Inspection on 22/06/09 for Speakers Court

This inspection was carried out on 22nd June 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Speakers Court 18/09/09

Speakers Court 11/09/08

Speakers Court 18/09/06

Speakers Court 31/01/06

Speakers Court 16/09/05

Speakers Court 23/02/05

Speakers Court 27/07/04

Similar services:

Ashlong House

Spring Lane Care Home

Avenues (The) (Neave Crescent)

Barrington Lodge Nursing Home

Beacon House Nursing Home

St Mary`s Convent & Nursing Home

1-3 Frederick Gardens

The Royal Star and Garter Home

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: Speakers Court St James`s Road Croydon Surrey CR0 2AU     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: Lee Willis     Date: 2 3 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 41 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 41 Information about the care home Name of care home: Address: Speakers Court St James`s Road Croydon Surrey CR0 2AU 02086650745 02086650745 laura.baker@scope.org.uk www.scope.org.uk SCOPE care home 7 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) : Number of places (if applicable): Under 65 physical 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 (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability ? Code PD Date of last inspection Brief description of the care home Speakers Court offers accommodation and personal support for up to seven adults with Cerebral Palsy and associated physical disabilities. The five self-contained flats that make up Speakers are owned by Croydon Churchs Housing Association, but are managed and staffed by the registered charity Scope. The services registered manager, Laura Baker, who has been signed off on long term sick leave since August 2008, resigned her position in July 2009 and will not be returning to Speakers Court. Sohail Edwin, who was apppointed the services new locum manager in May 2009, will remain in temporary charge of Speakers Court, while Scope look to recruit a permanent manager. Care Homes for Adults (18-65 years) Page 4 of 41 Over 65 0 7 0 6 1 0 2 0 0 8 Brief description of the care home Located in the Broad Green area of Croydon the service is relatively close to a wide variety of good leisure and community facilities. The service is also close to a number of very good bus, tram, and rail links with excellent connections to London and the areas surrounding Croydon. The five self-contained flats that make up Speakers all have there own front doors which open out onto a well maintained old converted church courtyard. Each flat has a large open plan lounge/kitchen area, separate bedroom, and en-suite toilet and bathing facilities. The flats have also been suitably adapted to meet the individually assessed needs and wishes of the occupants and maximise their independence. All the flats are wheelchair accessible. There is a separate office located within the complex, which has its own kitchen, toilet and shower facilities, and sleep-in room for staff. All the occupants are provided with copies of the homes Statement of Purpose and Guide. Scope currently charges between £39,000-£59,000 a year for each placement for facilities and services provided. Care Homes for Adults (18-65 years) Page 5 of 41 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: From all the available evidence gathered during the inspection process we have judged this service to continue to have a number of strengths, but also areas of particular weakness. We therefore now rate Speakers Court as a 1 star ADEQUATE performing service, which represents a deterioration in the overall standard of care provided since its last key inspection. The Commission is also taking enforcement action to secure compliance with regards medication handling practises and we have asked the providers to supply us with an Improvement plan setting out how they intend to address all the issues identified in this report and achieve better outcomes for the occupants. We spent 9 hours at the service spread over two days. During these site visits we met with 2 of the services occupants, the new locum manager, and 2 support workers. We also spoke with the services regional manager on the telephone. The remainder of the inspection was spent in the services office looking at various records and documents Care Homes for Adults (18-65 years) Page 6 of 41 including, care plans for all 4 of the occupants who currently reside at Speakers Court. 7 of our surveys were returned to us. The occupants completed 60 of them, and the rest came from care staff who work there. In addition To these surveys, the Services regional manager completed and returned our Annual Quality Assurance Assessment (AQAA) when we asked for it. This self-assessment document tells what the providers think they do well, what has improved since the homes last inspection, and what they think they could do better. Finally, an expert by experience, who is a person who has a shared experience of using care services joined us on the morning of the first day of this inspection. The expert by experience spoke to 2 occupants at length who he met in their flats. The expert helps us get a better picture of what it is like to live in a care service and key parts of this report are based on what the expert by experience told us. We used a lot of the evidence he provided us with to support the judgements we made about the services overall performance. Care Homes for Adults (18-65 years) Page 7 of 41 What the care home does well: What has improved since the last inspection? What they could do better: As mentioned above the single most significant factor that has contributed to the deteriorating quality of this service has been the long term absence of a permanent manager. Scope have been very proactive in their efforts to utilise their existing managers and the prompt recruitment of temporary locum managers on short term contracts to try and reduce the knock on affect to occupants and staff of not having a permanent manager. However, with the service experiencing 4 temporary managers in the space of 9 months it was somewhat inevitable that this continued lack of continuity has adversely affected occupant and staff morale, the services ability to effectively address outstanding requirements and good practise recommendations, and the overall standard of care provided by Speakers Court. There remains a lot for the existing temporary or the new permanent manager to do in order to improve the lives of the occupants, as well as keep them safe: The provider must appoint a suitably competent, qualified and experienced permanent manager to be in operational day to day control of the service. This will ensure the Care Homes for Adults (18-65 years) Page 8 of 41 occupants benefit from living in a service which is consistently well managed. The registered person shall maintain in respect of each service user a record of all medicines kept in the care home for the service user, and the date on which they were administered to the service user. This is a Statutory Requirement and the Commission is taking enforcement action to secure compliance. The way in which the service monitors its medication recording and administration practises must be reviewed as a matter