Inspection on 17/04/09 for Sybden

This inspection was carried out on 17th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sybden 21/04/08

Sybden 23/04/07

Sybden 25/01/07

Sybden 02/06/06

Sybden 16/08/05

Sybden 05/05/05

Sybden 07/01/05

Sybden 28/06/04

Sybden 16/10/01

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Sybden Pipers Hill Great Gaddesden Hertfordshire HP1 3BY     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: Julia Bradshaw     Date: 1 7 0 4 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 30 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 30 Information about the care home Name of care home: Address: Sybden Pipers Hill Great Gaddesden Hertfordshire HP1 3BY 01442269986 01442217646 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) : Turning Point Southern Area Office care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 6 Sybden is a residential home for six people, who have a learning disability and whose needs may require a high level of support. Sybden is a single storey country house, in the small in the village of Great Gaddesden, which is near the town of Hemel Hempstead . The home has been extended and sits amidst large gardens. The house is quite a long way from a shopping centre but does have a pub and small shop nearby. The home has its own minibus which takes people to their day centres and to the larger towns of Hemel Hempstead and St Albans. The inspection report, Statement of Purpose and Service User Guide is displayed within the home. The range of fees for Sybden are between £900 and £1200. Care Homes for Adults (18-65 years) Page 4 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: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The focus of the inspections undertaken by the Care Quality Commission is based upon outcomes for the people using the service. We looked at four care plans and tracked the individual care for those people. As part of the planning we look at information we received including the Annual Quality Assurance Assessment (AQQA) This is a self assessment document required by law in which the provider tells us how well they think they are meeting outcomes for individuals. We also looked at any concerns and also feedback from relatives, staff and the people using this service. We observed staff at work and how they interacted with the people living at within the Care Homes for Adults (18-65 years) Page 5 of 30 home. There was also a tour of the building in which the inspector had the chance to talk to the people using this service, the staff and the shift leader. What the care home does well: What has improved since the last inspection? What they could do better: There are several areas that the staff must improve upon in order to make sure people living at Sybden are kept safe and can enjoy a good quality of life. These areas include improvements to both the communal area and the garden area. The garden had broken furniture discarded in both the front and back areas which could create a health and safety hazard to both residents and staff. The hedges and borders around the perimeter of the garden were overgrown and unkempt, giving a shoddy and unpleasant appearance. There were also two broken window pains which had not been repaired. The small communal area of the home was unfinished and had areas of bare plaster and chipped paint, which made it unpleasant and uncomfortable for people to use. There was inadequate evidence to confirm that the person using the service had been consulted or involved in the drawing up of the care plan as there was no signature from either the service user or their representative on the care plans inspected. The complaints procedure must be improved to make sure that people have the chance to express their views and opinions, in a format that people can fully understand. The home must have a registered manager to make sure the home is run in the best interest of the people using this service. This manager must make sure that the staff are supervised properly and also given the right training to do their job well. On the day of this inspection two staff were spoken with and neither had received the minimum of six supervisions within the past year . One member of staff stated that they had not received formal supervision for the past three months. Staff on duty were unable to confirm what recent training they had received and there was no training matrix or written evidence on the day, to confirm staff had received the necessary training to carry out their role effectively. The staff must make sure people are not placed at unnecessary risk by completing and reviewing risk assessments. The home must have a current Statement of Purpose and Service User Guide in place to tell everyone who may wish to come and live at Syden, what the service is like. The staff must makes sure they provide opportunities for people to enjoy social and leisure actives both inside and outside of the home. Also there must be enough staff on Care Homes for Adults (18-65 years) Page 7 of 30 duty or available to make ensure everyone gets the opportunity to go out. 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. 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. People using the service are unable to access up to date information with which to inform their decision to move into the home. However, they can be confident that they will be assessed ensuring that any needs are identified and are able to be met at Sybden. Evidence: A total of two care plans were reviewed and evidence gained regarding the initial assessments that are carried out to access if the service can meet the needs of the person. Information is held regarding the persons history and current needs. An assessment of each persons needs and aspiration are made before the person moves into the home. Senior staff complete these assessments. The service also receives and seeks external specialist support through the community learning disability team based in Apsley, which includes community psychiatric nurses and psychology support, in order to ensure all the individuals needs are met. Whole life reviews occur to support the service users in achieving and reviewing their individual needs, goals and aspirations. The assessment process includes the gathering of information from other Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: professionals. The organisation has its own internal assessment forms, which are detailed and give a profile of the persons needs, likes, dislikes and detailed history. The two assessments seen gave detailed information. A