Inspection on 24/06/09 for Sharpe House

This inspection was carried out on 24th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sharpe House 05/07/07

Sharpe House 11/07/06

Sharpe House 24/11/05

Sharpe House 09/06/05

Sharpe House 22/06/04

Similar services:

The Vicarage

St George`s

Credence House

Radfords

Honeybourne House

Stallcombe House

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: Sharpe House 1 West Road Wiveliscombe Somerset TA4 2JS     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Alison Philpott     Date: 2 4 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Sharpe House 1 West Road Wiveliscombe Somerset TA4 2JS 01984629220 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: jeddinternational@yahoo.co.uk Jedd International Ltd. care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who may be accommodated is 10 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 folloiwng category: Learning disability - Code LD Date of last inspection Brief description of the care home The home is located in the small town of Wiveliscombe and is situated a short walk from the local community and its facilities. Sharpe House is a large detached property arranged over two floors. The layout of the home would not be suitable for service users with a physical disability. All bedrooms are single and have hand wash basins. Some bedrooms are located on the ground floor. The home does not have a passenger lift to reach the first floor. The home has dining room, lounge, conservatory, and two bathrooms, domestic style kitchen, laundry room and well-presented garden. Sharpe House is registered with the Commission for Social Care Inspection to provide personal care for up to 10 service users, under the age of 65yrs, who have a learning disability. The home is not registered to provide nursing care. The home is owned by JEDD International Ltd. The Registered Provider is Mr Declan Howlett. The registered Care Homes for Adults (18-65 years) Page 4 of 32 10 Over 65 0 Brief description of the care home manager is Marek Vaca. The homes current fee range is £350 to £830 per week. Additional charges include those for toiletries, hairdressing, transport some activities and chiropody. The home has two cars and service users currently contribute 50 of their DLA mobility component towards the cost of transport. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection which took place over 6 hours on 24th June 2009. Throughout the report the term we will be used as it is written on behalf of the Commission. As part of this inspection we received eight completed surveys from people who live at the home, seven completed surveys from staff and three completed surveys from health professionals. The home sent us their Annual Quality Assurance Assessment (AQAA) in June 2009. During the inspection we observed care practice, and spoke with people who live at the home, management and staff. We viewed the accommodation and facilities at the home. We looked at three individual care plans, and looked at records relating to medication, finance and health & safety. On the day of the inspection, eight people were living at the home. The focus of this inspection visit was to inspect the relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focusses on outcomes for people living at the home. The quality of the service is measured under four ratings. These are Care Homes for Adults (18-65 years) Page 6 of 32 excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The service users guide should be reviewed and updated so that people have accurate information about the home. The registered manager must ensure that peoples care plans are reviewed every six months. This is so that peoples changing needs and personal goals are identified and met. The registered manager should consider the use of a daily record for each person who lives at the home. This will provide a source of evidence to show that care is being provided as detailed in the care plan and to ensure a consistent approach and good quality of care for people using a service. This will also provide for the review of the care plan. The registered manager should implement a care plan for communication for people who live at the home with communication needs. This is so that staff have information to follow on how to communicate with people, and will enable them to understand what people want. The home should provide training in Somerset Total Communication so that staff are able to use signing with people who live at the home. The home records information about all of the people who live at the home in a book which is stored in the kitchen. The registered manager should ensure that information relating to people who live at the home is stored securely to promote confidentiality. The registered manager should ensure that medicines carried forward on the Medication Administration Record (MAR) Sheets are recorded so that there is a clear Care Homes for Adults (18-65 years) Page 8 of 32 audit trail. When MAR Sheets are hand written, two staff should sign to confirm the record has been checked and is accurate. The registered manager should ensure that the whistleblowing policy is updated so that it refers to current policy. The registered manager should obtain an up to date copy of the Somerset Safeguarding Adults Policy. The registered manager should obtain two signatures when carrying out financial transactions to safeguard people. The home must ensure that they have an appropriate staff induction training programme that meets the Learning Disability Qualification (LDQ)/Skills for Care guidelines. The registered manager must ensure that staff undertake mandatory training. This is to ensure that all staff are able to meet peoples needs appropriately and are up to date with current good practice. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes service user guide has not been reviewed to provide current information. The home has assessment procedures in place for people who would like to move there. Some staff are not trained to communicate effectively with people who live at the home. Evidence: The AQAA told us we have an up to date.. service users guide that provides good information about the home to prospective residents. We looked at the service users guide and found that it was last reviewed in 2004 and contained information that is no longer accurate. There have not been any admissions to the home since the last inspection. The manager told us that he would undertake an assessment to ensure that the home could meet the needs of people before they move in. People would also be invited to Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: visit the home and spend some time there to help them decide if it was the right place for them. The home told us on their AQAA total communication is used to enable service users to make informed choices effectively. Three of the eight staff who work at the home have completed training in Somerset Total Communication. One member of staff who completed a survey told us some of the service users are able to communicate with sign language. I feel that some of the service users would benefit if staff were able to sign. