Inspection on 04/08/09 for Severn Oaks

This inspection was carried out on 4th August 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Severn Oaks 25/06/07

Severn Oaks 09/05/06

Severn Oaks 12/12/05

Severn Oaks 05/04/05

Severn Oaks 11/01/05

Severn Oaks 07/05/04

Severn Oaks 03/12/03

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

Key inspection report Care homes for adults (18-65 years) Name: Address: Severn Oaks 6 Jesmond Road Clevedon North Somerset BS21 7SA 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: Sandra Jones Date: 1 4 0 8 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 33 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Severn Oaks 6 Jesmond Road Clevedon North Somerset BS21 7SA 01275878447 01275873775 rob.hogan@cintre.org 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) : Cintre Community Limited care home 7 Number of places (if applicable): Under 65 Over 65 7 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is 7 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 33 A bit about the care home Severn Oaks is in a residential area and provides support to younger adults with mild learning disability and complex needs. The home strives to promote independence and acts as a springboard for service users to move toward independent living. It aims to support service users to acquire the whole range of practical skills necessary for living in the community. The home is in a residential area close to the town, sea front and local amenities. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 33 How we did our inspection: This is what the inspector did when they were at the care home This key inspection was conducted unannounced in over three days in August 2009 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined and feedback was sought from the staff. Prior to the visit some time was spent examining documentation accumulated since the previous inspection including the Annual Quality Assurance Assessment (AQAA) and this information was used to plan the inspection visit. There are six people currently living at the home and three people were case tracked. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people living at the home and other related documents. The homes policies and procedures were also used to confirm the findings. Care Homes for Adults (18-65 years) Page 7 of 33 People at the home were invited to make comments about the standards of care and two people agreed to give feedback. The staff on duty were also consulted and the comments made were used to confirm the documentation. What the care home does well What has got better from the last inspection There has been a deterioration in the standards of care. Care Homes for Adults (18-65 years) Page 8 of 33 What the care home could do better There are eight requirements arising from this inspection and is based on assessments of needs, care planning, risk assessments, accommodation and staffing. The Statement of Purpose must be updated to ensure that people wishing to live at the home have sufficient up to date information so that they can make decisions about moving into the home. Homes needs assessments must be conducted by the home so that it can be determined that the skills of the staff can meet the needs of the people wishing to live at the home. The care plans in place must be clear about the way the needs of the people wishing to live at the home are to be met. Associated risk assessments must be developed to lower the level of risk so that risks can be taken safely. Management plans for people that challenge the service must be developed from a best interest approach with input from the social and healthcare professional. This will ensure that staff are consistent in the way they handle certain behaviour and a multiagency approach will ensure that the techniques used are within good practice guidelines. The property is in need of remedial action to ensure that the people accommodate Care Homes for Adults (18-65 years) Page 9 of 33 have a homely environment. The staffing levels must be reviewed to ensure that staff are able to manage aggressive and violent situation when they are working long hours. Specific training must be provided to ensure that staff have the skills to meet the changing needs of the people living at the home. In-house inductions in policies and procedures must be provided to increase new staffs awareness about the way the home operates. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sandra Jones Colston 33 33 Colston Avenue Bristol Avon BS1 4UA Care Homes for Adults (18-65 years) Page 10 of 33 01179307110 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 11 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home fails to provide sufficient information for people wishing to live at the home to make decisions about moving into there. Homes assessments are not undertaken and people cannot be reassured the staff are aware of their needs or have the skills to meet their needs. Evidence: Severn Oaks has a separate Statement of Purpose and Service User Guide reviewed in 2009. While the date indicates that the Statement of Purpose was reviewed, it is clear that the information is not up to date. For example It says that Control and Restraint is used, this form of physical intervention does not follow good practice and reassured by the staff no longer used at the home. The Service User Guide is symbolised with pictures and words so that the people for whom its intended can understand it. The organisations aims and objectives are to provide therapeutic and structured environment in a holistic framework. Accommodation is provided for up to 7 people within the age range of 16-45 with learning disabilities and behaviors that challenge. While