Inspection on 23/01/09 for Summerhouse

This inspection was carried out on 23rd January 2009.

CSCI found this care home to be providing an Poor 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Summerhouse 07/02/07

Summerhouse 05/04/06

Summerhouse 08/12/05

Summerhouse 09/06/05

Similar services:

21 High Street

Vale House

Chestnut Walk

The Old Vicarage

Cherwood House Care Centre

Ashley House

Ascot Nursing Home

Fountain View

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Summerhouse Summerhouse Guyers Road Freshwater Isle of Wight PO40 9QA     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Annie Kentfield     Date: 2 3 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Summerhouse Guyers Road Summerhouse Freshwater Isle of Wight PO40 9QA 01983755184 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) : Make All Ltd care home 11 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 11 The maximum number of service users to be accommodated is 11 The registered person may provide the following category of service only: Care home only(PC) to service users of the following gender: Either whose primary care needs on admisison to the home are within the following category : Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Summerhouse is a registered care home providing care support and accommodation for up to eleven adults with mental health needs. The home is a two storey detached period house located in a quiet residential area of Freshwater, close to bus routes. It is less than a mile from the amenities and shops of Freshwater town and the coastal amenities of Freshwater Bay. The building is similar to some other properties in Guyers Road. Summerhouse is suitable only for residents who are fully mobile, as there are steps to the front door and no lift to the first floor. Many of the residents have lived at the home for a number of years and have regular contact with a range of Health and Social Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home Care professionals. Most rooms are for single occupancy and are arranged over the ground and first floors. Bedrooms are not en-suite but all have a wash hand basin and residents have access to bathrooms and toilets on each floor. Residents have a communal lounge on the ground floor. The home has installed a new kitchen and this means that residents now have a separate dining room. There is a garden with seating areas for residents to use. The weekly fees may vary, and there are additional charges for chiropody. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: We made an unannounced visit to the home on 23 January 2009. This was with one inspector (Annie Kentfield) and the visit lasted for five and a half hours. During the visit we spoke to two of the residents, the registered manager and some of the staff. We looked at some of the homes records including care plans, medication records, staff recruitment and training records and some of the health and safety records. We also received the Annual Quality Assurance Assessment (AQAA) from the home. This is a self-assessment that tells about the home, what they do well, what they could do better and where improvements are planned. We sent surveys to 10 residents, 8 staff members and 5 health and social care professionals. We received completed surveys from 8 residents, 4 members of staff Care Homes for Adults (18-65 years) Page 6 of 32 and one health care professional. During the inspection we made immediate requirements about medication practice, risk assessments and staff recruitment. Following the visit we wrote to the registered provider to ask them to write and tell us what action they have taken to ensure the safety and well being of people living in the home. 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 set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 32 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. To ensure that residents care and support needs are met, a comprehensive assessment is undertaken before new residents decide to move into the home. Evidence: The manager showed a good understanding of the importance of pre-admission assessments, describing how, in the case of one new resident, there had been several visits to meet the resident and undertake a comprehensive assessment. This was to make sure that the home was able to provide the care needed for the resident. The resident then visited the home several times for overnight and weekend stays, then had a trial period of two weeks before making the decision to move into the home. The visits also gave the new resident the opportunity to meet other residents in the home. Records show that the manager worked closely with the community mental health services to ensure that the home was able to meet the residents care and support needs. Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is in the process of developing person centred care planning, as good practice. However, this is yet to be fully implemented and is not embedded into practice in the home. This means that people may not receive the individual care they need. Where risks to residents have been identified, the home is not always recording what action is being taken to minimise risks or events to safeguard residents. Evidence: Residents have an individual plan of care that outlines their care and support needs and what action staff must take to meet those needs. When we looked at three care plans we found that the home is in the process of developing person centred care planning. We saw new documents that set out clearly what is important to the resident, their likes and dislikes and other relevant information. Some of these documents have not yet been discussed and agreed with individual residents so it Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: could not be determined if they were reflective of their choices. Person centred care planning is not yet embedded into practice in the