of urgency and significantly improved. This good practise recommendation was made in the services last report but not fully implemented to a satisfactory standard. This will ensure the occupants receive the correct elves medication and that if and when medication recording or administering errors occur they are identified at an early stage and rectified. All the staff authorised to handle medication on behalf of the occupants should once again being reminded of their medication recording and monitoring responsibilities. This will minimise the risk of medication recording errors occurring and enable staff to identify them at an earlier stage should they happen. All the occupants must have up to date health care action plans that contain detailed information about the outcome of all the appointments occupants have with health care professionals. This will ensure anyone authorised to inspect the record can determine whether or not occupants health care needs are being suitably met and monitored. The provider should establish a time specific rolling programme that sets out in detail how and when they intend to repair and/or replace all the services ageing moving and transferring equipment. This will ensure the occupants moving and transferring needs continue to be met safely. A record of every fire drill or test of fire equipment (including the fire alarms) conducted within the service and of any action taken to remedy defects must always be kept in the service and made available for inspection on request. This will enable anyone authorised to inspect these fire records to determine whether or not they are sufficiently robust to keep the occupants, their guests and staff safe. Scope should also review the way it tests it fire alarm system and caries out fire drills with the Housing/Association who own the building because it is unclear is is responsible for conducting and recording these events. The way in which the service supervises and supports its staff team through one to one supervision sessions with the manager and peer group meetings should be reviewed and the number of opportunities staff have to express their views and to share best practise ideas. This recommendation was made in the services last report, but has not been fully implemented. The manager should also appraise the individual training needs and strengths of his staff team on an annual basis and establish an action plan to resolve any identified gaps in his staff teams knowledge and skills. This will ensure his staff team are suitably competent and trained to meet all the needs of the occupants. All the care staff who work in the service must receive or up date their training in fire safety, first aid, food hygiene, Scopes own safeguarding vulnerable adults, and Care Homes for Adults (18-65 years) Page 9 of 41 infection control. This will ensure all the staff have the necessary knowledge and skills to meet the needs and wishes of all the occupants. Sufficient numbers of the current staff team should also receive specialist training in working with adults with learning disabilities, communication difficulties, continence needs, as well increase their understanding of person centred care planning, Scopes complaints resolution procedures, and the Mental Capacity Act. Furthermore, Team leaders should be appropriately trained to perform their new role and responsibilities. This will enable them to carry out their duties as a team coordinator and effectively run the service in the managers absence. This recommendation was made in the services last report, but was not implemented. The occupants should have more involvement in the selection process of new care staff who work at the service. This will ensure the occupants views are taken into account in the recruitment of new staff and therefore have a greater influence on the way their home is run. The way in which the service manages its nighttime on-call system should be reviewed as current arrangements are unclear and are to heavily reliant on the manager taking responsibility for being on call every night. This will ensure the responsibility for doing on call is more evenly distributed amongst the staff team. All the occupants must have care plans that set out in greater detail all the support they require to ensure their unique communication and social needs and wishes are met. This will ensure staff have all the information they need to meet the communication and social needs and wishes of all the occupants. The way in which the service consults, enables the occupants to participate in the running of their home, and feeds back to them the outcome of their involvement should be reviewed. We recommend the service may wish to consider consulting the occupants about the possibility of reintroducing regular group meetings, as well as recording the outcome of monthly sessions occupants have with their keyworkers. This will ensure that suitably arrangements are in place to enable the occupants to express their views and have a positive impact on the way their service is run. Finally, the occupants should be consulted again about their social interests and their current programme of activities reviewed with them. This will ensure each occupants programme of planed social, recreational and leisure activities matches their interests and aspirations. 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 10 of 41 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 41 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. Prospective new occupants and their representatives do not have access to all the most up to date information they need to make an informed decision about whether or not the service is right for them. Prospective occupants can be confident that they will have the opportunity to find out about the service through planned visits and a thorough assessment of their needs and wishes. This also ensures prospective occupants, their representatives, and the service have all the information they need to make a decision about whether or not the placement would be suitable. Evidence: The new locum manager showed us a copy of the services Statement of Purpose and occupants Guide. These documents contained a lot of detailed an useful information about Speakers Court, but unfortunately neither had been up dated since 2006 to reflect all the changes that had occurred there in this time, including the new management structure for the service and all the qualifications and experience of new staff employed in the past 3 years. Care Homes for Adults (18-65 years) Page 12 of 41 Evidence: The manager confirmed the service now had a number of flats vacant, which Scope were in the process of trying to fill. The manager demonstrated a good understanding of what constituted best practise regarding assessing new admissions. He told us he was currently working closely with the services Regional manager to arrange for a prospective new occupant and their representatives to visit Speakers Court in order to enable them to view their flat and meet the other occupants and staff. Care Homes for Adults (18-65 years) Page 13 of 41 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 accurately reflect each occupants unique needs, strengths likes