the date on the Statement of Purpose indicates Page 13 of 33 Care Homes for Adults (18-65 years) Evidence: The arrangements for admission is briefly described with a more in-depth procedure supplementing the information held within the Statement of Purpose. The admission procedure is detailed and includes pre-assessments to be conducted by the staff to determine the individuals suitability to live at the home. Details about behaviors exhibited is sought at the time of admission with additional information which seeks staffs views on meeting the individuals needs. Comments from a member of staff was sought about the admission process who told us that previously potential admissions was a team decision. This has now changed and people are moved around within the organisations without any consultation or discussion. The two most recent placements occurred within the organisation and the records examined show that the home fails to consistently follow the admission procedure. A social workers needs assessment was in place for one person and staff said the needs assessment for the other person was in progress. Homes needs assessments were not undertaken by the staff, the assessment from the previous placement was used despite the placement having failed. The staffs failure to conduct an adequate assessment meant that it was not determined if the skills of the staff could meet the individuals needs. As a result of poor assessments one persons 1:1 support was not provided although funded by the funding authority. Contracts are in place and relate to the payment of fees, physical intervention, the procedure for termination of contract and house rules. However the consequences for breeching the house rules are not listed. Eg. No bullying yet no consequences for people that bully each other. For people to make decisions about living at the home, the consequences for breaking house rules must be listed. Care Homes for Adults (18-65 years) Page 14 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an inconsistent approach to care and people cannot be reassured that their care is personalised. There are concerns about the way risk assessments are used by staff. Evidence: Comments were sought from staff about the care planning process and were told that keyworkers gather information from other staff to develop the care plan, which is overseen by the person. Once the person agrees with the plan of action, it is signed to indicate agreement. Two people agreed to give feedback about the quality of care provided and one person was aware of their care plan and said that they were able to add comments to the care plan and attend reviews. Care plans contain relevant background information and all areas of needs are listed with development plans attached on the way the needs identified are to be met, these are then signed and dated by the person. The care plans in place are disjointed and information is difficult to find which creates inconsistencies in the way people have their needs met. Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: Social workers are involved in the care of the people currently accommodated and review meetings are convened at least annually. Following these meetings care plans are then amended and development plans are implemented. However, action plans are not specific and there are no clear instructions that guide staff on the actions to be taken. Where agreements are made with the person, there is no evidence that staff follow the agreements, for example a request not to have contact with family was disregarded by the staff team. The people are assessed by Avon and Wiltshire Partnership (AwP) Mental Health Team and the Community Learning Disabilities Team (CLDT) and for people with learned behaviours that fall outside the AWP and CLDT remit, referrals are made to a Clinical Psychologist. Feedback from the clinical psychologist was sought about the standards of care, who said there is a decline in the quality of care, people were more settled last year and the home is in survival mode. It was further stated that there is a lack of staff morale and leadership with staff fighting fires. People at the home have access to advocates and at present two people have advocates involved. While staff have undertaken Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS) training there is little evidence about the way people that need restrictions imposed are care for, for example, room searches. It is acknowledge that the person has agreed to the room searches. However, there is no clear evidence that DOLS and best interest pathways were followed for these room searches. Care plans must be clear about the way people that require restrictions imposed are care for. Keyworkers have 1:1 supervision with the person for the purpose of giving people the opportunity to discuss issues and activities. This supervision is individual and weekly, a report about the session is then reported and where necessary issues discussed are passed onto the manager. Risk assessments are in place for activities that involve an element of risk including selfharming, inappropriate behaviours and theft. Within the risk assessments are the activity, the triggers, consequences of the activity and preventative measures are listed. However, the information provides little guidance to the staff on the actions they must take to lower the risk. Risk assessments must guide the staff on the actions that are necessary to reduce the level of risk The way risk assessments are used raises concern, during the inspection one person was observed discussing the risk assessment with a member of staff. This person said that the risk assessment was not fully discussed because of staff time constraints which was then used against them the