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans contain a good level of detail. Some plans are not reviewed on a regular basis to make sure peoples changing needs and personal goals are identified and met. Records that are written about people when they are out during the day are not transferred to their care plans and are at risk of being lost. People who live at the home are able to take part in regular meetings to discuss what is happening there. Some information about people who live at the home is not stored securely to protect their confidentiality. Evidence: We looked at three care plans. These contained a good level of detail so that staff know how to meet individuals needs. The plans included what people can do independently, what support is needed and individuals preferences. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: The home told us on their AQAA that all service users have personal plans that are regularly updated. We found that one care plan had been reviewed in April 2009. The other two care plans had not been reviewed in the last six months; one was due to be reviewed in August 2008, the second plan was due to be reviewed in April 2009. One persons goal sheet was dated 2007. We looked at the care plan for one person who lives at the home and has communication needs. There was no communication plan in place for them. When discussing this with the manager, he was able to give a number of examples of how to communicate with the person and understand what they want. This information was not documented for staff to follow. One person who lives at the home has epilepsy. A record of seizures was maintained. There was detailed guidance for staff to follow in the event of a seizure. The home does not keep a daily record for each person who lives at the home. We found that information is recorded in communication books that people take out with them during the day. This information is not transferred to a record in the home. This presents a risk if the book is lost as vital information about peoples needs and changing needs are not recorded anywhere else. We discussed the need for daily records with the manager at the inspection. The home also records information about all of the people who live at the home in a book which is stored in the kitchen. This does not protect peoples information and does not promote confidentiality. A health professional told us communication has improved but could be developed further and the service could improve by attending day service to get better view of service users 24 hour needs. The home holds regular meetings for the people who live at the home so that people are able to take part in the running of the home. We looked at the minutes of the last meeting. There was discussion relating to menus and food preferences. The minutes are produced in symbol format so that they are accessible to people who live at the home. One person who lives at the home manages their own money. Risk assessments relating to water, money, keys, transport, behaviour management, radiators and medicines were available. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can do what they want to do. People are able to take part in activities, access the community, and attend day services and work placements. Some people who live at the home take part in domestic routines. Evidence: People who live at the home and completed surveys told us that they can do what they want to do during the day, in the evening and at weekends. The home told us on their AQAA most service users attend day services in Taunton. The others have supported work experience placements or a part time job. On the day of the inspection, six people had gone out. Two people remained at the home. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: One person was going out for a walk. They told us that they enjoy their work placement. The home told us on their AQAA all service users take an active part in the local community. They visit e.g. the local community centre, shops, library, restaurants, internet point, the church and the swimming pool. We looked at activities records which told us that during June people had been out for walks, cycling, to the local pub, the Watchet harbour and museum, a disco, the cafe. Staff comments relating to what the home does well included variety of activities. Comments relating to what could the home do better included an extra staff member when on weekends to allow more movement out of the house for service users and people are put in the same group to do things, some service users would really benefit from doing some things individually. The home is currently in the process of planning holidays with people who live there. The home has a small car available to take people out. Staff and a health professional told us they felt the people who live at the home would benefit from a larger car with more room. The home is also on a bus route. The home supports people to keep in contact with family and friends. Some people make regular visits to see family and spend time with them. The home phone is available if people want to make or receive calls. We observed planners for housekeeping tasks including laundry, food shopping, cooking and cleaning. Two staff commented that with more support some of the people who live at the home could be more independent in these tasks. People who live at the home assist with food shopping. The home has a four week menu. A Picture book has been introduced to help people to choose what they would like. Menus are discussed in meetings and surveys are given out to people who live at the home. We spoke with one person who lived at the home who told us the food is good and they had enjoyed making a ginger cake. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person who lives at the home benefits from having a key worker. People who live at the home have access to a range of health professionals. The homes medicines and records are generally well managed. Evidence: Each person who lives at the home has a designated key worker. A member of staff told us that one person had recently chosen them to be their new key worker. We saw records of healthcare visits to a range of health professionals in peoples care plans. People have also attended for annual health checks. We looked at the homes medication and records. Medicines are stored securely. No one at the home currently self medicates. The home uses a monitored dosage system. We looked at the Medication Administration Record Sheets (MAR). Peoples photos were included for identification purposes. These were no gaps in the records. Creams were dated on opening. One person who lives at the home carries medicine with them Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: when they go out. The home keeps a record of medicine leaving and coming back into the home. The MAR sheet for this medicine did not contain a carried forward amount. This means it was not possible to audit the amount of this medicine in the home. Where MAR sheets had been hand written, staff had not signed the sheet. The home told us on their AQAA all staff who give medication have received accredited training. Two staff were attending medication training on the day of the inspection. The home keeps a stock of homely remedies. The manager confirmed that the GP had agreed the contents of the homely remedies. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home know what to do if they are not happy or have any concerns. The homes policies and procedures generally protect people from the risk of harm. Evidence: The home has a clear and accessible complaints procedure in symbol format. People who live at the home and completed surveys told us they knew who to speak to if they were not happy. The home has not received any complaints since the last inspection. We looked at the homes whistleblowing policy. The homes policy is out of date as it refers to the Somerset Safeguarding Adults Policy (2007). There has been an update to the Somerset policy in September 2008 and this was not available at the home. External contact details were available on a separate sheet. The home ensures that it carries out the necessary protection of vulnerable adult checks before people commence work there. We looked at records relating to peoples monies which are held by the home. We checked one persons monies. These were found to be correct. There was only one Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: signature to confirm transactions. Care Homes for Adults (18-65 years) Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable, homely and safe environment. Peoples bedrooms are personalised to reflect their individual interests and tastes. The home is clean and tidy. Evidence: We viewed all of the bedrooms and communal areas in the home. The home has redecorated some bedrooms and the dining room since the last inspection. New flooring and carpeting has been fitted in the dining room and conservatory. Some areas would benefit from redecoration. The manager told us that there are plans to make further improvements to the environment. On the day of the inspection, the home had two vacant bedrooms. The manager advised that before people move into these rooms they will be redecorated to meet their individual preferences and tastes. Bedrooms were personalised to show peoples individual interests and tastes. We viewed symbols being used in bedrooms to assist people. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: Communal areas include a lounge, dining room and the conservatory which is used for activities. The dining room has french doors that provide access to the pleasant garden. The home was observed to be fresh and clean. We viewed liquid soap and paper hand towels throughout the home. Care Homes for Adults (18-65 years) Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff on duty to meet peoples personal care needs. Recruitment procedures protect people from the risk of harm. The homes induction and training programme does not currently provide staff with the skills and knowledge they need to meet peoples needs. Evidence: The home has a small staff team of eight. New staff have recently been recruited. The manager told us that the home sometimes uses agency staff. On the day of the inspection, the manager was the only staff member on duty. He was supporting the two people who were at home on the day. Two members of staff were on medication training. We looked at the rotas. The home has two staff working in the morning; two staff working in the afternoon and two staff who work a sleeping duty at night. The manager advised that extra hours are provided so that people who live at the home can take part in activities. There is also an emergency on call system in place. Staff told us if theres two staff in the house, theres no support for individuals to go Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: out. We looked at three staff recruitment files. These contained all of the necessary checks to ensure that people are protected from risk of harm. We found that one persons application form did not contain a 10 year employment history, only details from 2003 onwards had been provided. This was discussed with the registered manager at the time. We spoke with staff who had completed an induction when they started work at the home. They told us that they had completed shadow shifts where they had worked with an experienced member of staff. Two people commented that they were told to read the homes policy files and sign to say they had done so. One person has been working at the home for four months. They told us that training in food hygiene and manual handling had been booked. We found a sheet with Common Induction Standards written across the top. This listed items of in house training and videos to watch. This does not fully meet the Skills for Care Common Induction Standards. New staff working in services supporting people with learning disabilities are now required to undertake the Learning Disability Induction Award (Learning Disability Qualification). The award covers all the areas required by the Common Induction Standards. The home gave us a copy of the staff training plan. This covered the following areas; first aid; food hygiene; moving & handling; fire; health & safety; anti-discrimination; equal opportunities; intensive interaction; total communication; epilepsy; vulnerable