in bed a the weekend. All the people using the service who were asked said the meals were good. One person said, The meals are excellent. Menus offered a well balanced diet and people were asked to choose what they wanted to eat from an illustrated copy of the menu. The meal served at lunchtime looked wholesome and appetising. Lunch was unhurried allowing people time to socialise and enjoy their meal. A bowl of fresh fruit was available on each of the dining tables for people to help themselves when they wanted. All the people asked said they liked living at Rough Lee. One person said the home was excellent and everyone was friendly. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service were cared for in a manner which promoted their privacy and dignity. Deficiencies in the management of medication could put some people at risk. Evidence: Personal care was carried out in the privacy of the persons own room or the bathroom. Members of staff were observed attending to people in a polite and friendly manner. One person said, The staff will do anything you want them to do, they dont mind. Information about the healthcare problems of people using the service along with the care and support they needed from members of staff was included in the care plans we looked at. There were also records of the involvement of GPs and other healthcare professionals including optician, chiropodist and behaviour therapist in the care of people who use the service. We looked at records for the management of medication and found that a record of Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: medication received into the home was not always made. We checked a sample of medication records and stock but found it difficult to account for some medication. This was because medication was not dated on opening and the amount of medication left over from the previous month was not recorded on the new medication administration record. Keeping detailed and accurate records help prevent the mishandling of medication. Hand written instructions on the medication administration records were not signed or witnessed by another member of staff to indicate that the instructions had been copied correctly. A number of people using the service were prescribed medication to be taken when required. However, there was no written guidance for staff to follow explaining the symptoms each person might display when they needed their medication. Having clear written instructions for the administration of when required medication ensures people are given their medication only when they need it. The care plan for a person admitted for respite care contained a list of medication and stated that this person was self-medicating. However, a risk assessment had not been carried out to ensure this could be done safely. Moreover, there was no written guidance in the care plan for staff to follow about the support this person might need or how they should check that medication had been taken correctly. A medication administration record was not in place listing the medication to be taken, the dose and the time to be taken. There was no evidence to suggest that the manager or a senior member of staff checked the medication to ensure this was being managed correctly. The manager was advised to develop a system for regularly auditing of all aspects of the management of medication including staff competence. Care Homes for Adults (18-65 years) Page 18 of 31 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. Complaints would be taken seriously and investigated. Members of staff had the training necessary to ensure people who use the service were protected from abuse. Evidence: A copy of the complaints procedure was included in the statement of purpose and service user guide. An easy to read version of this procedure was given to each person using the service. The manager said no complaints have been made in the last year. No complaints have been made directly to the Commission. The eight members of staff who completed the survey indicated that they knew what to do if a person using the service or their relatives expressed concerns to them. We looked at the policies and procedures for safeguarding vulnerable adults. The procedure about the action to take if allegations of abuse were made did not clearly state that social services must be informed before any investigation takes place. The manager was advised to amend this procedure to ensure all members of knew the correct action to take if allegations of abuse were made to them. Discussion with two members of staff confirmed that they had received training in safeguarding vulnerable adults. They both said they would report any concerns to the manager immediately. Care Homes for Adults (18-65 years) Page 19 of 31 Care Homes for Adults (18-65 years) Page 20 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was equipped, furnished and decorated to a high standard and provided a very pleasant and safe place for people using the service to live. Evidence: A tour of the premises confirmed that the home was clean, tidy and well maintained. All areas of the home were accessible to people using wheelchairs. This provided a safe and comfortable place for people using the service to live. During the last year new wardrobes with lower hanging space had been fitted in the bedrooms. This promoted independence for people using wheelchairs by enabling them to reach their own clothes. All the bathrooms had assisted baths and a wet room with shower enabled people using wheelchairs to have a shower. A ceiling tracking system had been installed in one of the bedrooms and a bathroom in order to promote the safe moving and handling of people using the service. Communal areas were very spacious and suitable for a variety of social and cultural activities. To further improve the home the room and corridors beyond the lounge were being redecorated during this visit. People using the service were encouraged to bring personal items for their bedrooms to meet their own needs and preferences. This included pictures for the walls, photographs, televisions, music centres and personal computers. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: The grounds and gardens were well kept and accessible to all people using the service. All the laundry was done at the home. A suitable washing machine and tumble dryer ensured clothes were washed promptly and returned to people using the service. Gloves and plastic aprons were available for members of staff to use in order to protect themselves and people using the service from infection. Members of staff had also received training in infection control procedures. Care Homes for Adults (18-65 years) Page 22 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Training for members of staff was encouraged but a lack of thorough recruitment practices put people using the service at from unsuitable staff. Evidence: The duty rota provided details about the grades and number of staff on duty for each shift. Eight members of staff completed the survey and in answer to the question are there enough staff on duty to meet the individual needs of all the people who use the service three stated always, four usually and one sometimes. Two expressed concerns that staffing levels dropped due to sickness and holidays. Another member of staff wrote on the survey, I would like to see at least three carers on a shift at all times. Sometimes there are only two. Despite these concerns there was no evidence suggest that the needs of people using the service were not being met. However, the manager should make every effort to ensure that staff absence is covered. We looked at the files of three members of staff and one volunteer recruited since the last inspection. Only one of these files indicated that all the required information had been obtained before this member of staff and started working at the home. These included two written references and a Criminal Records Bureau check. These checks ensure people who use the service are protected from the employment of unsuitable Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: staff. However, the files of two members of staff indicated that they