Inspection on 15/04/09 for Stiperstones

This inspection was carried out on 15th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stiperstones 10/07/09

Stiperstones 05/01/09

Stiperstones 23/10/08

Stiperstones 21/04/08

Stiperstones 22/05/07

Stiperstones 10/01/06

Stiperstones 11/08/04

Stiperstones 26/04/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

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Dovedale Court

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Stiperstones Stiperstone Clappers Lane Chobham Surrey GU24 8DD     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Suzanne Magnier     Date: 1 5 0 4 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 34 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 34 Information about the care home Name of care home: Address: Stiperstones Stiperstone Clappers Lane Chobham Surrey GU24 8DD 01276858440 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Welmede Housing Association Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home Stiperstones is a care home for eight adults with learning disabilities and provides personal care only. The property is located in Clappers Lane, Chobham, Surrey and accommodation is provided on two floors accessed by stairs. The home has eight single bedrooms and facilities include a kitchen, lounge, dining area, office, laundry, bathrooms and toilets. The property has a private drive and a large garden, which is secure and easily accessible. Private parking is available. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 8 Brief description of the care home Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is zero star. This means that the people who use this service experience poor quality outcomes. Following the previous Key inspection by Ms Suzanne Magnier on the 23rd October 2008 it was evidenced that the service management had not met the requirements from the previous key inspection of 21st April 2008 and the commission served statutory notices to Welmede Housing Association for non compliance to meet the requirements made under the Care Homes Regulations 2001. A random inspection was carried out by Ms Suzanne Magnier Regulation Inspector on the 15th January 2009 to follow up the compliance, by the service, following the statutory notices served. The service was represented by an acting manager employed by Welmede Housing Association to work in the home several days a week as part of the improvement plan for the service. It was concluded that the registered persons had Care Homes for Adults (18-65 years) Page 6 of 34 complied with the requirements detailed in the statutory notice letters dated 8th December 2008. This report relates to the key announced inspection carried out by Ms Suzanne Magnier on the 15th April 2009 and also contains the information relating to the random inspection as above. This inspection was announced in order that the service could be represented by the newly appointed management team with the support from another Welmede manager who had been overseeing the service for several months. It was recognised during the inspection that efforts had been made to improve the outcomes for people using the service and these have been written in the report however it was recognised that there were still shortfalls within the home which the new managers had identified prior to the inspection and have given assurances to the commission will be addressed as part of the service improvement plan. For the purpose of the report the individuals using the service are referred to as individuals or people. The home had submitted the Annual Quality Assurance Assessment AQAA prior to the inspection, which was brief and gave limited information about the service generally. This was discussed with the manager who had been overseeing the service who recognised the shortfall yet advised that as she had been overseeing the service for the limited time it was difficult to complete the AQAA more fully. It is the expectation of the commission that further AQAA documents be completed more fully and is supported by appropriate evidence. The inspector arrived at the service at 09.00 and was in the home for seven hours. It was a thorough look at how well the home is doing. It took into account the information provided by the home and any information that CSCI had received about the service since the last inspection. The inspector spent time talking and observing the staff members and individuals in order to gain their views and opinions about the service. The inspector looked at how well the service was meeting standards and has in this report made judgements about the standard of the service. Documents sampled prior and during the inspection included the homes Annual Quality Assurance Assessment AQAA, care and person centred plans, risk assessments, medication procedures, staff files, a variety of training records, health and safety records and several of the organisations policies and procedures including the complaints and safeguarding procedures. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. One safeguarding referral has been made since the previous inspection which has been concluded. The final part of the inspection was spent giving feedback to the managers representing the service about the findings of the visit. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Adults (18-65 years) Page 8 of 34 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 34 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 34 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 individuals and their representatives have accurate information about the home in order that they can make an informed choice about moving to the home. The homes admission and assessment procedures ensure that individuals needs are appropriately identified and met and people can visit the home prior to residency. Evidence: The homes Statement of Purpose and Service user Guide have been updated since the previous random inspection and the improvements in the documents have been maintained to include large print and up to date photographs of the home and the local community. Both documents detailed the current facilities and services offered by the home. The newly appointed person in charge told the inspector that they would be making further changes to the documents to further improve them and make them more accessible to people living at the home. There have been no admissions to the home since the previous inspection. All the residents have been residing at the home for some years and their care needs assessments were developed whilst in the care of the previous care service provider. Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: There was evidence to support that initial assessment details for individuals moving into the home had been undertaken prior to the individuals admission to the home. Welmede have an admission and assessment policy and procedure to ensure that all prospective individuals have a care needs assessment prior to admission to the home to ensure that the homes staff would be able to meet the individuals needs. The policy includes encouraging prospective residents to visit the home meet with the other residents and have an overnight stay if they choose to prior to moving to Stiperstones if that is their choice. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The support personal care needs goals and aspirations of individuals needs must be kept up to date and evidenced as regularly reviewed and monitored to ensure that peoples changing needs are identified and met. Individuals are not always fully consulted about matters which affect their daily lives. The management of risk assessments need to be more robust to ensure the safety and wellbeing of individuals at all times. Evidence: During the random inspection conducted in January 2009 the acting manager advised that the homes staff would be attending Person Centred Planning training and Health Action plan training in the coming months which would assist staff to understand and work with a new style of care plans to be introduced to the home which support residents in a person centred way. One care plan was sampled during the random inspection and there was evidence that the documentation had been reviewed to reflect a better understanding of the current needs of the individual. The care plan included up to date risk assessments and clear written guidelines for staff in order that Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: they could provide consistent care and maintain the individuals abilities. During the key inspection it was identified that routines in the home remained to a large extent as task based and not led by the individuals living at the home for example one staff member was cleaning an individuals bedroom whilst the individual was downstairs sitting in the lounge. Another individual was seen to be anxious to leave the lounge dining area and some staff were unsure as to whether the individual would be safe in the garden area alone. There was little documented evidence to support that individuals or their representatives have been involved in how they would like to receive care and the one care plan sampled identified that the documents were not up to date and did not reflect the current support provided by staff in the form of a predictable agreed working practice. There was evidence during the inspection that some individuals had had their care and support needs reviewed by the local authority representatives yet some individuals had not received reviews for several years. Following the inspection this was discussed with a representative of the local authority who assured the commission that reviews of peoples care would be being undertaken during the next several months. The home has a key worker system yet there was an inconsistent approach to the responsibilities for example one individuals room was viewed as very dirty the individuals clothes stored in a chest of drawers were untidy and also contained other peoples clothing a wardrobe in the persons room was locked and obstructed by another piece of furniture when the wardrobe was opened at the request of the inspector it contained items of clothing and a boxed stereo system which the inspector was advised may belong to the individual but the senior staff member was unsure. The one care plan sampled identified that the risk assessments were generic and did not accurately reflect the hazards being presented in the individuals life. There was some evidence to support that individuals are supported to make an informed choices and take risks yet some limitations are routinely placed on individuals for example reluctance to promote a male resident to have positive relationships with female care staff due to perceived historical patterns of behaviour and communication. The commission acknowledge that following the previous key inspection staff, with the support of a manager overseeing the home have recognised some of the shortfalls in the service and some improvements have been made. The care planning system was discussed with the new managers of the home who agreed that there was a need for a complete review of the care plans which would include the reassessment of individuals current needs and the formation of person centred plans to reflect the needs and the Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: support for individuals. More attention would be paid individuals ways of communicating, their aspirations and goals in their lives and encouragement for individuals to maintain their skills and acquire lost skills. It has been required that arrangements must be made to ensure that all care plans and risk assessments for each individual are reviewed and up to date. In order to ensure that individuals are provided with the appropriate care, treatment and supervision and to ensure that peoples changing needs are identified to ensure their safety and well being at all times. Care Homes for Adults (18-65 years) Page 15 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are able to exercise some choice in the daily lives yet this needs to be better managed to support people in taking part in planned social and recreational activities and the dining arrangements. Individuals are supported to maintain bonds with family and friends. The home offers an improved healthy and balanced diet. Evidence: It was evidenced through sampling a daily record book that staff have continued to support people in their local community and promote opportunities for people to take part in social activities however there still remains a shortfall in offering a planned, consistent and predictable meaningful activities programme to all individuals. When a senior member of staff was asked how many and who was attending the local sensory suite the staff member was unsure and when a Welmede support worker arrived to take an individual swimming it was realised that it was the half term holidays and the swimming pool may have been too busy which may affect the person being