Inspection on 23/09/09 for Sandbourne House

This inspection was carried out on 23rd September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sandbourne House 13/09/07

Sandbourne House 27/09/06

Sandbourne House 25/01/06

Sandbourne House 26/09/05

Sandbourne House 23/03/05

Sandbourne House 08/02/05

Sandbourne House 18/02/04

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 26/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Sandbourne House 1 Sandecotes Road Parkstone Poole Dorset BH14 8NT The quality rating for this care home is: zero star poor 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: Jo Johnson Date: 2 4 0 9 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 45 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 45 Information about the care home Name of care home: Address: Sandbourne House 1 Sandecotes Road Parkstone Poole Dorset BH14 8NT 01202742284 01202742284 sandbournehouse@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Helen Somerville,Mrs Janet Lesley Young Name of registered manager (if applicable) Miss Lyn Mogg Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 8 0 care home 8 learning disability Additional conditions: The maximum number of service users who can be accommodated is 8 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 45 A bit about the care home Sandbourne House is a large house in Lower Parkstone, Poole. Up to 8 people can live at the home. There are 6 people living there and 1 bedroom is used for people who come for short stays. Everyone has their own bedroom and they share the kitchen/dinging room, lounge, bathrooms and garden. You can walk to the local shops and there is a local bus service to Poole and Bournemouth. There is a car that people use. Care Homes for Adults (18-65 years) Page 5 of 45 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: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 45 How we did our inspection: This is what the inspector did when they were at the care home The inspection was unannounced (we did not let the home know we were coming) on 23rd and 24th September. The inspector looked around the house. The inspector talked with people who live at the home. The inspector looked at care plans. Care Homes for Adults (18-65 years) Page 7 of 45 The inspector looked at some of the paperwork about the home and the staff. The inspector talked to the staff and the manager. What the care home does well The home is welcoming, relaxed, clean, and tidy. Care Homes for Adults (18-65 years) Page 8 of 45 People and staff get on with each other. Most people who live at the home are given support to enjoy their leisure time and do things in the community. Some information has pictures to make it easier to understand. Staff have been trained in how to care for people. Care Homes for Adults (18-65 years) Page 9 of 45 Not many staff leave so the same staff keep supporting people. What has got better from the last inspection Pictures are used for planning the menus. The upstairs windows have been made safe. Care Homes for Adults (18-65 years) Page 10 of 45 There are more staff on duty when people need more support . The manager has been CQC registered with us. What the care home could do better Care plans must be kept up to date so that staff know what care and support people need. Care Homes for Adults (18-65 years) Page 11 of 45 Risks need to be assessed and managed so staff know what to do so they can keep people safe. Some people need to given support to be occupied during the day and develop their social skills, and their skills around the house. Staff need to write down when people have been hurt, what they have done about it and what care and support they have given them. People must see health workers when they need to, to make sure that they stay well. Care Homes for Adults (18-65 years) Page 12 of 45 There need to be as needed plans for taking medication. This is to make sure that people have this medication safely. Staff need to know what is abuse, how to report it and how to keep people safe. The manager needs to tell us and Poole Social Services when people hurt each other. Care Homes for Adults (18-65 years) Page 13 of 45 The manager must check whether staff need to be awake at night to make sure that people are safe. New staff need to be fully checked to make sure they are safe to work with people before they start work. The management of Sandbourne House needs to improve to make sure that people live and benefit from a well run home. The owner needs to do a report of how things are at the home each month. Care Homes for Adults (18-65 years) Page 14 of 45 The manager needs to send the Inspector important information about the people at the home. There needs to be a fire risk assessment that tells people what to do if there is a fire. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 15 of 45 If you want to speak to the inspector please contact Jo Johnson Telephone: 03000 616161 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 16 of 45 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 17 of 45 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. Some of the information about the home is out of date and not accessible to all people. Not all of the people living at the home had an opportunity to give their views and opinions about people moving into the home. Some people did not have a planned introduction to the home. Evidence: The statement of purpose needs updating to reflect the correct manager details, contact details of the commission and that the home now offers respite care. The service user guide is now supported by some pictures, this would be more accessible if it was supported by photographs as well. The last person to move in was spoken with and their care records looked at. They have now lived at the home for a year. There was an initial assessment completed by the home and then they had one visit to the home a fortnight later and then they moved in after another three weeks. The individual told us that I came to look around but no-one was in just XXX (owner). Didnt come for tea, didnt stay