and dislikes, and personal goals, but do not provide staff with enough information about the support each occupant requires to meet their assessed needs, wishes and aspirations. The services arrangements for consulting the occupants and ensuring they have sufficient opportunities to participate in the day to day running of their home are rather variable at present and should be reviewed to make them more transparent and consistent. Sufficiently robust systems are in place to ensure the occupants are able to take responsible risks and to live their lives as independently as possible. Evidence: We looked at two care plans in depth and agree with the statement made by the services Regional manager that Scope - have implemented a more person centred Care Homes for Adults (18-65 years) Page 14 of 41 Evidence: assessment process at the service which identifies peoples needs. The plans viewed contained lots of useful information about occupants unique personal, social, and health care needs, what their likes and dislikes were, and what their personal goals were for the future. The two occupants spoken with at length both confirmed they had been fully involved in developing their new care plans with their keyworkers as stated in the services AQAA. Documentary evidence was produced on request that showed us care plans were being reviewed at egfualr intervals with all the relevant parties, and up dated accordingly, as recommended in the services last report. Most of the staff who returned our surveys told us they were always given up to date information about the needs of the occupants, while one wrote this was usually the case. However, the new care plans do not contain sufficiently detailed information about how staff should be supporting the occupants to enable them to meet their personal needs and goals. This was most notable in respect of peoples social, communication and health care needs and preferences. Occupants health care needs and the support they require will be examined in greater depth in Outcome group No4 - Entitled Health care support. We agree with the statement made by the services regional manager in the AQAA that providing person-centred planning training for staff is one way it could improve its overall performance. We also recommend in conjunction with improving the detail in care plans regards occupants communication needs and wishes staff also receive further training in this area of practise. The locum manager confirmed that the service continues to work a keyworker system as stated in its AQAA. Both occupants met told us they got on relatively well with their designated keyworkers and felt able to approach them about most things. We agree with the statement made in the services AQAA that - developing a second tier key worker will ensure the occupants do not get missed out when circumstances persist and their key worker is not available. Progress made to achieve this aim will be assessed at the services next inspection. The locum manager told us that as stated in the AQAA the occupants views about how their service is run is always sought at - case reviews, key worker meetings and adhoc one to one sessions and taken into account in respect of how their home is run. The two occupants met told us they were having one to one meetings with their designated keyworkers, but this only happened sometimes and was not on a monthly basis as stated in the services AQAA. Furthermore, the manager was unable to provide us with very much documentary evidence that showed us these occupant/keyworker sessions were being held at regular intervals. Keyworker should be appropriately maintaining records of these meetings which the services states in the AQAA should outline what people have done over the last month and what they want to achieve in Care Homes for Adults (18-65 years) Page 15 of 41 Evidence: following months. 100 of the occupants who currently reside at Speakers Court returned our surveys and all ticked always in response to the questions - Do you make decisions about what you do each day and can you do what you want during the day, evening and weekend? However, we did receive some rather mixed feedback from the occupants regarding the suggestion that group meetings be reintroduced, with some in favour of them and some against. One occupant told us - they sometimes felt isolated in their flat and the way staff feed things back to them could be improved. The expert by experience also wrote in their report both the occupants they met felt they had - a high level of choice and control over their lives on a day-to-day basis, but the level of communication they had could probably be improved. In light of all the significant changes that have occurred within the service in the past year and the fact the management are currently in the process of assessing the suitability of a number of new referrals we strongly recommend Scope consult the occupants about the possibility of reinstating group meetings for the occupants who wish to participate. A comprehensive set of risk assessments were contained in the two care plans being case tracked, which covered various aspects of these individuals personal, social, and health care needs. It was evident from the comments made by the locum manager and staff met that they were committed to supporting the occupants to take more responsible risks and to do more for themselves. The expert by experience wrote in their report that both the occupants they had met told them - they highly valued the independence they felt they had at Speakers Court and compared it favourably to their previous living arrangements in a long stay hospital or a very regulated institutionalised residential home. For example: one occupant indicated managing his own medication and personal appointments, while another told the expert - I go round London on my own. All the risk assessments viewed had been reviewed in the past year and up dated accordingly to reflect any changes in need and/or circumstances. Care Homes for Adults (18-65 years) Page 16 of 41 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. The occupants can choose to participate in a relatively wide variety of meaningful social activities each day, although the way the service ensures activity programmes continually reflect individual occupants changing social interests should be reviewed and care plans updated accordingly. The occupants are supported by staff to choose the ingredients they buy, prepare and the food they eat at mealtimes. Evidence: On both days of this inspection the majority of the occupants were engaged in various social and leisure activities, both within their flats and the local community. This included, shopping with staff for clothes and/or food, having lunch out, and attending classes at day centres. An occupant wrote in one of our surveys they had completed staff always take me shopping. Care Homes for Adults (18-65 years) Page 17 of 41 Evidence: One occupant spoken with at length about their leisure interests told us they enjoyed going to life sporting and musical events and had already made plans this summer to go with staff to watch the tennis at Wimbledon, and the cricket at the Oval. The expert by experience also wrote in their report