supported Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: and the swimming trip was cancelled. These observations supported the lack of a planned programme of activities during the day of inspection. It has been required that arrangements must be made for a planned and consistent activities programme to be introduced in the home in consultation with individuals living in the home in order that they know what is happening in their daily lives and they have a choice and can be supported to make decisions. The new managers of the home have acknowledged and spoke during the inspection about improving the flexibility of staff and resources in the home to provide a service which is led by the individuals living in the home rather than led by tasks undertaken by staff. It was observed that all individuals were supported to have breakfast at the same time and a staff member advised that at breakfast it was viewed as general practice for everyone to wait for all individuals to have their breakfast together. The new managers were aware of peoples rights to exercise choice, fairness, dignity, respect and freedom of movement in the home and have assured the commission that these aspects of peoples care and support will be further implemented and maintained in the home. There was evidence to support that individuals meaningful relationships are promoted by staff and the home continues to support individuals to maintain links with family and friends and people significant to them. The breakfast mealtime was observed and as previously documented all individuals were supported to have their breakfasts together in the dining room. A large table and a smaller table were available and it was observed that there were no table coverings condiments limited crockery and cutlery. Several staff were at hand to support individuals during the mealtime yet the dining experience was viewed as uninteresting and did not support people to have a positive experience. The midday meal was served in the large garden and one staff member was noted to be attentive and responding and interacting with individuals in a way that promoted an interest in the activity of the mealtime. It was confirmed during the inspection that very few individuals are encouraged to use their kitchen and their general access is to put crockery in the sink or dishwasher. It has been required that the dining arrangements be reviewed in order to offer individuals improved choice and take into account peoples wishes and feelings. Staff confirmed that some individuals have been supported to help with the food shopping for the home. The homes staff have introduced a weekly dinner menu which is set out in colourful pictures of meals which individuals can identify and are Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: supported by staff to make informed choices about what they would like to eat. The homes freezer has been organised to ensure that the food on the menu is stored in the freezer compartments which are labelled for each day of the week. The homes menu offers choice and some individuals have been referred to the local authority dietician for additional nutrition and dietary advise. The homes fridges and freezers were well stocked and the quality of food prepared and on offer at the home reflected individuals nutritional needs and was satisfactory. Care Homes for Adults (18-65 years) Page 18 of 34 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. Individuals health care needs are generally met yet the recording of health care needs to be improved. Individuals choice, dignity and respect is not consistently promoted. Medication procedures need to be further strengthened to ensure that medication is administered to all individuals in a safe way at all times. Evidence: Records of health care appointments within one care plan evidenced that the individual was supported to attend health care appointments both inside and outside of the homes environment. The recording of the appointments needs more attention and this was discussed during the inspection with the commission being advised that improved monitoring would be implemented with the introduction of the health action plan training and individual plans for each person at the home. There was evidence to support that some staff have improved their practice when offering personal care and were able to inform the inspector of the way in which they had supported the individual to get up in the morning. Whilst speaking with a senior member of staff they told the inspector that they had partially supported an individual Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: up in the morning as they kept getting called away. This was not viewed as good practice and did not reflect the rights of the individual receiving care to respect and dignity and it has been required that individuals must be supported with respect, privacy and dignity at all times. Following the previous inspection the home have implemented a monitored dosage system and have an up to date medication policy and procedure in place. The inspector was told that the home is not currently supporting any individuals with the administration of controlled medicines and no individual self medicates. Records evidenced that systems were in place for the ordering, stock taking and returns of medication. During the sampling of the medication administration charts it was observed that there was an omission of a staff signature for some as required medication and some topical creams had the labels obscured which was viewed as potentially placing the individual receiving medication at risk. It has been required that arrangements must be made that all medicine procedures in the home must be strengthened in order to promote the safety and well being of people receiving medicines. One written comment card from a healthcare professional was received by the commission and stated that the home keeps an organised manner when it comes to each individual and their medication and within the last few months the care home have kept very good communication with the dispensing chemist and the doctors to make sure medication is controlled and sorted in advance. Care Homes for Adults (18-65 years) Page 20 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals who use the service can be supported to express their concerns and have access to a complaints procedure. The service needs to be more proactive in supporting and promoting peoples human rights. Evidence: The home have an up to date complaints procedure which is also in a pictorial format