overnight, just moved in. The manager told us that this individual moved in as an emergency. Page 18 of 45 Care Homes for Adults (18-65 years) Evidence: There is a new admission checklist in use at the home. However, this was incomplete for this individual. There is a written contract in place but this is not accessible to the individual. The manager told us and showed us that there are records of visits, introductions and consultation with people at the home about one new person who is thinking about moving in. Two people told us that they had met this person and that they are coming to stay the night. Care Homes for Adults (18-65 years) Page 19 of 45 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. Care plans and risk assessments are not always detailed enough or completed for all areas identified in assessments to ensure that peoples specific needs are identified and met. Evidence: The care record folders include lots of information. There is also a working personal care plan and a standex record system. There is lots of information about people but it is not easy to find relevant information or see what people have been doing or the care provided to them. The standex system uses codes for activities and other personal care activities. This is not accessible to the individuals or they do not contribute to their record keeping in any way. The plans seen lack detail, in some specific areas, in the action staff need to take to support people and to minimise and promote positive risk taking. The care plans have been reviewed infrequently. The last care plan reviews in the care records were dated January 2009. One persons needs, how they spend their days and Care Homes for Adults (18-65 years) Page 20 of 45 Evidence: behaviours had changed and their care plan and timetable had not been reviewed or updated to reflect all of these changes. There were some areas that had been identified in peoples assessments and care records that had not been planned for or risk assessed. For example: One person needs staff support with transfers. There is only a basic tick list moving and handling risk assessment in place. The risk assessment does not describe the actions that staff are to take or how the risks are minimised. One person is presenting behaviours that may challenge other people in the house. The individual is also wakeful at night and has been disturbing other people. No risk assessments have been completed for these behaviours nor is a risk management strategy in place. We identified in the daily records and behaviour monitoring records for one person, adult protection safeguarding concerns. These included incidents where the individual had hurt other people living at the home. There were also incidents where the individual had sustained some bruising. There were records for one of the incidents of bruising. However, there was no record of investigation for the second incident of bruising. We raised this with the manager who told us that it had been looked into but no records were made. Body maps had also not been completed for either incident. Each persons file contained a brief personal profile. These did not give a full picture if peoples lives and who they had previously lived with and detail important milestones in their lives since and before moving into the home. It is important that these profiles are updated as at least one of the people living at the home communicates differently. This is so staff have full information about people, so they can meet all of their assessed needs and have a greater understanding of them as an individual. The two staff surveys told us that they have up to date information about the needs of the people at the home. There are lots of photographs on the dining room wall that show what people have been doing. However, they do not have individual ongoing life story books or works. Life story books have photographs and items in them that show what the person has been doing in their lives. Staff should develop life story books/works with people living at the home, as these give a much more interesting picture of how people have been spending their time and people may find them easier to follow than written records. This means that people can be actively involved in the monthly reviews of their plans and goals Life history books should also be developed that include details and photographs of their Care Homes for Adults (18-65 years) Page 21 of 45 Evidence: history such as family, friends, where they have lived, pets, work etc. These life history books will assist both the person and staff in remembering their past and will assist staff to have a greater understanding of them as an individual. There are new staff working at the home so it is important that this information is available to assist staff in getting know the people who live at the home. Care Homes for Adults (18-65 years) Page 22 of 45 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people participate in a range of social, leisure, and educational and occupational opportunities. Those people who do not have planned or organised opportunities may not be having meaningful, stimulating or fulfilled lives. Evidence: On the first day of the inspection five people were at home. One person was out in the community independently. People chose where to spend time in the lounge, dining room or in their bedrooms throughout the inspection. Some people attend activities including local community day services, college courses, adult education classes and work placements. People attend social clubs in the evenings if they choose to. There are monthly meetings between the people at the home. Care Homes for Adults (18-65 years) Page 23 of 45 Evidence: The survey from one person (completed with a relative) told us that they sometimes make decisions about what they do each day and that they can do what they want during the day, evening and weekends. There are a small number of people who actively take part in the day to day living in the house such as cooking, laundry and cleaning. There needs to be a more proactive and positive risk