adults; medication and infection control. There are a number of areas that have not been completed by all staff. Two staff told us they were due to attend some training. We looked at two care plans that stated staff are trained in intensive interaction and total communication. Three of the eight staff who work at the home have completed training in Somerset Total Communication. Three staff who work at the home have an NVQ level 2 or above. One member of staff is working towards their NVQ. Staff told us that the home has regular staff meetings. An agenda is placed on the noticeboard before the meeting so that staff can write down what they would like to discuss. We saw a staff supervision planner displayed on a noticeboard. When we asked staff on surveys does your manager give you enough support and meet you to discuss how Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: you are working?; two staff said regularly; two staff said often and three staff said sometimes. We looked at the supervision record for one member of staff. This contained a good level of detail. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is developing its management structure. There are some inconsistencies in the information provided on the AQAA and what we found during the inspection. The home has some areas that need further development. The home has quality assurance systems in place. Peoples health and safety is promoted and protected. Evidence: Marek Vaca is the Registered Manager. He has been employed at the home for over three years, and was registered with the Commission last year. Marek has completed NVQ 4 and the Registered Managers Award. An assistant manager has been appointed to support the manager in developing the home. We found areas that need further development within the home. At the last inspection Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: on 5th July 2007, we recommended that the registered person should ensure that the staff induction programme met the Skills for Care Common Induction Standards. We found at this inspection, this had not been introduced. We have now made this a requirement. The home sent us their completed AQAA. This made statements about the homes service user guide, staff training and review of care plans. We looked at information during the inspection and found that these statements were not accurate. We found that information relating to care planning was not always being documented. The home doesnt currently keep a daily record for each person who lives at the home. Records that contained information about people who live at the home were not being stored securely. We looked at the homes quality assurance systems. The provider usually visits the home every week. Reports about the visits are maintained. We found that these contained a good level of detail. The manager sent surveys to relatives in October 2008. The results had been put together and the home had followed up comments where necessary. The home does not currently send surveys to other stakeholders and interested parties. We discussed the value of obtaining their views and feedback with the manager. We looked at up-to-date health & safety and service records relating to the following; Gas Safety; electrical installation; portable appliance testing; fire alarms & extinguishers. The home hasnt had a environmental health visit since the last inspection. The manager told us they use safer food, better business pack. We found a cupboard containing hot pipes was unlocked. The manager told us a contractor who had visited the day before had access to the cupboard. The cupboard was locked immediately to ensure that people were not at risk of burns. Cleaning chemicals were stored securely and data sheets were available. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 The registered manager must ensure that peoples care plans are reviewed every six months. This is so that peoples changing needs and personal goals are identified and met. 30/09/2009 2 35 18 The registered manager must ensure that staff undertake mandatory training. This is to ensure that all staff are able to meet peoples needs appropriately and are up to date with current good practice. 31/10/2009 3 35 18 The home must ensure that 30/09/2009 they have an appropriate staff induction training programme that meets the Learning Disability Qualification (LDQ)/Skills for Care guidelines. Care Homes for Adults (18-65 years) Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure that staff are able to meet peoples needs appropriately. 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 2 1 3 The service users guide should be reviewed and updated so that people have accurate information about the home. The home should provide training in Somerset Total Communication so that staff are able to use signing with people who live at the home. The registered manager should implement a care plan for communication for people who live at the home with communication needs. This is so that staff have information to follow on how to communicate with people, and will enable them to understand what people want. The registered manager should consider the use of a daily record for each person who lives at the home. This will provide a source of evidence to show that care is being provided as detailed in the care plan and to ensure a consistent approach and good quality of care for people using a service. This will also provide for the review of the care plan. The registered manager should ensure that information relating to people who live at the home is stored securely to promote confidentiality. - The registered manager should ensure that medicines carried forward on the MAR Sheets are recorded so that there is a clear audit trail. - When MAR Sheets are hand written, two staff should sign to confirm the record has been checked and is accurate. The registered manager should obtain two signatures when carrying out financial transactions to safeguard people. - The registered manager should ensure that the Page 30 of 32 3 6 4 6 5 10 6 20 7 8 23 23 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 whistleblowing policy is updated so that it refers to current policy. - The registered manager should obtain an up to date copy of the Somerset Safeguarding Adults Policy. 9 34 The registered manager should obtain and document a 10 year employment history for staff applications to ensure that people are protected from the risk of harm. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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