that both the occupants they had interviewed had told them - they felt they had good access to leisure and community opportunities if they wanted to pursue them at the times that they wanted to access them most of the time. An activity schedule included in one occupants care plan referred to a wide variety of leisure interestrs this inidviual liked to pursue on a regular basis, which included shopping for their own food, attending services at a local church every Sunday, and being an active member of a local social club. However, a lot of the written and verbal feedback received from a number of the occupants and staff indicated the opportunities occupants have to engage in meaningful social activities could be improved. A member of staff who completed our survey wrote - carers should be allowed more time to take the occupants out more on trips to the shops, seaside, and parks, while an occupant wrote - it would be better at Speakers Court if more activities like bingo were arranged. Another occupant told us they no longer went swimming with staff and did not go to concerts as much as they would like, despite this being identified as an achievable aim in their care plan, because their were either not enough staff available or staff did not fancy it. Staff met told us this occupant no longer wished to go swimming and their care plan needed to be revised to reflect this change of heart. We recommend staff consult the occupant concerned to clarify their views about swimming and attending concerts, record the outcome of the review, and take the necessary steps (if any) to achieve these goals. Furthermore, the fact the pages of occupants daily diaries were loose leaf meant the information they contained was not being keep in any particular order, made determining what activities the occupants had engaged in recently very difficult. We recommend the service keeps information about what the occupants do each day in single bound documents for ease of referencing purposes. It was evident from the feedback received from the occupants and staff met that the service continues to operate an open visitors policy. Typical comments made included, the relative of one occupant often stays over night in their flat when they visit because the distance they have travelled, i dont tend to have any of my friends visit me here, but i know they could, and visitors are always made to feel welcome at Speakers court. Care Homes for Adults (18-65 years) Page 18 of 41 Evidence: Comments made by the occupants and staff, records kept, and practises observed, showed us that as stated in the services AQAA - the occupants have their own allowance to spend on food of their choice, do their own food shopping, choose what to eat at mealtimes, and do their own cooking (with support). Care Homes for Adults (18-65 years) Page 19 of 41 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. In the main suitably robust arrangements are in place to ensure the occupants physical and emotional health care needs are met, although the way staff record the outcomes of the appointments occupants with various health care professionals and monitor the continued suitability of all is moving and transferring equipment must be reviewed. The services medication recording, administering and monitoring practises remain inadequate and are therefore continuing to put the occupants at serious risk of harm. The death of occupants are consistently handled with respect and as the individual would wish. Evidence: Moving and transferring assessments were included in the two care plans examined in depth. Staff met demonstrated a good understanding of best practise regarding recognised moving and handling techniques and told us the entire staff team had either recently received or were about to refresh their training in this area of practise. Care Homes for Adults (18-65 years) Page 20 of 41 Evidence: Occupants met both told us that as stated in the services AQAA - Personal care is conducted in privacy. The expert by experience told us - an occupant had a hoist that has been playing up and commented that it had been the same hoist for 18 years. One occupant told the expert - It stopped (the hoist) with me in it the other week. The manager confirmed that there had been a number of break downs regarding the services ageing hoists in the past year and that as a consequence they had arranged for a suitably qualified engineer to review the continued suitability of the services moving and handling equipment. The review carried out in May 2009 identified a number of faults with the current equipment, which have been subsequently fixed. However, we do agree with the comments made by the expert by experience that the providers need to start thinking about how they are going to upgrading all the services rather out dated moving and transferring equipment in the near future. During this two day inspection two health care professionals were observed visiting the service to meet the occupants. AQAA states the service is good at supporting the occupants to access appointments with hospital out patient departments and specialist health care providers. The two occupants met both confirmed this was usually the case, although we are aware that a recent complaint regarding an occupant missing a health care appointment because of a break down in staff communication was recently upheld by Scope. In addition, information contained in care plans regarding the outcome of any health care appointments occupants attend is also variable. We therefore agree with the comments made in the services AQAA by its regional manager that we need to develop a more effective way of monitoring occupants access to health and ensuring any follow up actions from appointments are implemented. The requirement issued in the services last inspection report regarding medication records being appropriately maintained by staff has not been met. An unacceptable number of recording errors and gaps where noted on Medication Administration Record (MAR) sheets used since March 2009 where staff had failed to correctly sign for medicines they had dispensed to people who use the service. This is despite it being stated in the AQAA that - we (Scope) have reviewed our medication procedures within the service and now have a more robust process in place to minimise any potential errors. Furthermore, poor medication handling practises were observed on the second day of his inspection when a member of staff waited over half an hour to sign for medicines they had administered that morning on behalf of a person who uses the service. These Care Homes for Adults (18-65 years) Page 21 of 41 Evidence: major shortfalls in staffs medication practises have also occurred despite the fact that everyone authorised to handle medication on behalf of the people who use the service received approved refresher training in the safe handling of medication in March 2009. In addition to these medication recording errors the good practise recommendation we made in the services last report regarding the way it monitors staffs medication handling practises to ensure they remain safe has evidently not been implemented. We were notified by the service about a significant incident that occurred