taking approach to more people being involved in the day to day living at the home. These are important life skills that people should be encouraged to develop, particularly for those people who do not attend any structured community day opportunities. People told us that they can have friends over. People are supported to maintain contact with families and other important people in their lives. During the inspection a staff member wrote a letter for one person to their friend. The last person to move in does not access community day services. They told us that they go out on day trips. However, they do not have any regular planned activities or a weekly timetable as other people at the home have. At their previous home they regularly attended a local church. We asked them if they if they have been to church since they moved in a year ago, they said not yet. One person chose to stop going to community day services in March of this year. Their timetable had not been updated to reflect any planned or structured replacement for day time activities. The individuals care records included a recording that the GP believes that their night time wakefulness and change in behaviours was due to lack of stimulation. The manager told us that health and social care professionals were investigating other day services. However, we are concerned that this individual has not been having any regular social occupation and or activities of daily living to replace the three days community day services that stopped in March. People spoken with told us that they all usually get on well with each other. However, from daily records and talking to people and staff, one person has been disturbing at least one other person at night and going into their bedroom uninvited. The staff have told the individual to tell the other person to go back to bed as this will help the sleep in staff. Since one person has moved out the previous week there is only a sleep in member of staff. They now sleep at the back of the house on the ground floor and have a baby monitor to listen as to whether one person gets up. There are no records of how often the member of staff is woken and or records of whether when the individual gets up whether they have disturbed or been into the bedrooms of other people. It is not clear how this will be monitored when the staff are not in the main part of the house and how staff will be alerted to other people who may be wakeful at night. The manager told us that if the night staff are waking that two of the people get up and Care Homes for Adults (18-65 years) Page 24 of 45 Evidence: sit with the staff. It is not clear whether this was happening when there was a waking agency staff member for over a year and how this was managed then. The records show that people are provided with a well-balanced and nutritious diet. All food being stored in the kitchen looked fresh and was well within the use by date. People told us that they plan the menu once a week. There are pictures and cookery books that people use to help them choose. This should be developed further with photographs of meals. People do not do the weekly food shop, again this is something that people could be involved in during the day. Care Homes for Adults (18-65 years) Page 25 of 45 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. The health and personal care that people in this home receive is not always based on their individual needs. Evidence: There were positive relationships and interactions observed between staff and the people who live at the home. The staff encouraged and supported people in a relaxed way. People and staff clearly enjoyed each others company, smiled, and laughed with each other and staff. People spoken with and the surveys told us that staff treat them well and listen to what they say. In the main peoples health records and care plans showed that their right to goodquality physical and mental health care is being promoted. The records show that as part of promoting their health people make regular visits to an optician, specific health consultants, their GP, physiotherapists and a chiropodist visits when needed. However, the last person to move had raised with staff that they had not yet seen a dentist and that they had been there a year. We discussed this with the manager who told us that there had been some difficulties with getting the individual registered with Care Homes for Adults (18-65 years) Page 26 of 45 Evidence: the right dentist. We acknowledge this but individuals health needs must be followed up in a timely way. It is recommended that peoples health and care plans be reviewed on a monthly basis to make sure that any elements of their care and support are not missed. This individual has a yellow health action plan record from their previous home that has not been used. This record is a useful document for people, the staff and health professionals as it is a central record that everyone can contribute to, record appointments and is easy to follow. The yellow health book is supported by pictures so it is more accessible to people. Only the last person to move in has a Health Action Plan at the moment. All of the people should have these specific health reviews with specialist nurses and the local GP practice. This should be followed up to ensure that people have accessible information from health professionals about their health. Staff are trained in the medication policies and procedures during induction and there is a medication training programme. Records of administration of medication seen were correct and medication was stored safely. A number of people have PRN (as required) medication. Some of the plans for taking as required medication did not specify under what circumstances it is to be given, how long between doses and what is the maximum dose in 24 hours. PRN (as required) medication plans must be written. The prescribing practitioner or health professional should approve these medication plans where possible. This is so that staff know how and when to safely administer as required medication. To date there have not