to support individuals on how to make a complaint or raise a concern if they are dissatisfied and a complaints book detailing the chronology of events for investigating complaints was sampled. It was evident that the majority of individuals living in the home would not be able to tell of any dissatisfaction with the service provided, and would be reliant on staff recognising that they were unhappy. The local authority multi agency procedures for safeguarding adults dated 2008 were available and one safeguarding referral had been received by the home the outcome of which has been concluded. The inspector sampled that the home has a policy statement regarding reporting abuse which was noted to be in accordance with the local authoritys multi agency procedures in order to safeguard people in their care. Training records evidenced that staff had undertaken safeguarding vulnerable adults training and where updates to training were necessary these had been booked. Welmede have a whistle blowing policy and procedure in place. The use of restricting peoples access to areas in their home was discussed with the homes new managers Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: who demonstrated an understanding of rights to peoples liberty. The new managers have assured the commission that an improved awareness of peoples human rights to dignity, choice, respect and empowerment will be further recognised and promoted in the home to offer a service which is more person centred as previously required within the report. Care Homes for Adults (18-65 years) Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables individuals to live in a generally safe and comfortable environment. Some maintenance and repairs need to be undertaken and some procedures reviewed to promote and include opportunities for individuals to be more involved in their daily routines. More robust arrangements must be made for the control of the spread of infection in the home to ensure the safety and well being of all individuals at the home. Evidence: Following the previous inspection several areas in the home have been decorated which include all individuals bedrooms and hallways. Several individuals have new furniture and furnishings in their rooms which offer a more homely and personalised private space. During the tour of the premises, as previously documented one individuals room had not been recently cleaned and care and attention to detail within the room had not been recognised. Several items of new furniture had been purchased by individuals and the furnishings had not been assembled for the use of the individuals. Several overhead lamps did not have lamp shades there was supplementary heating in some individuals rooms with free standing heaters present which the deputy manager advised she would investigate their use. Tiles needed to be replaced in a toilet and Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: access to the fire extinguisher in the laundry needed to be reviewed. Arrangements within the laundry were discussed with the deputy manager and it was agreed these would be reassessed with regard to the spread of infection in the home and the process of soiled and clean laundry being in the laundry area at the same time, and issues of clean laundry being put back into the same laundry basket as the soiled. There was also discussion regarding the inclusion of individuals having the opportunityto be involved in the laundry with a staff member. It has been required that more robust arrangements are made for the control of the spread of infection in the home and satisfactory standards of hygiene and safety are maintained in all areas of the home to ensure the safety and well being of all individuals. It was confirmed that there was some discussion that the specialised bath did not meet the bathing needs of all individuals and it was being proposed that the bath be replaced with a walk in shower which would be more effective for people to use. Care Homes for Adults (18-65 years) Page 24 of 34 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. Staff in the home are not currently fully trained to support people who use the service. The day to day running of the service needs to be more efficient and planned. Recruitment practices have improved to protect people living at the home. Evidence: The home is currently supporting 8 individuals. Welmede have recruited a new homes manager and deputy and several new care staff which has been beneficial to the improvement of the home and the reconsideration of the ethos of the home. It was observed that there were sufficient staff available on the day of the inspection yet as previously documented the deployment of staff was unplanned and not organised which led to a sense of disorganisation on the shift examples of which have been documented within the report. The new managers advised that the rotas are to be reviewed and based around delivering outcomes for individuals receiving care and not led by staff requirements. Welmede have a recruitment and selection policy and one staff file was sampled of a person who had been recently employed by the home. The file contained the relevant checks to confirm a safe vetting process to ensure the protection of individuals receiving care. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: Following the previous inspection Welmede have supported staff to undertake mandatory training and the commission have been advised that all staff will be undertaking the Learning and Disability Award Framework Induction and Skills for Care in order to improve staff practice and ensure that staff have the skills and abilities to provide the care and support needed by the individuals living at the home. Care Homes for Adults (18-65 years) Page 26 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new management and administration of the home is not yet fully established. All staff need to improve their awareness to offer a service which is based on providing an increased quality of life for individuals living at the home with the focus on person centred care and seeking the views and opinions of all people associated with the service. Individuals general health, safety and welfare has been strengthened. Evidence: The home has been managed over several months by a registered manager from another registered service owned by Welmede. This manager was present during the announced visit to support the newly appointed person in charge and their new deputy manager. The overseeing manager explained that her role had been