home. Where risks to residents have been identified, these have been recorded with details of what action staff need to take to safeguard residents. However, at the last inspection we made a requirement for the home to complete a risk assessment for one resident who is at risk when going out alone and at risk of falling and harming themselves. This requirement has not been met and there is no risk assessment recorded for this resident, although it is evident from accident records that this resident is still at risk of self-harm. The manager told us what action is taken to safeguard this resident from self-harm, but this has not been recorded in writing. The care records for this person did not contain this information as required to demonstrate that care has been provided. Lack of records means that the management of risks/events cannot be reviewed and updated and changing care needs may be overlooked. We spoke to one resident who confirmed that they were being supported by staff in the home about making an important decision in their life. We also noted that staff have taken appropriate action to meet the needs of another resident to ensure that the resident is supported to take risks as part of an independent lifestyle and their right to autonomy is respected. The home operates a key worker system and records show that residents are encouraged to meet with their key worker every month to review personal goals and needs. Care Homes for Adults (18-65 years) Page 13 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The food in the home is of satisfactory quality and the menu is varied to meet different dietary needs or choices of the residents. People using the service are supported to maintain contact with friends and family and some of the residents have access to activities or resources within the local community but consultation with the residents on choices and preferences with regard to activities and social events is not recorded in individual plans. Evidence: The manager told us that the routines in the home are relaxed and informal and residents are able to choose when they want to be alone or in company. However, we did not see evidence in the care plans, or in the key worker reviews, that residents are supported to explore options of their choice with regard to activities, daily living skills Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: or social development. Comments from residents in the surveys varied from being satisfied that they could do what they want to do during the day or evening, or weekend, to one resident who told us they would like more to do at weekends such as going to Newport on the bus or go to airshows. Residents go out to the local shops and some of the residents have bus passes and travel on their own to visit family or friends. Residents are encouraged to tell staff when they are going out and when they plan to be back. There is a notice on the kitchen door with times when residents can access the kitchen if they want to make themselves a drink. None of the residents are currently employed or involved in voluntary work. Some of the residents go to a local day resource centre in Freshwater. We saw some artwork displayed in the dining room that some of the residents have done at the resource centre. Although the annual quality assurance assessment from the home said that there are regular resident meetings, we were told by the manager that residents have decided they do not want to have group resident meetings and that residents prefer to do activities on their own. We were told by the manager that group activities such as trips to the beach or the cinema have been arranged in the past, but not currently. During the summer months BBQs are sometimes arranged in the garden. The manager told us that if a resident wanted to go shopping or on a trip out, or attend a church service, staff would support the resident to do this. The home has a car that can be used to take residents out. Two members of staff told us in the surveys, that they would like to be able to arrange regular outings for those residents who would benefit from going out and mixing in public places. The manager confirmed that residents manage their own financial affairs or with independent support. The manager keeps records of small amounts of personal allowance that are looked after for some of the residents. All staff take turns in preparing and cooking the meals in the home. We noted the meal served looked appetising and residents seemed to enjoy it. Staff try to make menus varied and nutritious. Residents decide what food they like to eat and as the menus are flexible the meals can be changed if an alternative is called for by way of special request. Special dietary requirements or likes and dislikes are recorded in care plans. Fresh fruit was seen to be available. Care Homes for Adults (18-65 years) Page 15 of 32 Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The healthcare needs of the residents are assessed and staff support residents to receive healthcare checks as required. Complete and accurate records of medication received into the home, and given to people, are not kept. Poor medication practice puts residents at risk of not receiving their medication as prescribed, at all times, and at risk of harm. Medication policy and procedures have not been reviewed in line with current good practice guidance. Residents are not assessed for the ability to manage their own medication. Evidence: There are currently nine residents living at Summerhouse. All are fully mobile and none has a disability that requires aids or adaptations in the home. Residents are largely self-caring being able to manage their own personal hygiene, with prompting where appropriate. We noted that staff knocked on bedroom doors and waited for a response before entering. Bedroom doors are not lockable. The manager told us that Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: residents