to date been any controlled drugs in the home and there is not any controlled drugs storage. Care Homes for Adults (18-65 years) Page 27 of 45 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 poor 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 are listened to by staff and procedures are in place to respond to complaints. The shortfalls in staff and managers knowledge and understanding of the homes adult protection safeguarding procedures means that allegations may not be reported to the relevant authorities and people are potentially at risk. Evidence: The complaints information has been reviewed since the last inspection. It is now supported by pictures to make it easier to follow for people. It is recommended that it also include photographs of the manager and owner so people know who to complain to. People told us they would talk to staff if they were unhappy. However, the survey told us that people dont know how to make a complaint. The two staff surveys told us that they know what to do if someone has concerns about the home. The adult protection safeguarding policy and procedures at the home need reviewing as they refer to a previous manager and do not include the contact details of the local authority and the commission. There have been two adult protection safeguarding matters at the home since the last key inspection. The most recent allegation was not reported to the local authority help desk as detailed in the local authority safeguarding protocol nor was the incident reported Care Homes for Adults (18-65 years) Page 28 of 45 Evidence: to us. The manager did report the initial incident to the learning disability team and again when additional information was available and there was a five day delay before the team responded. There was no separate record of the incident, the dates and times of the safeguarding referrals or the actions taken to reduce the immediate risks to the individual. We hi-lighted that if correct procedures had been followed that both the local authority and we would have responded to the alert and the risks may have been reduced sooner. During the course of the inspection as identified in the Individual Needs and Choices section there were further adult protection safeguarding incidents that had not been acknowledged as abuse or reported to the local authority. We made an adult protection safeguarding alert following the inspection. Incidents where people are physically aggressive and or harm other people at the home must be reported to us under regulation 37. A referral must also be made to the local authority so they can determine whether it needs investigating. People are supported to manage some aspects of their finances. Most people choose to go to the bank to collect their money. The manager and senior support worker check the records on a monthly basis. Care Homes for Adults (18-65 years) Page 29 of 45 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. The home is well maintained and furnished so that people live in a clean, comfortable and homely environment. Evidence: There is a warm and welcoming atmosphere in the home and at the time of the visits, it was homely, comfortable and safe. People living there were able to move around easily and freely and to go to their bedrooms if they chose. Since the random inspection all of the first floor windows that are accessible to people have had restrictors fitted. Three people showed us their bedrooms. The bedrooms reflected their individual lifestyles, interests and tastes. The home was clean and free from any offensive odours. A few people are involved in the daily chores of looking after the house. The manager told us that there are plans to refurbish the upstairs bathroom within the next year. There are established policies and procedures in place for the control of the risk of infection in the home and staff practices during the visit were seen to be Care Homes for Adults (18-65 years) Page 30 of 45 Evidence: safe. Care Homes for Adults (18-65 years) Page 31 of 45 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. People are supported by a staff team that know them well. The night time staffing arrangements need to be closely monitored to make sure that people are not placed at risk. The poor recruitment practices at the home potentially place people at risk of harm from staff that have not been been checked whether they are suitable to work with vulnerable people. Evidence: Since the last inspection the staffing at the home has been reviewed. There is now more support for people during the day and there is now only a sleep in member of staff. As detailed in the Lifestyle section. The manager must reassess whether the current staffing arrangement of a staff sleep-in is sufficient. This is to make sure that there is enough staff to meet all of the needs of the people at the home without placing restrictions on any individuals and protecting other peoples right to privacy and undisturbed sleep. The home has a low turnover of staff with only a few staff leaving since the last inspection. Staff sickness levels are also low and this means that a consistent staff team that they know well supports the people living at the home. The staff rotas for one month were seen, the rotas only include staff initials. The rotas should include staffs full name and role so it is clear who is working and in what capacity. Care Homes for Adults (18-65 years) Page 32 of 45 Evidence: It is recommended that a photographic rota be produced so that all of the people in the house know who is going to be on duty. Three staff files of the most recently recruited staff were seen. There was not a record in the files of their start date. It is recommended that a checklist be developed so that the manager can check whether all of the information has been received before staff start work. Two of the files included two or three written references, these had been verified by telephone. However, one of the staff files only included one reference and no copies of the individuals identification. Two written references must be obtained before staff