to meet the requirements made during the last inspection and which it has been confirmed have been met and to work alongside staff to raise awareness and offer a mentoring role and arrange staff training. The newly appointed person in charge and the deputy manager had been in the Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: service for less than a month yet demonstrated that they were aware of the shortfalls within the service and were proactive during the inspection to highlight the service shortfalls. The plans for improvement in the service were discussed openly and indicated that the improvements would be based on providing an increased quality of life for individuals living at the home with the focus on person centred care. It was noted that the AQAA supplied to the commission was brief and gave limited information about the service generally. This was discussed with the manager who had been overseeing the service who recognised the shortfall yet advised that as she had been overseeing the service for the limited time it was difficult to complete the AQAA more fully. It is the expectation of the commission that further AQAA documents be completed more fully and are supported by appropriate evidence. Evidence was seen to support that the views and opinions of individuals living at the home and other stakeholders are actively sought through meetings, contact with peoples relatives and friends and visitors to the home. Comment cards received by the commission did not include any feedback obtained on behalf of individuals living at the home but from some staff who were concerned about their terms and conditions of employment which had recently changed. The homes senior management have developed a new Regulation 26 visit form which was sampled during the random inspection visit and is currently under review at other Welmede homes. The acting manager advised that the form will offer continuity of actions needed by the home as a result of the monthly unannounced visits and be a more thorough assessment of the registered service. Recently completed forms were sampled. Health and safety checks within the home have been maintained and records were sampled. The gas safety, electrical certificates and a current insurance indemnity certificate were sampled and all documents up to date. The inspector affirmed the procedures that the home must report any incidences to the commission under Regulation 37 notifications of any event that affects the well being and welfare of people in the home. It is acknowledged that the Welmede Housing Association and the interim manager and new managers have made efforts to improve the service and facilities offered to people in their care however there remain shortfalls which must be addressed that continue to potentially affect the health, safety and welfare of individuals and staff. The shortfalls include the lack of an efficient and planned, consistent service delivery Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: which is based on a person centred approach of care and includes up to date care plans which detail the care and support needs of individuals. Risk assessments are not current to reflect the actual hazards in peoples lives and the measures in place to reduce the risks. There is lack of evidence to support that individuals skills and abilities are promoted, a lack of planned and consistent activities which includes evidence to support the activities are meaningful to individuals and their responses have been sought and medication procedures need to be further strengthened. It is required that the home must forward to the commission an improvement plan detailing how the home intends to improve the services provided in the home to ensure the safety and well being of individuals in their home. The requirements made during the inspection and detailed within the report have a bearing on the safety of, and outcomes for, the people who live at the home and the failure to comply with the regulations is an offence and will lead to enforcement action. Care Homes for Adults (18-65 years) Page 29 of 34 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 30 of 34 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 12 Arrangements must be made to ensure that all care plans and risk assessments for each individual are reviewed and up to date. In order to ensure that individuals are provided with the appropriate care, treatment and supervision and to ensure that peoples changing needs are identified to ensure their safety and well being at all times. 30/09/2009 2 12 16 Arrangements must be 30/09/2009 made for a planned and consistent activities programme to be introduced in the home in consultation with individuals living in the home. In order that they know what is happening in their Care Homes for Adults (18-65 years) Page 31 of 34 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 daily lives and they have a choice and be supported to make decisions. 3 17 12 Arrangements must be made that the dining arrangements be reviewed. In order to offer individuals improved choice and take into account peoples wishes and feelings. 4 18 12 Arrangements must be made to ensure that individuals are supported with respect, privacy and dignity at all times. In order to reflect peoples human rights. 5 20 13 Arrangements must be made that all medicine procedures in the home must be strengthened. In order to promote the safety and well being of people receiving medicines. 6 30 23 Arrangements must be made for the control of the spread of infection in the home and satisfactory standards of hygiene and safety must be maintained in all areas of the home. 30/09/2009 30/09/2009 30/09/2009 30/09/2009 Care Homes for Adults (18-65 years) Page 32 of 34 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 In order to ensure the safety and well being of all individuals. 7 35 18 Arrangements must be made for all staff to undertake training necessary for the work they are to perform. In order to improve staff practice and ensure that staff have the skills and abilities to provide the care and support needed by the individuals living at the home. Arrangements must be made for an improvement plan to be sent to the commission. Which sets out the methods and timetable by which the registered person intends to improve the services provided in the care home. 30/09/2009 8 42 24A 30/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 33 of 34 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. 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