in December 2008 when staff failed to administer one occupants prescribed medication for a week. It was also concerning to note that it took a week for this on going error to be spotted. We spoke with speakers Courts new temporary locum manager and a member of staff who was designed in charge of overseeing the services medication practises during the second day of this inspection. It was evident from comments both these senior staff made that they were unclear what, if any, arrangements were in place to routinely monitor medication handling practises within the service in order to keep the occupants safe. The service is now required to introduce far more robust quality monitoring of its medication handling practises, including, recording, administration, checking in, and disposal of unwanted medicines. All these negative comments about the service medication handling practises notwithstanding it was nonetheless positively noted that based on assessed willingness and capacity one occupant was being actively encouraged and supported by staff to look after their own medication in their flat and to self medicate. It was also clear from records produced by staff on request and their comments that they understood why it was importance to promote this independent living skill, while discreetly monitoring its practise. It was also evident from comments made by the occupants and staff that the recent death of an occupant was sensitively and respectfully handled in accordance with wishes identified by the individual in their care plan. Care Homes for Adults (18-65 years) Page 22 of 41 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. The services arrangements for dealing with concerns and complaints are sufficiently robust and understood by staff to ensure people who use the service feel listened too and safe. All allegations of abuse are taken seriously by the service and are dealt with in a very open, prompt and professional manner ensuring the risk of the occupants being harmed, neglected and/or abused is minimised. However, not enough of the services staff team have received Scopes own safeguarding training, which will need to be rectified needs to ensure they have the necessary knowledge and skills to keep the occupants safe. Evidence: All four of the occupants who currently reside at Speakers completed and returned our satisfaction surveys and ticked Yes in response the question - Do you know who to speak to if you are unhappy? The expert by experience also told us that both occupants they met told him - they were aware of and had seen the complaints procedure. One occupant had needed to use it to make a complain regarding how the service was being managed. He had gone to Scopes head office to complain and was satisfied with the outcome. 100 of staff who completed our surveys told us they knew what to do if someone raises concerns about the service. The manager confirmed that as stated in the services AQAA three formal complaints about its operation had been made since the last inspection. The services complaints book Care Homes for Adults (18-65 years) Page 23 of 41 Evidence: showed us all three of the aforementioned complaints had been fully investigated in an open and transparent manner and resolved to the complainants satisfaction. The manager assured us that action had already been taken to remind staff about their duty of care to support occupants to keep their appointments with health care professionals and to wear protective clothing at appropriate times. The manager and a member of staff met both demonstrated a good understanding of what constituted abuse and who they needed to notify if they suspected or witnessed the occupants being harmed, neglected and/or abused. The service has made two referrals to the local authorities (Croydon Social Services) safeguarding team in the past year. In each instance the locum manager who was in charge of the service at the time followed local safeguarding protocols and notified all the relevant external agencies, including Croydons safeguarding team for vulnerable adults, the funding authorities, Scopes own complaints and safeguarding team, and the CQC, without delay. It was agreed the first of these disclosure, which related to staffs poor medication practises, be passed back to the provider for them to carry out their own internal investigation using their complaints procedures. The complaint was upheld following a thorough investigation and appropriate action taken to minimise the risk of a similar incident reoccurring, which included sending all the staff team on a safe handling of medication refresher course. The second referral was accepted by the local safeguarding team and following an investigation into the conduct of the services registered manager the Councils findings were inconclusive. Services AQAA states that all staff have undertaken the Croydon on-line safeguarding vulnerable adults training. The services locum and regional manager both acknowledge that not enough of the current staff team have attended the providers own safeguarding vulnerable adults training, which is mandatory for all Scopes support workers. Care Homes for Adults (18-65 years) Page 24 of 41 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 interior decoration of the one self contained flat viewed, including its fixtures and fittings, are well maintained ensuring the occupant lives in a very homely and comfortable environment. The services arrangements for controlling infection are sufficiently robust to ensure the people who use the service also live in a very clean and safe environment. Evidence: The one occupant who invited us to view their flat told us their self contained flat contained all the equipment they needed to live their life they wanted. The also told us they liked the way it had been decorated and considered their flat to be home. The flat was very personalised with all manner of pictures, photographs and ornaments. The flat viewed was very clean and fresh. 100 of the occupants wrote in our surveys they returned that their flats were always kept fresh and clean. Each flat has its own washing machine, which is capable of dirty laundry at appropriate temperatures in line with infection control standards. Care Homes for Adults (18-65 years) Page 25 of 41 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 enough staff on duty at all times, although insufficient numbers are suitably trained to meet the needs of all the occupants. The services arrangements for recruiting new staff are sufficiently robust to minimise the risk of individuals who are not fit to work with vulnerable adults being employed, although the occupants should be given more opportunities to participate in the staff selection process and have their views about the suitability of new staff taken into account more. Evidence: All four occupants who currently reside at Speakers Court wrote in our surveys that care staff and managers who work there always treated them well, and the vast majority also told us that staff and managers usually listen and act upon what they say. All the staff met during this inspection, including the manager, were observed interacting with the occupants in a very kind, respectful and professional manner. On both days of this inspection two care staff were always on duty. Staff duty rosters sampled at random showed us it was the norm to have two staff on duty during the day, which the manager told us he believed it was sufficient to meet all the occupants needs and wishes. 