start work and copies of identification kept. This is to make sure that staff are suitable to work with vulnerable people and to be able to confirm their identity. Two of the files included CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable Adults) checks that had been obtained before the staff started work. The most recently recruited member of staff who was supernumerary during the inspection started before a POVA check had been obtained and their CRB had not yet been returned. Staff must not start work in any capacity before a POVA check has been received and then they must be supervised until the receipt of the CRB check. The staff member who is supervising the new worker should be identified on the rota. This is to make sure that people are not put at risk from staff who have not been properly checked and they are supervised until checks are returned. There is an induction programme in place that is based on skills for care standards. The manager told us in the AQAA that Our training consists of: Medication administration, first aid, Challenging behaviour, equality and diversity, health and safety, infection control, fire training, food hygiene, abuse awareness, manual handling and risk assessment and any other training relevant to individual job roles. Staff records show that they now have regular supervision and their are regular staff meetings. Staff surveys show that the manager meets and gives support regularly. Care Homes for Adults (18-65 years) Page 33 of 45 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home do not benefit from or live in a home that is consistently managed or recruits some staff safely or that has effective monitoring systems. Evidence: The manager has recently been registered with the Commission. The manager completed the AQAA (Annual Quality Assurance Assessment) and was able to demonstrate where they had improved the home over the last year and identify some areas for improvement. During the visit staff appeared confident in their roles, the home was relaxed and people appeared at ease and comfortable. There are a number of serious shortfalls in the assessment of risks for people, care plans, access to health care, the recognition and reporting allegations of abuse, staff recruitment and the reporting to the commission. The manager told us that she has started to develop a Quality Assurance system that Care Homes for Adults (18-65 years) Page 34 of 45 Evidence: includes annual surveys for people, a weekly and monthly job checklist and has produced an action plan that is based on the KLORA ( Key Lines Of Regulatory Assessment). However, there is no regular auditing or monitoring of care plans, care records, incidents and accidents. The registered provider has not undertaken any Regulation 26 visits since 2007. The registered provider and manager told us that this was because they were at the home most days. We identified that allegations of abuse and events that effect the well being of people had not been reported to us under Regulation 37 notifications. Information sent to us in the AQAA (Annual Quality Assurance Assessment) in September 2009 tells us that equipment is serviced or tested as recommended by the manufacturer or other regulatory body. We looked at the fire records at the home and the fire risk assessment. The fire risk assessment was out of date and did not include that one of the people at the home is a wheelchair user. The emergency information kept at the main entrance to the home was also out of date and did not include the details of all of the people living at the home Care Homes for Adults (18-65 years) Page 35 of 45 Are there any outstanding requirements from the last inspection? Yes No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 36 of 45 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 6 17 Body Maps must be completed following any inury and behaviour monitoring records must be consistently followed up. The management team must regularly review the records kept about people. Staff must be given clear direction as to what actions they must take to follow up any information they records. This is to make sure that any areas of concern are followed up at the time, monitored on a regular basis, that people are consistently supported and kept safe. 01/12/2009 2 6 15 Peoples care plans must be reviewed, kept up to date, 01/12/2009 Care Homes for Adults (18-65 years) Page 37 of 45 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action and include all the individuals needs identified in their assessments. This is so staff know what care and support people require to make sure that all their needs are met and they are well cared for. 3 9 13 Any areas of risk identified for an individual must be assessed and these assessments must include clear descriptions of the action staff need to take. 01/12/2009 This is so that any risks are minimised and staff know what action to take to keep people safe whilst promoting positive risk taking. 4 11 12 People must be provided with 01/12/2009 opportunities to develop their social, emotional, communication and independent living skills. People must be provided with suitable stimulation and have the opportunity to be occupied. This is to ensure that people have a good quality of life and well being. Care Homes for Adults (18-65 years) Page 38 of 45 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 5 19 13 People must have access to health professionals such as dentists. 01/12/2009 This is to make sure that peoples health needs are met. 6 20 13 Individual PRN (as required) medication plans must be written that specify under what circumstances it is to be given, how long between doses and what is the maximum dose in 24 hours. 01/12/2009 This is so that staff know how and when to safely administer as required medication. 7 23 13 There must be a clear adult protection and safeguarding procedure that is easy for staff to follow. 01/12/2009 This is so they know how and to whom they can report any allegations of abuse. 