following day. Care Homes for Adults (18-65 years) Page 16 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are opportunities for people at the home to shape their lives and are supported to participate in occupation, education and independent living. Evidence: Each person has a Personal Development Plan based on daily living skills, personal care and preparing for independent living. Learning styles questionnaires are completed with the person to determine the best way to provide information. For example pictorial formats. The persons aim for the future and how this is to be approached is sought and a record made. A preparing to move section is used to support people with moving into independent living. This is clear evidence that steps are taken to support the person to shape the lives they lead. Education is offered and 1:1 support is offered for people that need additional support with learning. Staff assist individuals to seek college courses and were told that in the past a home tutor had been used to support one person. People are also supported to seek occupation opportunities and one person has been in paid employment. Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: There is a rota of activities which shows that people are supported to seek employment, education and independent living skills. There is an expectation that people participate in household chores and the tasks allocated include cleaning communal areas, with staff cleaning the kitchen. House meetings are weekly and generally well attended by the people at the home, the minutes of the meeting are taken and an action plan developed where tasks from the meeting are identified. A house representative who acts as a link between staff and people at the home is appointed from the resident group each month. The people at the home are independent and with the exception of one, the people at the home can leave the home independently. There is an expectation that people return by 10:00 pm otherwise the police is informed. There are house rules which are signed by the person and as previously mentioned, the consequences of breaking the house rules are not specified. For example, there is an expectation that people participate in household chores and the staff told us that when people refuse they will complete the task. The leisure activity to be undertaken cannot then take place because staffs time has to be used to complete chores. Two people were consulted about the opportunities available for education, occupation and leisure. One person said that they participate in education, go out with staff support and is clear about the reasons for these arrangements. This individuals also said that there are many house rules and is unclear about the consequences of breaking the house rule. This statement was then corrected by saying that when individuals refuse to do household chores, the staff will say that the leisure activity cannot take place because they must then undertake the task. Another person who also acts as the homes representative agreed to give feedback and said that they live independently in the annexe of the home, this individual listed the house rules and only knew the consequences for refusing household chores. The reps. role was then discussed and it includes speaking to the individuals at the home and discussing these views at staff meetings. Care Homes for Adults (18-65 years) Page 18 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people at the home receive appropriate personal and healthcare support. Evidence: People at the home are independent and do not require assistance from staff with personal care. Health action plans are in place which lists the health care professionals involved with a brief medical history and members of staff record of appointments. The nature of the appointments with the outcomes of the visits are recorded and medical advise is passed on through handovers and reports. Staff explained the arrangements in place for visiting health care professionals. We were told that some people are able to visit the home independently and some are accompanied by the staff on request or when suggested by staff because of concerns. Two people were asked about the arrangements for health care, we were told by one person that they self medicate and visit the GP independently. While the other one said they are accompanied by the on health care visits. Risk assessments are in place for people that self medicate and one person selfmedicates fully while others do it with staff support. Medications administered by the staff Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: are through a monitored dosage system and the records checked show that staff sign the records after medications are administered. Care Homes for Adults (18-65 years) Page 20 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home know who to approach with complaints and overall they feel safe. A multi agency approach to developing management plans for behaviors that challenge would ensure that people have positive behavior management plans that follow best interest. Evidence: There is a Complaints procedure in place and a record of complaints is maintained. Three complaints were received in the last twelve months which relate to loud music and with the exception of one made by a neighbor, the people at the home made the other two complaints. The level of satisfaction from the complainants were sought. However, the advise given to the neighbour shows that staff are not always able to resolve situations at the lowest level. For example staff advise to a neighbour was to contact Environmental Health for noise pollution. The Cintre organisation Whistle Blowing and Safeguarding Adults policy in place reinforces a commitment