could have a key to their bedroom on request. However, two members of staff told us that residents would have more privacy and security for their possessions if they were able to lock their bedroom door when they wanted to. Care records show that residents health care needs are addressed in a number of ways. Residents are supported to access their GP, dentist, optician and other health care services. We were told that residents receive an annual health check from the practice nurse, who visits residents in the home. The manager confirmed that residents medication is reviewed annually by the community pharmacist. The manager told us that they are able to contact community mental health services if they have any concerns about residents mental health. Medication is kept securely stored in a locked cupboard and the manager confirmed that the home does not have any controlled drugs at present, also that the storage cupboard meets amended regulatory requirements for the safe storage of controlled drugs if this should change. The manager confirmed that staff who dispense medication have received appropriate training in the safe handling of medication in the home. Complete and accurate records are not kept of medicines given to people. Gaps in the recording sheets for medication mean that residents may not be receiving their medication as prescribed, at all times, and their health and welfare needs not met. The home does not have a correct audit trail for medicines received into the home, dispensed, or returned to the pharmacy. Some of the medication record sheets had not been signed by an authorised person to record how much medication had been received and checked as correct. Three resident medication records contained gaps in the recording over a four week period, and we were unable to check whether the medicine had been given to the resident or not because the home does not have a correct record of how much medication there should be. We spoke to one resident who told that they always receive their medication at the right time but we were not able to check with the other residents. The manager told us that she would check with staff who had dispensed the medication to ensure that residents had received the medication. Pirenzepine that is prescribed to be given once daily had not been recorded on two days in a two week period. The medication had been hand written onto the medication record without a signature and date from a person authorised to do this. It is safer practice that when it is necessary to handwrite on a medication administration record Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: chart in the home that the member of staff writing the chart, signs and dates the chart and that a second carer checks the entry for accuracy and then initials the chart. One resident is prescribed paracetamol to be given as and when required up to four times a day. The information on the medication administration did not match the instructions on the box of prescribed medication. The paracetamol was hand written onto the medication administration record but had not been signed and witnessed as received, and that it was correct. Another resident was given paracetamol but this was not recorded on the medication administration record as being prescribed. There is a risk that the resident may be given the wrong amounts of paracetamol. Quetiapine that is prescribed to be given as and when required had been given on some days and not others, but staff have been using different codes to record whether given or not. There is no written guidance for care staff on the circumstances as to why and when this medication should be offered. Staff do not have access to current good practice guidance on the safe handling of medication in care homes, that is produced by the Royal Pharmaceutical Society of Great Britain. The guidance can be downloaded from the Commission website. We discussed the errors in the medication records and the lack of a correct audit trail for medication, with the registered manager. We left an immediate requirement notice. Following the inspection we wrote to the registered provider to ask them to send us, in writing, details of the action they have taken to address these serious concerns. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home treats residents complaints seriously and would respond appropriately. The manager is aware of procedures to follow if there are concerns, or allegations, of residents being abused. Some of the staff have received training in safeguarding awareness. Evidence: The home has a formal complaints procedure and would follow this if and when complaints are received. In the surveys, residents told us that they would speak to their key worker, or the manager, or a friend, if they had any concerns about anything in the home. The manager told us that the home has not received any complaints about the service and was very clear that residents would certainly voice their concerns and that any concerns would be listened to and taken seriously. Although the home does not have resident meetings, residents have the opportunity to speak to their key worker if they have any concerns. The manager confirmed that the home has a safeguarding adults policy, which is linked to the Isle of Wight Social Services guidance. There was a safeguarding referral and investigation into concerns about the home, that took place last year. No further Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: action was taken. The manager demonstrated an understanding of the procedures to be followed in the event of suspicion or allegation of harm or abuse. The manager told us that all staff receive training in safeguarding awareness, however, we looked at three staff files and did not find a record of safeguarding training. The manager told us that the training will be arranged for staff in March. The home did not have available a staff training matrix that shows what training has been completed and when updates to training are due, for all staff. Therefore, we could not confirm that the rest of the staff team have done safeguarding training. We have identified that the home has not carried out a comprehensive risk assessment and action plan for one resident who is identified to be at risk of harm to themselves at certain times. The home does not carry out thorough recruitment checks on new staff and this has the potential to place residents at risk of harm or abuse. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clean, safe, homely and comfortable environment for the residents. Evidence: Since the last inspection the home has installed a new kitchen in what was a small lounge at the back of the home. This has transformed the previous small kitchen/diner into a separate dining that has room to seat all of the residents at mealtimes. The manager told us that the dining room furniture is new and there is a dresser to store mugs and other items that the residents use for meals. Some of the residents were sitting in the lounge at the front of the house, watching TV, and some of the residents were in the dining room, other residents were in their rooms. Decorative items such as pictures, plants and flowers, provide homely touches to make the home feel like home. The manager told us that the home is waiting for new curtains for some of the rooms, and told us that there is an ongoing programme to improve the decoration and Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: furnishings in the home. The first floor bathroom has been decorated as well as some of the bedrooms. One of the bedrooms is shared, an arrangement that has been ongoing for about six years. Both residents confirmed that they are happy with the arrangement. Residents can personalise their bedrooms as they choose. The manager told us that residents can have a lock and key to their room on request. We were told by the manager that residents do not have a key to the front door but can come and go until 10pm, when the front door is locked. The manager said that night staff would wait up if residents are likely to out later than 10pm. All areas of the home were noted to be clean and tidy. One support worker also works in the home as a cleaner. The laundry area is currently located between the kitchen and dining room. Cleaning products are kept in a locked cupboard. The manager confirmed in the annual quality assurance assessment that all staff have received training in good practice in infection control and the prevention of cross infection. Toilets and bathrooms have liquid soap and paper towels as good practice in infection control. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not ensure that all necessary recruitment checks are in place before new staff start working in the home. This means that residents may at risk of harm or abuse. Staff receive training appropriate to the job they do and to meet the needs of the residents. However, staff are not provided with training in the mandatory area of moving and handling and this may mean that residents and staff are at risk of harm from poor practice in the home. Evidence: Three recruitment files were seen. Two staff members had started work before a POVA first check had been received. The manager did not realise that there needed to be proper recruitment checks in place, including a POVA first check before a person starts working in the home. Once this check has been completed the person can then start work under supervision as stated in the Department of Healths guidelines for the Protection of Vulnerable Adults (providing the home already has two written references and a full employment history). The three files did not contain proof of identity for the members of staff and one file Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: did not contain a full employment history for the staff member. Two files did not contain a written reference from the previous employer and in two files, the home had not obtained a second written reference. Failure to carry out thorough checks on new staff has the potential to place residents at risk of harm or abuse. Individual lists of training completed are kept in personal files. The manager did not have a training matrix that showed what training all staff have completed and when updates are due. The annual quality assurance assessment told us that staff training includes specific mental health awareness and that 4 staff have done some training in the new Mental Capacity Act. The manager has not yet obtained a copy of the Mental Capacity Act Code of Practice, we were told that the manager would request a copy and also up to date guidance on how the Mental Capacity Act will affect practice in the home. The manager confirmed, and we saw evidence of this, that the home uses the nationally agreed common induction standards (for care) with all new staff. The manager arranges staff training in areas of safe working practice such as health and safety, first aid, medication, infection control, and fire safety. The annual quality assurance assessment told us that 8 out 18 care staff have received suitable training in food safety and food hygiene. We did not find any evidence of staff training in safe moving and handling. The manager told us that she did not think that moving and handling training is relevant to the needs of the residents. However, there is a resident who is at risk of falling and staff must be aware of safe ways to assist this resident when required. Moving and handling is a mandatory area of training required for all staff to ensure that they support and meet peoples needs safely and to ensure safe working practice for staff in the home. The AQAA told us that 9 out of 18 staff have achieved a National Vocational Qualification (NVQ) in care at level 2 or 3. Some of the files contained records of formal staff supervision. Supervision is not arranged on a regular basis and one new member of staff who started in July 2008 had received one formal supervision that was recorded. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a number of systems in place to monitor the quality of the service provided, however, some regulatory requirements have not been met. This means that residents are not consistently protected from the risk of harm and practice in the home may not be safe at all times. Evidence: The manager is experienced and has relevant qualifications in care, management, and community mental health care. Comments from residents and staff and evidence from discussion with the manager, and looking at some of the homes records, demonstrate that residents and staff enjoy a good working relationship with the manager. Several comments from staff told us how much they enjoy working in the home. The manager told us in the AQAA that the home has a policy on equality and diversity and that this is promoted in practice in the home because residents are encouraged to be fully independent and to live full and active lives. However, the AQAA did not provide supporting evidence to demonstrate this. In addition, the home has not Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: developed and put into practice person centred care planning to demonstrate that people receive the individual care that they need, that takes into account their personal goals, aspirations and choices. The home is small and domestic in scale and the manager and staff are in daily contact with the residents. In addition, residents have the opportunity to talk to their key worker. The manager told us that formal satisfaction questionnaires for the residents have not been a successful way of seeking feedback about the home and that one to one meetings between residents and key workers have proved a better way of finding out if people are happy with the service provided. The AQAA told us that as a result of listening to the views of the residents, changes have been made to the menus. The registered provider makes a monthly inspection visit of the service and writes a report. However, the inspection reports have not identified those areas where regulatory requirements have not been met; in the areas of medication practice, risk assessments and staff recruitment. Failure to meet these regulatory requirements has the potential to place residents at risk of harm. We looked at some of the health and safety records for the home. These confirm that there are regular checks and servicing of fire safety equipment and electrical and gas installations in the home. However, the home has not maintained a record of twice yearly staff fire safety instruction and fire drills, as required at the last fire safety inspection in 2005. The last recorded fire drill was on 4/4/08 and recorded the residents involved, but not staff who attended. This means that staff may not know what to do in the event of a fire, to protect people in the home. The most recent food safety inspection in October 2008 gave the home a full five star food safety rating. The manager carries out a weekly check on all aspects of health and safety in the home. However, although this records that medication procedures in the home have been checked, we found a number of errors and gaps in the medication records. There is no clear audit trail for medication received, administered or returned. Residents may be at risk of not receiving their medication, as prescribed, at all times and the health and welfare of the residents is at risk from poor medication practice. The recorded temperatures for hot water in the basins and baths is around 60 degrees. This is very hot. The manager is not sure what the recommended temperatures should be. The manager told us that residents in the home are not at risk from scalding, but will seek advice on this from the Environmental Health Department to ensure the safety of the residents. Care Homes for Adults (18-65 years) Page 27 of 32 Care Homes for Adults (18-65 years) Page 28 of 32 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 9 13 To ensure that an 23/02/2007 assessment has been undertaken of specific risks involved with the activities of a named individual. Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Unecessary risks to the health or safety of service users are identified and so far as possible eliminated. Care staff must have clear written guidance on the action they must take to manage risks or events, and the action plan must be regularly reviewed to ensure residents are protected. 27/02/2009 2 20 13 The registered person must make arrangements for the safe recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. There must be a correct record of medicines received and given to residents to ensure residents receive their medication as prescribed. Care staff must have access to good practice guidance. 27/02/2009 Care Homes for Adults (18-65 years) Page 30 of 32 3 34 19 Staff recruitment procedures 27/02/2009 must meet regulatory requirements with regard to pre-employment information and checks. The home must demonstrate that staff are suitable to work in the home and the residents are protected. 4 35 13 The registered person must 27/03/2009 make suitable arrangements to provide a safe system for moving and handling service users. The home must demonstrate that working practice in the home is safe for residents and staff. 5 39 24 The registered person must establish and maintain a system for evaluating the quality of the service provided by the home. Robust systems for monitoring practice in the home should ensure that regulatory requirements and minimum standards are being met. Monitoring should include seeking the views of the residents and making changes for the benefit of the residents. 27/03/2009 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 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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