Inspection on 17/12/09 for Sunnybrook

This inspection was carried out on 17th December 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sunnybrook 05/02/09

Sunnybrook 07/03/08

Sunnybrook 29/03/07

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Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Sunnybrook 2a Beech Road Ashurst Southampton Hampshire SO40 7BE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sue Kinch     Date: 1 7 1 2 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 30 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Sunnybrook 2a Beech Road Ashurst Southampton Hampshire SO40 7BE 02380292300 02380293970 sunnybrook@consensussupport.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Corich Community Care Ltd care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 9. 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 Sunny Brook began operating in November 2006 and Corich Community Care Limited is the Registered Provider. It is a care home that provides support and help for adults with learning difficulties and with complex needs and behaviours that challenge the service. The building is a detached two- storey house situated in its own grounds and it is close to local shops and services. All people living in the home are accommodated in single rooms with en-suite facilities. The garden is enclosed and includes a summerhouse in which activities take place. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 9 Brief description of the care home All people that move into the home are referred through local authority adult services departments or health care trusts. When consideration is being made to use the service on behalf of someone by such organisations they are provided with information about the homes service and the facilities. A copy of a report of the most recent inspection of the home carried out by the Care Quality Commission is available in the home. The reported fee structure at the time of the site visit on 17th December 2009 was £1600 -£3800 per week. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection was carried out following an assessment of information held by CQC about the home and of information received since our last visit. We received an Annual Quality Assurance Assessment document from the manager of the home. During our visit to the home between 11am and 18:45pm we met the people currently living in the home and were assisted by staff in their communication. We spoke with several staff about the systems and procedures, training and support and the needs of people living in the home. We spoke with the manager, viewed a sample of documents relating to the care provided, staff and systems and saw some shared and individual areas of the home. The visit took 8 hours. We also spoke with a care manager. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: We noted that some visual aids are in use to help with communication but that these were not obvious during our visit and there were few symbols or pictures distributed throughout the home. People living in the home rely on non-verbal communication and the new manager said that he had plans to address this. There are still several areas of the home that people cannot use with out staff support to access them. There are not enough risk assessments demonstrating that relevant people have been involved in the decision-making and there is insufficient guidance to ensure that staff practices leads to minimal restrictions. We made a requirement about this in the last inspection report and it has been repeated. More attention is needed to the documentation in relation to medication to show that it is provided as prescribed. We have made a requirement about medication and the manager gave assurances that staff competence would be assessed. There must be more evidence in the home that people are offered a varied and nutritious diet. CQC must be notified of all incidents in the home which potentially put people living in the home at risk. This is to demonstrate that action has been taken. Attention is needed to improve the furnishings and cleanliness of the home and the manager said that some action was planned and that further monitoring would take place. At the last inspection we made a requirement about full pre employment records being available for people recruited to work in the home. This has not yet been completed and the requirement has been repeated. Care Homes for Adults (18-65 years) Page 7 of 30 There has been a large turn over of staff and the manager recognises that work must take place to ensure that all staff have the necessary training to meet general and specific needs of people living in the home and has been making arrangements to address this. However staff have not yet received all of the training they need to meet peoples needs. Work must take place to increase the quality assurance in the home so that practices in the home are monitored to ensure that the needs of people living in the home are consistently met. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 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 9 of 30 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. Admissions to the home are preceded by a pre admission assessment and plans to meet needs but information provided about the home is not available in a range of accessible formats meaning that the availability of information to new people is not maximised. Evidence: At the last inspection we found that a process for admission was in place including assessments consultation with others and visits but no one had recently been admitted. At this inspection we noted that there had still not been a new admission to the home although the manager was aware of the process needed before an admission. At the last inspection we also commented that information available about the home needs to be updated to maximise access to information and to ensure that how the home operates is clear. Consideration is also needed to ensure that some information is accessible to all people moving into the home including the use of pictures and signs or other media products. Care Homes for Adults (18-65 years) Page 10 of 30 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. Since the last inspection the management and staffing