had been allowed to start working at the home before two written references were obtained. Moreover, one of the references for each of these two members of staff was dated more than two months after the they had started working at the home. A reference for one of these staff was from a family friend and because the form related to employment issues only one question was answered. This question asked if there was any reason why the candidate should not be employed. There was no information about the candidates suitability for working with people with disabilities. A reference for the other member of staff was from a friend. The manager was advised not to accept references from close friends of the applicant. A recently appointed volunteer had not completed an application form, written references and a Criminal Records Bureau check had not been requested. In fact the only information about this person was their name and address, date of birth and nearest relative. Employing people without following thorough procedures puts people using the service at risk from unsuitable members of staff. Discussion with members of staff and the manager confirmed that training for members of staff was encouraged. Induction training was in place for new members of staff but this only consisted of a check list. The manager was advised to develop this programme to ensure it provided new members of staff with the knowledge they needed to provide person centred care for people using the service. Members of staff said they had received training in basic food hygiene, moving and handling, medication, health and safety, safeguarding vulnerable adults and first aid. In addition to this half of the care workers had National Vocational Qualifications in health and social care at level 2 or above. Care Homes for Adults (18-65 years) Page 24 of 31 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 views of people using the service are considered when decisions about the care and facilities provided at the home are made. A lack of thorough management procedures in some areas could put people using the service at risk. Evidence: The registered manager is experienced in caring for younger adults with disabilities. She has completed the National Vocational Qualification in health and social care level 4 and is currently working towards the Leadership and Management qualification. However, it is the managers responsibility to ensure that people using the service are protected from the employment of unsuitable staff and volunteers by having thorough recruitment procedures in place. It is also the responsibility of the manager to ensure that all aspects of the management of medication are audited regularly. These audits would enable the manager to identify poor practice, any mistakes and check the competence of the members of staff responsible for the administration of medication. The manager would then be able to take the necessary action to prevent people using the service from being put at risk from poor practice. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: The manager explained that the views of people using the service were often obtained by chatting with them informally. Regular meetings of the relatives and friends support were held. People using the service also attended these meetings to discuss events such as the summer fayre and holiday destinations. The manager stated in the Annual Quality Assurance Assessment that as result of listening to people using the service menus had been changed to increase the choice of food offered and given the opportunity to go on holiday in smaller groups. Although the member of the management committee responsible for supporting and supervising the manager visited the home and completed reports under regulation 26 this has not been done consistently every month. A report was not available for January, March or April 2009. It is important that these visits take place every month in order to ensure that the home is being run in the best interests of the people using the service. Policies and procedures for safe working practices were in place. These help to make the sure the home is a safe place to live and work. Fire alarms and emergency lighting were tested monthly. A fire drill was held every six months. We looked a the records of routine servicing of equipment. These included an up to date gas safety certificate and evidence that the testing of small electrical appliances was carried out annually. Although the electrical installation certificate had expired the manager informed us a few days later that arrangements had been made to renew this. Care Homes for Adults (18-65 years) Page 26 of 31 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 34 19. Schedule 2 In order to safeguard residents from abuse thorough recruitment procedures must be in place for all members of staff including volunteers. To ensure the manager receives proper support and supervision the registered person must make an unannounced visit to the home every month and provide a report for the manager under regulation 26. A copy of this report should be supplied to the commission. (Timescale of 30/12/05 not met.) 22/05/2007 2 41 17(2) Schedule 4 (5) 29/07/2007 Care Homes for Adults (18-65 years) Page 27 of 31 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 20 24 A system must be put in place to regularly audit all aspects of the management of medication including staff competence. This will ensure medication is managed safely. 24/07/2009 2 20 13 A risk assessment, care plan 03/07/2009 and medication administration record must be completed for each person using the service who self-medicates. This will ensure the person is able to manage their own medication safely. 3 20 17 A record of all medication 03/07/2009 received into the home must be kept. This will enable medicines to audited to make sure they are being given correctly. 4 34 19 Two written references and a protection of vulnerable adults first or an enhanced 26/06/2009 Care Homes for Adults (18-65 years) Page 28 of 31 Criminal Records Bureau check must be obtained before members of staff including volunteers start working at the home. This protects people using the service from the employment of unsuitable staff and volunteers. 5 41 17 The responsible individual 31/07/2009 must make an unannounced visit to the home every month and provide a written report for the manager under regulation 26. This will ensure the manager receives proper support and supervision. 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 A report about the social activities and care given should be completed during each shift. This will ensure members of staff have up to date information about each person in order to provide continuity of care. Clear written instructions should be in place for staff to follow to ensure medication prescribed when required is given correctly. Hand written instructions on the medication administration records should be signed and witnessed. This ensures that instructions have been copied correctly. All containers of medication should be dated when they are opened. The amount of medication left over from the previous month should be recorded on the new medication administration record. This will ensure medication is managed correctly and enable accurate checks to be made. The procedure to follow should be amended to clearly state 2 20 3 20 4 20 5 23 Care Homes for Adults (18-65 years) Page 29 of 31 the correct action to be taken if allegations of abuse are made. This will ensure all members of staff will know what to do if allegations of abuse are made to them. 6 7 34 35 To ensure references are objective they should not be requested from close friends of the applicant. Induction training should be further developed to ensure it meets the Skills for care standards. This will help new members of staff to acquire the knowledge they need in order to provide person centred care for people using the service. The registered manager should make sure robust systems are in place so that people using the service are not put at risk. 8 37 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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