50 of the staff who returned our surveys told there were always Care Homes for Adults (18-65 years) Page 26 of 41 Evidence: enough staff on duty to meet the needs of all the occupants, while the rest informed us that this was usually the case. At night the service has one member of staff sleep-in with a second designated away from the site but on-call for emergencies. However, it was not clear from the duty rosters examined which staff were designed on-call each night. The two staff spoken with at length told us without hesitation that they would always contact the services manager if an emergency occurred while they were sleeping in. The manager confirmed he had been contacted a number of times by sleeping-in staff in the past few months to deal with night time emergencies and seemed unaware it was the practise to shared the responsibility of being on-call with members of staff who were suitably competent and able to reach the service within half an hour. The services regional manager told us over the telephone that the Team coordinator based at Blake Court (another Scope service in the area) should be sharing the responsibility of on call with the manager of Speakers Court. We strongly recommend the service reviews its night time on-call arrangements and makes it clear which members of staff are willing and capable of being designated this task and what their responsibilities would be in the event of an emergency. All the occupants and staff met told us the service had been very reliant on temporary agency staff until recently, but with the recruitment of three new staff in the past year the crisis in staffing levels had significantly improved. Duty rosters inspected showed us that the same three temporary agency staff who were relatively familiar with the occupants preferences and routines had worked approximately one shift a week in the past three months, which represented a significant reduction in the service use of temporary staff. The manager demonstrated a good understanding of what constituted good practise regarding the recruitment of new staff and was adamant that in accordance with best practise no staff would be permitted to stat working at the service without providing them with a satisfactory Criminal records Bureau (CRB) checks and references. 100 of those staff who returned our surveys ticked Yes to the questions - Did your employer carry out checks, such as Criminal Bureau Records and references, before you started working for them? Documentary evidence was produced on request in respect of the services three newest recruits, which included: proof of their identity; CRB and Protection Of Vulnerable Adults (POVA) First checks; two written references from previous employers; completed job applications with full employment histories; and (where applicable) Home Office approved work permits and visas. The expert by experience wrote in their report that occupants they had met had told Care Homes for Adults (18-65 years) Page 27 of 41 Evidence: them they were not directly involved in the recruitment of new staff. We recommend the manager looks into ways of enabling the occupants to be more involved in the selection process of new staff. 100 of those staff who returned our surveys ticked Yes to the question - Do your induction cover everything you needed to know about the service? A relatively new member of staff spoken with at length told us their induction, which was currently on going, had covered their role and responsibilities were as a support worker, health and safety at work, safeguarding awareness, the occupants needs needs, equality and diversity and communication. The manager told us that all his current staff team had received equality and diversity training, over 50 had either achieved or were working toward their National Vocational Qualification in care level 2 or above, arrangements had already been made for staff to refresh their moving and transferring and health and safety training. However, staff files examined indicated that insufficient numbers of staff had either not received and/or recently up dated their training in a number of vital areas of practise, including fire safety, first aid, food hygiene, Scopes own safeguarding (See Outcome Area 5), and infection control. Furthermore, no staffs training needs and strengths had not been formally appraised in the past 12 months and a plan established to rectify any gaps in their knowledge and skills. More staff should also receive specialist training in working with adults with learning disabilities, continence promotion, Mental Capacity, and complaints resolution. The manager told us a senior member of staff based in the other Scope he runs in the area has been appointed the Team coordinator for both these services. It was evident from the managers comments made during this inspection that he was not entirely sure what their responsibilities were and whether or not they had been appropriately trained to be a team coordinator as recommended in the services last report. Care Homes for Adults (18-65 years) Page 28 of 41 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 occupants do not currently benefit from living in a service that has been consistently well run for the past year because of the unusually high turnover of managers it has experienced in the past year. To ensure continuity of care the service needs to appoint a suitably competent, qualified, and experienced manager to run Speakers court on a permanent basis as soon as reasonably practical. The supervision and support care staff who work at the service receive has improved in the past 6 months, although there remains considerable room for further improvement in this area. Scope have established some good internal systems for monitoring the quality of care its services provide, although this service could do more to ascertain the views of all its major stakeholders and use their findings to maintain and/or drive up standards. In the main the services health and safety arrangements are sufficiently robust to keep the occupants safe, although it is unclear who is responsible for testing its fire alarm system and carrying out fire drills. This will needs to be clarified as a matter of urgency with the Housing Association who own the building. Care Homes for Adults (18-65 years) Page 29 of 41 Evidence: We have recently been notified by Scope that the services registered manager, Laura Baker, who has been on long term sick leave for the best part of 2008/09, has resigned and will therefore not be returning to Speakers Court. Typical comments we and the expert by experience received from the occupants met included, i didnt like the way Laura ran the place,i dont want her (the former registered manager) coming back here, she (former registered manager) was not particularly approachable or interested in us, having little contact with the occupants when she was running Speakers Court, and I want a person (manager) who I can talk