to protecting people from abuse. The Whistle Blowing policy reassures staff who report poor practice that they will be protected from reprisals. It is acknowledged that the purpose of the policy is to create a culture of openness, where staff feel able to report poor practice. However, the implications for not reporting poor practice is not stated. Members of staff must be informed that they may be subject to disciplinary procedures for not reporting poor practice. There is one Safeguarding Adults referral in progress made by the staff and social worker Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: about alleged abuse by one person towards another. Two people living at the home agreed to give feedback about the way complaints and protection are managed at the home. Both people said they would approach their keyworker and one also named the Residential Care Manager(RCM)as another person they would discuss complaints with. Regarding protection, one person said that they felt safe while the other only felt safe sometimes and this was mainly when staff were present. Individuals were asked if staff shouted at them and these were their comments, they are quite nice actually and they dont shout and no one shouts not really. The Residential Care Manager said that staff are trained in line with General Services Physical Intervention and Diffusion linked to BILD. The organisations trainers visit and regularly review risk assessments. The management plans for three people that present with bullying, violence and self-harm behaviours were examined. Within the plans the observations, triggers and strategies to prevent escalation of behaviours, diffusing and using physical intervention are described. However, risk assessments and care plans for these behaviours are also in place which are not linked to the management plans creating inconsistencies in the way these behaviours are managed by the staff. Also there is no evidence that management plans, risk assessments and care plans are reviewed following behaviours that challenge. A system where incidents are reviewed to assess the techniques used by the staff to then amend the management plans will ensure that staff safely and appropriately manage behaviours that challenge. While members of staff told us that social workers, psychologists and psychiatrists are aware of the management plans, there is no evidence that the action plans were developed using a multi agency approach. People at the home can at times bully each other and the management plan in place is to contact the police. An action plan that guide staff on the initial steps to the triggers that then diffuse and divert the behaviours exhibited and emergency services are used only as a last resort are not in place. The staff search another persons room. However, a clear plan on the way room searches are to be conducted with the staff and people to be present during the searches are not in place. Also more information is needed about the way the home handles people that self-harm. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Remedial action must be taken so that the people at the home can benefit from a homely environment. Evidence: Severn Oaks is a large period property in a residential area which blends well with its environment, close to shops, amenities and bus routes. Arranged over three floors with communal space on the ground floor and bedrooms on the first and second floor. The personal accommodation is in single bedrooms and with the exception of one all bedrooms are en-suite. On the second floor there are two independent living flats for people that are preparing to live independently in the community. A tour of the property was conducted and it is evident that there are areas of the home that require attention in order to provide a homely environment for people living at the home. It was understood from the staff that a maintenance plan already exists and the areas of repair viewed during the tour are incorporated and will be addressed. There is a large lounge at the front of the building with plenty of comfortable seating, and there is a spacious dining room next door to this. The kitchen is big enough to accommodate more seating. Care Homes for Adults (18-65 years) Page 23 of 33 Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at the home can be reassured that the staff employed at the home are suitable to work with vulnerable adults. However they cannot be reassured that staff working long hours are able to manage difficult situations. The manager must ensure that staff attend specific training and induction so the changing needs of the people at the home can be met by skilled staff. Evidence: The recruitment processed was examined to determine that the staff employed are suitable to work with vulnerable adults. Since the last inspection one person was employed and their personnel file was examined to assess the recruitment process followed. A completed application form that seek the individuals employment history, the names of two referees and disclosure of criminal background is held within the personnel file of the most recent employee. Two written references and Criminal Record Bureau show that the homes recruitment procedures are robust and staff suitable to work with vulnerable adults are employed. Feedback from this member of staff about the recruitment process followed was sought and we were told that candidates were shortlisted from the application form and the selection of staff was based on the interview, references and clear CRBs. Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: It is evident from the induction prgramme that there is a corporate skills induction which includes statutory training. However, there is no evidence that an in-house induction where policies and procedures were discussed. Members of staff must receive an induction that incorporates in-house induction about the way the home operates. Vocational qualification is encouraged and all staff have either accomplished NVQ 3 or are working towards this qualification. It is acknowledged that staff have refresher training in Safeguarding Adults and Positive Response Training. However, other specific training that meets the range of needs of the people accommodated is not provided to all staff. Members of staff must attend training that ensures they are able to meet the changing needs of the people at the home. The rota in place was examined and shows that there are two staff from 7:00-9:00 a.m, staffing levels then increase to three until 10:30 p.m. when two sleeping-in staff come on duty. There is a shortfall of 3 full time staff currently covered by bank and existing staff. Some staff are currently working long hours raising concerns about staffs ability to manage violent incidents. Two people at the home were consulted about the staffs abilities to meet their needs. We were told that generally the staff know how to meet their needs. Care Homes for Adults (18-65 years) Page 26 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people at the home cannot be reassured that the home benefits from strong leadership and consistent practices. The people living and working in the home benefit from a safe environment because of the checks and practices conducted. Evidence: At present the manager is on a period of leave from the home and the Residential Care Manager (RCM) is acting-up into the position of manager. Comments about the manager were sought from the two people giving feedback and one person said that they get on alright with the manager. Members of staff were also consulted about the management of the home and they told us that people were a lot happier before and they are in a state of limbo. This statement was also echoed by the health care professional who said that there is a lack of structures and systems and the home is in survival mode. The findings of this inspection in terms of inconsistencies with the way staff manage behaviors that challenge and inappropriate assessments together with the comments made raises concerns about they way the outcomes for people living at the home. Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: Facilities for cash and valuables exist and a sample of cash held on behalf of the people at the home was conducted. The records examined coincided with the balances held in safekeeping and the receipts in place supported the purchases made on behalf of the people at the home. The standard fees charged at the home are £1500.00 per week which can increase or decrease depending on the persons level of need. The home ensure compliance with associated legislation to ensure people living and staff that work there do so in a safe environment Contractors are used to service equipment and appliances, and fire risk assessments are completed to ensure that where a potential of fire is identified preventative action is taken. Care Homes for Adults (18-65 years) Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 1 1 4.(1)(a)(b)(c), 5. The Statement of Purpose 25/08/2007 (1)(a)(b)(c)(d)(e)(f and Service Users Guide ) Sch. 1 must include all the required information. Care Homes for Adults (18-65 years) Page 29 of 33 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 1 6 The Statement of Purpose must be kept under review. 03/12/2009 The Statement of Purpose must include sufficient information to enable people wishing to live at the home to make decisions about moving there 2 2 14 The registered provider must 03/12/2009 not provide accommodation to any person unless an assessment of needs has taken place. The manager must undertake needs assessments before admission to ensure that the staff have the skills to meet the needs of the people wishing to live at the home. 3 6 15 A written plan on the way the individuals need are to 03/01/2010 Care Homes for Adults (18-65 years) Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action be met by the staff. Care plans must be clear about the way the needs of the people accommodated are to be met. 4 9 13 The registered person must ensure that any activity is free from avoidable risk. 03/01/2010 Risks must be assessed to develop an action plan to lower the level of risk 5 23 13 The registered person must ensure that people at the home are protected from abuse. 09/11/2009 Management plans for people that challenge the service must be developed from a best interest approach with input from social and healthcare professionals 6 24 23 The registered person must 10/01/2010 ensure that the premises are kept in good repair. Remedial action must be taken so that the property can offer a homely environment to the people living at the home. 7 33 18 The registered person must 09/10/2009 Care Homes for Adults (18-65 years) Page 31 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action ensure that staffing levels meet the range of needs of the people accommodated The manager must ensure that staff able to manage violent and aggressive incidents when they have been working long hours. 8 35 18 The registered person must 09/01/2010 ensure that new staff receive an induction and are trained to perform the are employed to perform. The manager must ensure that new staff have a period of in-house induction and attend specific training that meets the changing needs of the people accommodated 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 Care Homes for Adults (18-65 years) Page 32 of 33 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. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!