8 23 13 Incidents where people are 01/11/2009 physically aggressive and harm other people at the home must be reported to the commission under regulation 37 and to the local authority under adult protection safeguarding Care Homes for Adults (18-65 years) Page 39 of 45 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action procedures. This is to make sure that any allegations are appropriately investigated and actions taken to safeguard the people living at the home. 9 33 18 The manager must reassess 01/11/2009 whether the current staffing arrangement of a staff sleepin is sufficient. This is to make sure that there is enough staff to meet all of the needs of the people at the home without placing restrictions on any individuals and protecting other peoples right to privacy and undisturbed sleep. 10 35 16 POVA check, two written references and copies of identification must be obtained before staff start work. 01/12/2009 This is to make sure that staff are suitable to work with vulnerable people and to be able to confirm their identity. 11 39 26 The registered provider must 01/01/2010 complete monthly Regulation 26 visits. Care Homes for Adults (18-65 years) Page 40 of 45 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action This is to make sure that the quality of the service is regular assessed and reviewed. 12 39 24 The overall management of the home must improve, and develop effective ways of assessing and monitoring the quality of the service. This is so that shortfalls are identified, are improved on and the quality of the service is kept under constant review. 13 41 37 Regulation 37 notifications must be made for all events that effect the well being of people living at the home. This is to ensure that the home is effectively monitoring and reporting incidents in the home. 14 42 23 A fire risk assessment must be reviewed to include: The fire hazards you have identified, The actions you have taken or will take to 01/12/2009 01/12/2009 01/03/2010 Care Homes for Adults (18-65 years) Page 41 of 45 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action remove or reduce the chance of a fire occurring, Persons who may be at risk, particularly those especially at risk. The actions you have taken or will take to reduce the risk to people from the spread of fire and smoke, The actions people need to take in case of fire (your emergency plan). The information, instruction and training you have identified that people need and how it will be given. This is to ensure the fire safety at the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The statement of purpose should be updated. The service user guide should be supported by photographs of the home and of key people, such as the providers and staff. This is so that people have accurate, up to date and accessible information about the home. People should have the opportunity to have a number of visits to the home and the views of the people already living at the home should be sought. Records of the visit and peoples view should be kept. This is to make sure that the home can meet peoples needs and that people are consulted as to who is going to move in. Staff should develop life story books/works with people Page 42 of 45 2 4 3 6 Care Homes for Adults (18-65 years) 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 living at the home, as these give a much more interesting picture of how people have been spending their time and people may find them easier to follow than written records. This means that people can be actively involved in the monthly reviews of their plans and goals. 4 6 Life history books should be developed that includes details and photographs of their history such as family, friends, where they have lived, pets, work etc. These life history books will assist both the person and staff in remembering their past and will assist staff to have a greater understanding of them as an individual. Peoples care plan profiles should be updated. This is so staff have full information about people, so they can meet all of their assessed needs and have a greater understanding of them as an individual. Care Plans should be further developed in formats that are accessible to individuals. The care record keeping system should be reviewed so that it is easier to follow, reflects how people have spent their time and the personal care and support provided to them and is not reliant on codes. People should be given the opportunity to fulfill their spiritual needs. There needs to be a more proactive and positive risk taking approach to more people being involved in the day to day living at the home. These are important life skills that people should be encouraged to develop, particularly for those people who do not attend any structured community day opportunities. A collection of photographs of food should be developed so that the people who communicate differently can participate in the menu planning on a weekly basis. Peoples health records should be reviewed on a monthly basis so that important health matters are not missed again. 5 6 6 6 7 6 8 9 11 11 10 17 11 19 Care Homes for Adults (18-65 years) Page 43 of 45 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 12 19 Yellow health action plan books should be followed up to ensure that people have their health needs assessed and have accessible information from health professionals about their health. It is recommended that the complaints procedure also include photographs of the manager, provider and staff so people know who to complain to. It is recommended that a photographic rota be produced so that all of the people in the house know who is going to be on duty. The rotas should include staffs full name and role so it is clear who is working and in what capacity. A recruitment checklist should be developed so that the manager can check whether all of the information required has been received before staff start work. 13 22 14 33 15 16 33 35 Care Homes for Adults (18-65 years) Page 44 of 45 Helpline: Telephone: 03000 616161 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) 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. 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