to about things. In the past nine months the service has had four different temporary managers in place. The general consensus of opinion expressed by all the occupants and staff met was one of frustration about the service constantly changing managers. Typical comments we and the expert by experience received from occupants and staff included, the frequent change in managers is annoying and is having a negative impact on the permanent staff team, we (the staff) just carry on regardless, but it is frustrating for the occupants and staff to continually have new managers here, one manager does things in a certain way and 24 hours later another manager does things differently, and Im unhappy about it - we need a permanent manager. This issue regarding management turnover with acknowledged by the services regional manager in its AQAA and we agree with the statement he makes regarding barriers to improvement - although progress has been made in certain areas the improvement has not been as significant as we would have liked because of the absence of a full time permanent manager. Although the providers have done relatively well to ensure a suitably competent people have always been placed in temporary control of the service in the absence of a registered manager, the recruitment of a suitably qualified and experienced individual to be in permanent day to day control of both Speakers and Blake Courts is now well overdue. Sohail Edwin is an agency member of staff who was appointed the services new temporary locum manager for three months in May 2009. He has five years experience as a manager of a residential care service for vulnerable adults, has been registered by the former CSCI as a care home manager in the past, and is currently studying for his Registered Managers Award, which is equivalent to a NVQ level 4 in care. Typical comments made by the occupants about his management style were in the main very positive and included -hes ok- you can talk to him, and i like him hes a nice guy. However, the written feedback we received from staff who completed our surveys about the support they get from their managers was very mixed. In response to the Care Homes for Adults (18-65 years) Page 30 of 41 Evidence: question - Does the manager give you enough support and meet with you to discuss how you are working? One member of staff wrote regularly, another often, and another sometimes. The manager told us that each member of his current staff team had received at least one supervision session with him and attended at least one staff meeting, of which two had been held in 2009. This represents an improvement in the supervision and support staff who work at Speakers receive, although we agree with the managers comments that there remains considerable room for further improvement in this area. We have therefore repeated the recommendation made in the services previous report regarding staff one to one supervisions and peer group meetings. Copies of monthly inspection reports carried out by managers of other Scope services were produced on request. The contents of these reports revealed these internal audits had been very thorough and had covered the views of the occupants and staff about how the service was run and any complaints made about its operation. The manager told us he would always use the findings of these so called Regulation 26 reports to consider new ways of improving the service. The manager conceded that he was not aware that there was currently any systems in place to seek the occupants, their relatives, and other representatives views about the service on a regular basis and for the results of such surveys to be published annually. The manager, staff, and occupants all told us that the services fire alarm system is tested on a weekly basis as required in its last inspection report, and that fire drills are carried out at regular intervals. The services regional and locum managers both confirmed Croydon Churches Housing Association (CCHA) who own the building are responsible for arranging the services fire safety tests and keeping fire records up to date. The service is reminded that it is a legal requirement for records to be kept in a care service of every fire practise or test of fire equipment (including fire alarms) conducted there and of any action taken to remedy defects. We recommend Scope reviews its current fire safety testing and recording arrangements with CCHA to enable staff at Speakers to have more control over these processes and to have least have access to their own fire testing records. The manager was able to produce documentary evidence on request that showed us the service fire risk assessment for the building had recently been reviewed and up dated accordingly as required in a recent Regulation 26 report. The expert by experience wrote in their report that - There was a general feeling that health and safety procedures were in place. Certificates of worthiness were produced on request that showed us the services fire extinguishers, fire alarms, and portable electrical equipment had all been tested by a suitably qualified engineer in the past Care Homes for Adults (18-65 years) Page 31 of 41 Evidence: year in accordance with the regulations and manufactures guidelines. Care Homes for Adults (18-65 years) Page 32 of 41 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 20 13 When medication is administered to occupants it must be clearly recorded. This will enable anyone authorized to inspect medication records to determine whether or not the occupants are receiving the correct levels of medication. 01/11/2008 Care Homes for Adults (18-65 years) Page 33 of 41 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 1 6 The services Statement of 01/08/2009 purpose and Guide must be kept under constant review (i.e. at least annually), and where appropriate revised to reflect any changes in provision. This will ensure prospective new occupants and their representatives have all the information they need to make an informed decision about whether or not to live at Speakers Court. All the occupants must have 01/09/2009 care plans that set out in greater detail any specialist communication needs of the occupants and their preferred method of communication. This will ensure staff have all the information they need to communicate effectively with the occupants in their preferred method of Page 34 of 41 2 6 17 Care Homes for Adults (18-65 years) 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 communication. 3 6 12 All the occupants must have 01/09/2009 care plans that set out in greater detail all the support they require to have their unique social needs and wishes met. This will ensure staff have all the information they need to meet the social needs and wishes of all the occupants. All the occupants must have 01/08/2009 up to date health care action plans that contain detailed information about the outcome of all the appointments occupants have with health care professionals. This will ensure anyone authorized to inspect the record can determine whether or not occupants health care needs are being suitably met and monitored. 