changes have had an impact on consistency in the service provided meaning that some needs have not been addressed. The home now has a new manager and staff are being recruited and trained but the home does not use enough visual aids and has not risk assessed adequately meaning that peoples communication and choices are not maximised. Evidence: From conversations with staff, management and a care manager we obtained evidence that the needs of people living in the home are influencing the care provided. One staff member said that what people do is dependent on what they like doing and an example was given of how one person does not find it easy to keep still. Staff said that the persons preference for walking often happened. The person was supported to do go out on two trips while the inspection was taking place. Care plans are in place and there was evidence of two recent reviews for people with the subsequent review of support provided and reviews were being planned for the Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: other people. Care plans are detailed and include many aspects of care needs. One care plan viewed had 29 sections showing that many areas of needs had been considered. We noted that day to day records are mostly maintained to show what people have been doing and of their general progress. A care manager commented that the turnover of staff and previous management style had meant that staff had not been developing all the skills necessary to support the person they care managed but with the recent change in management of the home over the last few months things had improved. There was more consistency from use of other staff from another home run by the organisation and communication had improved. Conversations with the staff were positive about the needs of people living in the home and confirmed that they read care plans and keep themselves up to date. Changeovers between shifts take place to support this. During the visit care workers were clear about who they were individually supporting and attempting to engage people in activities that they thought they were interested in. They also respected peoples choice not to take part in activities. They were observed to be interacting in a friendly way with people living in the home and encouraging communication. As people living in the home rely on non verbal communication and staff need to observe people to understand many of their needs. We noted that few objects of reference or visual aids are routinely used in the home to aid communication. This was discussed with the manager who agreed to review this. This could aid people in making their needs known and obtaining their views where possible. In general care plans include some risk assessments although, some but not all of these had been regularly reviewed. The manager was aware that risk assessments had not recently been reviewed meaning that the most appropriate strategies may not be in place. In the last inspection report we required that risk assessments must be carried out to demonstrate the reasons for limiting access to any areas of the home and to show that appropriate consultation has taken place. This is to ensure that independence is promoted and only necessary restrictions on freedom of movement based on health and safety are used. Before we visited the home we were told in the AQAA that this had yet to be completed. During our visit we noted that some of the areas of the home are still locked without clear risk assessments demonstrating that this is entirely necessary for specific people. We asked to see all risk assessments in relation to this and were shown only two and these did not include the least restrictive control measures to minimise risks to people. The manager told us that he could not see any reason why the ground floor bathroom was locked and a month ago had requested its Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: removal but was still waiting for it to be done. The outcome is that people living in the home have to, for example ask to have the door unlocked before using the toilet, to access their rooms and en suite facilities. This compromises peoples ability to take control of their daily routines and their dignity. The requirement is repeated. We considered the way the personal information is stored in the home as we raised issues about this at our last inspection. During this inspection we noted that this matter had been addressed. We asked staff about confidentiality and they demonstrated an understanding of it. Care Homes for Adults (18-65 years) Page 13 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are provided with activities that they like although this is under review with plans to increase the range of opportunities available and involvement in household and personal decisions. People are supported with meals but choice is not fully promoted and recording does not demonstrate that diets are fully monitored. Evidence: From observation of activities in the home, talking with staff, reviewing records, talking with the manager and considering the information provided in the AQAA before the inspection we found evidence that staff are considering the individual needs and wishes of people living in the home and taking this into account when planning what to do each day. Staff told us that there are some regular activities and others are decided on daily basis. Some activities are also planned but people are able to make choices and elect not to take part. Staff said that all people are either allocated a Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: certain amount of one to one time a day and one person is supported by two staff. So it is possible to plan to do things that people like doing. Records are held of activities that people are involved with and these were sampled. These are generally recorded and reflected the activities that staff talked about. We heard of regular activities in the community including walks in the New Forest, shopping, writing letters, using the ball pool, swimming, using the QE2 centre and going out for drives. People were taken out during the inspection in the morning for shopping, driving and feeding ducks, and in the afternoon for walking. One person was supported with domestic activities and