5 20 13 The registered person shall maintain in respect of each service user a record of all medicines kept in the care home for the service user, and the date on which they were administered to the service user. 01/08/2009 4 19 17 Care Homes for Adults (18-65 years) Page 35 of 41 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 a Statutory Requirement. This will ensure the occupants receive the correct levels of medication. 6 20 13 The way in which the service 01/08/2009 monitors its medication recording and administration practises must be reviewed as a matter of urgency and significantly improved. This good practise recommendation was made in the services last report but not fully implemented to a satisfactory standard. This will ensure the occupants receive the correct medication and that if and when medication recording or administering errors occur they are identified at an early stage and rectified. 7 23 13 All the people who work at the service must receive Scopes own safeguarding vulnerable adults training. This will ensure all the staff have the necessary knowledge and skills to minimise the risk of the occupants being harmed, neglected and/or abused. 01/09/2009 Care Homes for Adults (18-65 years) Page 36 of 41 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 8 35 18 All the care staff who work 01/10/2009 in the service must receive or up date their training in fire safety, first aid, food hygiene, and infection control. This will ensure all the staff have the necessary knowledge and skills to meet the needs and wishes of all the occupants. The provider must appoint a 01/10/2009 suitably competent, qualified and experienced permanent manager to be in operational day to day control of this service. This will ensure the occupants benefit from living in a service which is consistently well managed. A record of every fire drill or 22/08/2009 test of fire equipment (including the fire alarms) conducted within the service and of any action taken to remedy defects must always be kept in the service and made available for inspection on request. This will enable anyone authorised to inspect these fire records to determine whether or not they are sufficiently robust to keep 9 37 9 10 42 17 Care Homes for Adults (18-65 years) Page 37 of 41 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 the occupants, their guests and staff safe. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Person centred care planning training should be provided for all staff that work at the service. This will ensure all staff have the necessary knowledge and skills to meet the needs and wishes of all the occupants in a person centred way. The way in which the service consults, enables the occupants to participate in the running of their home, and feeds back to them the outcome of their involvement should be reviewed. We recommend the service may wish to consider consulting the occupants about the possibility of reintroducing regular group meetings, as well as recording the outcome of monthly sessions occupants have with their keyworkers. This will ensure that suitably arrangements are in place to enable the occupants to express their views and have a positive impact on the way their service is run. All staff who work at the service should receive specialist communication training. This will ensure all the staff are able to understand and communicate effectively with all the occupants in their preferred method of communication. The way in which the service records information in daily diary books should be reviewed to make them more orderly as current arrangements make it difficult to determine what social , leisure and recreational activities the occupants have the opportunity to participate in each day. The occupants should be consulted again about their social interests and their current programme of activities reviewed with them. This will ensure each occupants programme of planed social, recreational and leisure activities matches their interests and aspirations. The provider should establish a time specific rolling Page 38 of 41 2 7 3 7 4 12 5 12 6 18 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 programme that sets out in detail how and when they intend to repair and/or replace all the services ageing moving and transferring equipment. This will ensure the occupants moving and transferring needs continue to be met safely. 7 20 All the staff authorised to handle medication on behalf of the occupants should once again being reminded of their medication recording and monitoring responsibilities. This will minimise the risk of medication recording errors occurring and enable staff to identify them at an earlier stage should they happen. The way in which the service manages its nighttime on-call system should be reviewed as current arrangements are unclear and are to heavily reliant on the manager taking responsibility for being on call every night. This will ensure the responsibility for doing on call is more evenly distributed amongst the staff team. The occupants should have more involvement in the selection process of new care staff who work at the service. This will ensure the occupants views are taken into account in the recruitment of new staff and therefore have a greater influence on the way their home is run. Team leaders should be appropriately trained to perform their new role and responsibilities. This will enable them to carry out their duties as a team coordinator and effectively run the service in the managers absence. This recommendation was made in the services last report, but was not implemented. Sufficient numbers of the current staff team should receive specialist training in working with adults with learning disabilities, continence needs, as well increase their understanding of Scopes complaints resolution procedures and the Mental Capacity Act. The manager should appraise the individual training needs and strengths of his staff team on an annual basis and establish an action plan to resolve any identified gaps in his staff teams knowledge and skills. This will ensure his staff team are suitably competent and trained to meet all the needs of the occupants. The way in which the service supervises and supports its staff team through one to one supervision sessions with the Page 39 of 41 8 32 9 34 10 35 11 35 12 35 13 37 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 manager and peer group meetings should be reviewed and the number of opportunities staff have to express their views and to share best practise ideas. This recommendation was made in the services last report, but has not been fully implemented. 14 39 The way in which the service ascertains the views of occupants, their relatives and other representatives should be reviewed and arrangements made for it to be done on a regular basis and the results published at least once a year. This will ensure the services major stakeholders views are listened too and acted upon. Scope should review the way it tests it fire alarm system and caries out fire drills with the HousingfAssociation who own the building because it is unclear is is responsible for conducting and recording these events. 15 42 Care Homes for Adults (18-65 years) Page 40 of 41 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. 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