another person spent time in their room. Staff said that they offer activities and opportunities and then see how people react to them. People are encouraged to be involved in household activities and the manager told us that the service could be better at involving people in shopping more and in purchasing their personal items and plans to ensure that these activities and cooking happen more often. This will offer people more opportunities to make decisions and choices. Contact with families is encouraged and records show that this is frequent. We had feedback from a care manager that communication with a family is now good and regular. Families are involved in reviews of care and staff are encouraged to assist in making arrangement for visits to relatives including providing transport. People are provided with a clean and pleasantly furnished dining area and are supported individually by staff at small tables in order to meet their individual needs. At the time of our visit we noted that staff sat with people for meals and said that when possible they also ate the meal although this was sometimes difficult due to the needs of the people that they are supporting. We noted that at the meal time staff took individual approaches to supporting people to eat to meet their varying needs. They said that choice is offered although we were given varied views about the quality of the food. For example one person told us that there was a mixture of good meals including a regular Sunday roast but also convenience foods and too many chips and wedges. Records of food provided are held but are not in enough detail and some gaps exist meaning that these records are not useful to review intake or variety provided. A staff member told us that there are snacks available. However the kitchen is locked and snacks have to be requested. This does not promote independence or choice. Risk assessments regarding restricted areas of the home are addressed in the section on individual needs and wishes. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: The home does not have a cook and therefore staff on duty have to cook except for when the laundry worker carries out the tasks. They also share food hygiene responsibilities. We received a comment about the level of cleanliness and hygiene in the kitchen and a discussion about monitoring this was held with the manager who agreed to check that procedures were in place. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are receiving support with their health from an increasing range of local health professionals and benefiting from medication reviews but recording needs to be addressed to ensure that people receive their medication safely. Evidence: In the sample of records viewed we noted that personal and health care needs are recorded in peoples care plans. They also generally showed that medical matters are followed up and action is taken although we noted from a conversation with staff that a recent doctors appointment had not been recorded. The associated medication change however, was recorded in the medication sheets and drugs administered as prescribed. A member of staff told us that there are annual health checks and weight is monitored. An example was given of a recent positive outcome of a medication review for one person. A staff member also spoke of involvement of a psychiatrist, dentist, occupational therapist and speech therapist. The latter was being asked to review all people living in the home. Another member of staff said that communication between staff is good and that this includes health needs which staff monitor and another said Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: that they are kept up to date. We sampled aspects of the medication system in the home and found that the recording practices are not fully carried out and monitored meaning that people may not be having all of the medication that they have been prescribed. Records were not initially found for administration of a fortified drink. When they were found they were incomplete. The manager agreed to address this straight away. In the sample of records viewed we noted that records were not made of the drugs taken out of the home or returned when people are away for weekends meaning that the overall intake is not fully monitored. We raised issues about other aspects of procedures for taking drugs out of the home in the last inspection report also. In the AQAA the manager indicated awareness that this issue still needed to be addressed. We have made a requirement about medication procedures. Although the home requires two trained staff to sign for medication given, records of administration in general contained some gaps indicating that people have not had some medication and lack of management monitoring. The manager agreed that this needed to be addressed but had failed to pick up that there was a serious issue in relation to people safely receiving their medication. In the AQAA we were told that medication is carried out by trained staff. We were also told that 47 of staff are trained in medication administration. At the inspection records of reviews of staff competence were not available. The manager agreed to address this. However, as the service has failed to address previous requirements a requirement is made to ensure that this is carried out so that people are competent to administer medication. Care Homes for Adults (18-65 years) Page 18 of 30 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. People living in the home and involved relatives are able to influence the service received and are able to raise their concerns but records of complaints are not sufficiently detailed to enable review and improvement. Staff awareness of adult protection is increasing through training but the management do not always inform CQC of incidents in the home and of procedures followed. Evidence: The home has increased the contact with involved families through regular phone calls and this is evidenced in the records viewed during our visit. In the AQAA the manager stated that families consequently feel that they can raise issues. No formal complaints have been logged from families although three complaints were recorded. Some information was documented about the outcome although a conversation with management provided a clearer view and the manager agreed that recording would increase to give details of the outcome. At the previous inspection we were told that staff would be receiving training in the Mental Capacity Act. This matter had been raised due to the levels of support needed by people living in the home. We noted that some staff were trained in February 2009 but as staff turnover has continued we noted that further training is planned for new staff as at the time of our visit records and conversations indicated that 7 of the 17 staff had received training in this, and Deprivation of Liberty safeguards(DOL). The latter is also important as one person in the home has a DOL agreement. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: We made a requirement in Feb 2009 that records in the home must include reasons for decisions made on peoples behalf, who was involved and how it will meet needs. This is to ensure that the rights and interests of people are properly protected. This was discussed with the management of the home. They showed us records of examples of how this is being addressed and had made some progress although acknowledged that this needed further development. During discussions with the management we were made aware of a safeguarding matter which the home had not reported to us although the matter had been addressed with social services and had now been closed. Another matter discussed with the manager had also not been reported as required the Care Home Regulations 2001. This was pointed out to the manager who agreed to check the relevant regulations for reasons to notify CQC. Staff are being trained in safeguarding and records in the home indicated that this is ongoing. Staff have shown awareness off whistle blowing procedures and a member of staff spoken with was aware of their role in safeguarding and when to involve social services. Care Homes for Adults (18-65 years) Page 20 of 30 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. Improvements to the physical environment and cleanliness are needed to offer people living in the home a more comfortable and clean environment with fewer restrictions. Evidence: Before our inspection visit in the AQAA we were told of plans to improve the environment including replacing the lounge chairs, having some carpets replaced and addressing locked areas of the home (referred to in more details in the section on individual needs and choices). At the inspection the manager told us that these things still needed to take place and that carpets were to be cleaned the next day. He also said that work needed to take place to improve the environment. We noted that he said there is a programme of refurbishment for the home. We observed some areas of the home. We noted that the dining room was well furnished and flooring was in good condition. The individual bedrooms sampled were adequately furnished but some had locked en suite facilities with no clearly documented rationale for this. There were no curtains in the lounge, sofas are very low and uncomfortable to sit on and few images for visual stimulation. We received a comment from one person about aspects of cleanliness not being to standard in the home and noted that levels varied. We were told by the manager in Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: the AQAA and the staff that people living in the home are encouraged to be involved in the cleaning. Otherwise staff did it and mostly at night. The ground floor bathroom paintwork was not clean and we noted in the cleaning task lists completed by staff this was not included in the tasks. The manager agreed that the quality assurance system needed to be reviewed and that although there were lists of tasks for staff a system needed to be in place to monitor that these were carried out in all areas of the home. In the AQAA the manager said that staff are given infection control training. At the inspection visit we noted that the records indicated that eight of the existing staff had received the training. We noted fifteen at the last inspection. We were informed of a large turnover of staff in the last year and this indicated a need for ongoing training in this area and checking the knowledge of new staff to the home to ensure that people living in the home are supported by trained staff. A requirement is made about training in the staffing section. Care Homes for Adults (18-65 years) Page 22 of 30 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 is currently experiencing staff changes and use of temporary staff which is affecting the continuity of care and provision of sufficiently trained staff to meet the needs of people living in the home. The recruitment procedure continues not to be robust and does not ensure that people living in the home are supported by fully vetted staff. Evidence: From observations and discussions on the day our visit we noted that staff are allocated to work with specific people for each shift with one person allocated two staff. Team leaders are working in the home on each shift and we noted that they were giving guidance to staff as the shift progressed. Staff spoke about the needs of particular people living in the home and some of the factors taken into account when deciding on tasks in or out of the home. They said that all other people living in the home have certain amount of 1-1 support daily although at times meeting all needs is more difficult when a second person needing two staff is also supported out of the home. However, one staff member said that at times a 7th shift member is available for this purpose. We noted that staff also do the cooking in the home and a staff member said that at times this means that there may be one staff for two people in the home during these times but that they could meet needs. The laundress also covers the cooks role at times. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: The home has had a large staff turnover with 14 staff leaving in the last 12 months and at the time of our visit 7 vacancies. The manager said that they were having a successful recruitment drive with new staff starting. Agency staff were working regularly in the home and some were on shift on the day of our visit. One spoken with had worked in the home often over a period of time and new the people in the home fairly well. The home also had several staff to induct and assess to achieve 50 assessed at NVQ level 2 or above. Staff from another home have also been working in the home. So people living in the home have experienced much change in support. A member of staff said that now team-leaders are in place with other staff working across shifts the consistency is improving. More recent consistency was also commented on by a care manager. In the last report we made a requirement that records of employment checks must be completed and held at the home before a member of staff commences work in order to maximise protection of people living there. At this inspection we sampled records again and found that they were not sufficiently detailed to show that this requirement had been met. One person started before a POVA first or CRB had been completed and references were not detailed. For another there was no reference from the previous care employer and a third person had one reference. Discussions with staff the manager and training officer and information from the AQAA and computerised records held in the home showed that staff have been provided with some training and there is an ongoing training programme. Some of the courses that people have attended in the last year include The Mental Capacity Act, managing behaviours including an accredited physical intervention course, reporting and recording, moving and handling customer care, and fire and safeguarding. However, although there is an ongoing programme, some staff still need to complete essential and more specialised training such as communication and autism. The training officer said that priorities are health and safety, safeguarding, moving and handling, first aid and induction for working with people with learning disabilities. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and quality assurance in the home has been inconsistent in the last twelve months leading to a varied service demonstrated in this and other sections of the report meaning the people are at risk of some needs not being met. Evidence: In the last inspection report we required that the registered person must ensure an application is submitted to the Commission for the registration of the appointed manager. At the last inspection the manager had been in post for a few months. He was registered on 30th June 2009 in respect of the home and the requirement had been met. However he then left on 31st July 2009. After a period of interim management the home, without CQC being fully informed of further changes, and CQC reminding the organisation for a need to have a registered manager, the organisation appointed a new manager on 16/11/09 and we were told by him that steps were being taken towards submitting an application for registration. We have already informed the organisation by letter that an application for registration of a manager should be received by the commission by January 2010. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: Discussions were held with the manager and a staff member about the systems in the home and how they were monitored. During the inspection it took time to find relevant information about staff training, staff recruitment and risk assessments even though requirements were made about the latter two in the last inspection reports. Discussions revealed no clear processes for monitoring to ensure that systems were effective and this included medication cleaning and hygiene. The manager agreed that he needed to spend time in the home checking systems and ensuring that they are fully effective. As noted in the staffing section areas of health and safety are being prioritised for staff training in the home to ensure that sufficient numbers have been trained as the current training record at the time of our visited indicated approximately just over half of the care staff trained in some of these areas. We sampled other aspects of health sand safety checks in the home. We found that fire checks, where checked, are regularly carried out although quality checks are needed to ensure that timescales are kept to. We found evidence of a recent legionnaires check. General risk assessments were recorded in 2008 but the manager had not carried out reviews of these. Care Homes for Adults (18-65 years) Page 26 of 30 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(7) Risk assessments must be carried out to demonstrate the reasons for limiting access to any areas of the home and to show that appropriate consultation has taken place. This is to ensure that independence is promoted and only necessary restrictions on freedom of movement based on health and safety are used. 05/04/2009 2 34 19 Records of employment 05/04/2009 checks must be completed and held at the home before a member of staff commences work in order to maximise protection of people living there. Care Homes for Adults (18-65 years) Page 27 of 30 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 17 17 The home must be able to demonstrate that people living there are offered varied meals. This is to demonstrate that they are offered a nutritious diet. 30/03/2010 2 20 18 The registered persons must 30/03/2010 ensure that staff are trained in medication procedures and their competence assessed . This is to ensure that medication is administered safely. 3 20 13 There must be suitable arrangements for the recording, safekeeping and handling of medication in the home. This is to ensure that people routinely receive prescribed medication. 30/03/2010 Care Homes for Adults (18-65 years) Page 28 of 30 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 4 23 13 Incidents in the home 30/03/2010 including those in relation to safeguarding matters must be reported promptly to CQC. This is to ensure that local procedures are used regularly when incidents occur in the home. 5 39 24 The home must develop an 30/03/2010 effective quality assurance system to routinely assess its effectiveness in providing a service to meet the needs of people living in the home. This is to identify where improvements are needed for service users. 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 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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