contract is then drawn between the service provider and the placing Authority. The agreement includes the terms and conditions within the home and the rights of the people who live at Sybden. The service does not currently have a written agreement with the service user and the home. The assessment process involves several prearranged visits to the home, initially people come to look around the service and then a tea visit is arranged and where appropriate, both overnight stays and weekend stays before a final multi-disciplinary decision is made. We did not look at the Statement of Purpose and Service User guide on this occasion as the staff on duty were unable to locate these documents. Care Homes for Adults (18-65 years) Page 11 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can not be confident that their care plans accurately reflect their needs so ensuring that care and support is provided by staff appropriately. Evidence: Two care plans were inspected in detail and generally were found to adequate. There were pre-admission assessments completed, there was an initial care plan was in place for both. A pen picture was in place for both people but with limited information. Some information on one persons health care needs was included. However individual notes of one care plan had not been kept up to date and some information contained in one care plan for a person with particularly challenging needs had not been dated. Neither of the care plans inspected had been signed by the person using the service or their representative. The person in charge stated that the service is in the process of further developing all care plans into a person centered plan format which can be more easily understood by the people using the service. Neither of the care plans identified the persons aspirations or goals. There was insufficient evidence to confirm that the Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: person using the service had been involved in the care plan. The majority of people living within Sybden would be unable to fully consent to the details within this document and therefore a Representative should consent on their behalf. This ensures that the rights of the individual are respected, honoured and implemented. Everyone living at Sybden is supported within the whole life review framework and reviews occur to ensure changing needs are continuously assessed and reviewed. However one care plan inspected did not contain the most recent review minutes and action plan from their whole life review. This omission was passed on as part of the inspection feedback. Ranges of risk assessments are completed within the service and action points recorded. However two risk assessments seen on the day had not been signed or dated. There was also limited information available in relation to individual risk assessments. To ensure peoples safety it is imperative that people that live at Sybden have up to date risk assessments for any activity that presents as a risk. There was inadequate evidence on the day to confirm that people had been involved in their care planning with no signatures from either the person using the service or their representative on the two care plans that were case tracked. The people living at Sybden have limited communication skills and therefore the information received by way of the CQC questionnaires was limited but one service user communicated that they liked going out on the minibus. The Community learning disabilities team based in Apsley provides specialist health care support. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be assured that they will be offered social and leisure opportunities to meet their needs and aspirations. Evidence: Three people attend either Jarmans or Earthworks daycentres, on a part-time basis. Two people currently do not have daycare placements. The staffing levels on the day of this inspection were limited and therefore for the people remaining at home during the day, activities primarily involved riding on the minibus to take other service users to their daycare placements or accompanying the member of staff who is doing the weekly food shop. This was confirmed by the staff on duty and also the activity logs within the individual care plans. However the AQQA states that We access the community using shops, cinema, pubs restaurants Gateway club. Help people maintain contact with their family. They have their own personal organisers where family Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: celebrations birthdays etc are noted so visits or cards can be sent. In the summer months we go walking along the many local footpaths. Evidence on the day did not confirm these statements. Neither care plan contained detailed information on activities provided and there were several gaps within the individual activity logs. People living at Sybden deserve the opportunities to enjoy meaningful activities within the home and also opportunities to enjoy social and leisure activities within the local community. Access to transport is through the on-site minibus and one person also has their own transport funded by their disability living allowance payments. The person on duty informed us that no holidays were provided last year due to lack of funding. Menus were seen on the day and reflected the dietary and cultural needs of the people living at Sybden by providing a range of meals that have been identified within the individuals care plan and created by involving the carers and families of the service users. The menu seen included a variety of Currys as well as Sunday roasts and snack foods. The shift leader stated that they are able to consult with the community dietitian, when necessary. The menus are provided in a pictorial format to assist in people making informed choices for both their meals and snacks. Care Homes for Adults (18-65 years) Page 15 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 who use the service have their health and personal care needs carried out effectively and respectfully. Evidence: The medication cupboard is located within the main office of the service. Medication that had been received into the home has been recorded accurately. All staff have been trained and inducted in the administering medication. There is currently no controlled medication held in the medication cupboards, however there is a robust procedure in place for the administration of these medications, if required. The current medication policy was seen on the day but was dated 2008. This should be updated to ensure the policy reflects any recent changes to the services medication systems or procedures to ensure the health and welfare of the people living at Sybden is maintained at all times. There was a reconciliation carried out on one persons prn (only when required) paracetamol and this proved to be accurate. All non blister pack medication should have a date of opening recorded. One bottle of medication did not have this recorded. Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: Health records are maintained within the main care plan and reflect the needs of the individual, including any specialist support people may receive and any visiting health professionals , dentists , opticians or chiropodists. Personal care support is provided by a well balanced gender mix of staff, as everyone living within Sybden are male service users. The specialist mental health support services are provided by the community mental health team based at the Orchards and the Community Learning Disability Team based in Apsley. Care Homes for Adults (18-65 years) Page 17 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 cannot be assurred that the current system for managing complaints ensures that their views and opinions are heard. Evidence: The service uses the organisations complaints procedure. However on the day of this inspection there was no evidence of a formal complaints system in place or evidence to confirm how issues that are raised are managed and resolved. A pictorial version of the complaints procedure was seen in the office but nowhere else in the building. Although a detailed procedure is in place to ensure that people using the service are protected from abuse and harm, not all staff spoken to on the day could demonstrate their understanding of the term safeguarding and the inspector had to reiterate the term by giving an example of abuse. The termwhistle blowing also appeared unfamiliar to this person. Evidence to confirm that all staff have received the appropriate safeguarding training could not be obtained on the day of this inspection. Staff records were unable to be inspected as the current managers post is vacant and staff on duty were not authorised to have access to these confidential documents. However the AQAA completed in February 2009 stated that Recruitment is carried out to a high standard as seen by staffs personal records. Also the Annual Serice Review completed in April 2008 did not highlight any concerns relating to the selection and recruitment of staff. Care Homes for Adults (18-65 years) Page 18 of 30 Care Homes for Adults (18-65 years) Page 19 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Sybden are currently at risk due to the inadequate health and safety standards in place and are not provided with a homely or safe place in which to live. Evidence: The inspector arrived at the home at approximately 8.30 a.m. and had difficulty accessing the home due to the security call bell system at the front gates being broken. The security of the main gates still requires attention and is not entirely safe in preventing people from wandering out of the home and on to an open road. This is mainly due to the gates being very low and also due to an ineffective locking device. Several areas of the environment are inadequate and found to be in a shabby and unkempt state. These included, the external grounds of the home where the grass was very long and there were several items of broken garden furniture scattered about the garden. Hedges were very high and the maintenance of the surrounding borders was poor. There are two sitting rooms in the home and the smaller small sitting room was unfinished with paintwork and plastering needing to be completed and only partially decorated. There were two broken pains of glass, one in a service users bedroom and the other in the shower room. The bedrooms were generally well maintained and staff had worked hard to personlise these with people. However there should be an Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: environmental audit carried out on all aspects of this service in order to improve the standards for the people living within Sybden. There were two electrical insect machines within the sitting room and within the main hallway. These are both unsightly and unnecessary in a domestic style home and should be removed. This creates an institutional atmosphere and would only be required if there had been an identifiable risk of pests. The staff on duty were unable to confirm that this was the case and therefore these devices are unnecessary. It is the responsibility of all staff to ensure that the home is maintained to an acceptable standard at all times and that health and safety standards are maintained. Fire records were checked including, the latest fire drill was on the 19/02/09, the annual fire inspection was dated 17/02/09 and the last weekly check was carried out on the 16/02/09. The fire policy which was not dated. The latest fire training could not be evidenced. Care Homes for Adults (18-65 years) Page 21 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. People can not be assured that staff are appropriately trained to meet their needs. Evidence: The managers post has been vacant for a period of seven months and therefore the shift leader conducted this inspection in their absence, however we did speak to the area manager on the telephone during the course of this inspection to clarify some issues. The rotas were checked and confirmed that the service provides adequate staffing numbers throughout both the day and night time. However this cover does not provide adequate additional staffing to provide daytime activities to people when not attending their daycare placements. On the day of this inspection there were three people on duty and all the residents were at home. The shift leader informed us that there were currently five full time care staff posts vacant. These posts were currently being covered by bank and agency staff. There was inadequate evidence, with staff training records out of date and no training records available for the year 2008/9 records to confirm that staff have received the mandatory training necessary to carry out their role effectively. The AQQA states that We ensure supervision is carried out monthly instead of the 6 a year. Staff spoken to stated that they had not received regular supervision since the previous manager had left the service. This service is clearly suffering from not having a permanent manager in post and systems have Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: slipped. The general morale of staff was low and unmotivated, with staff on duty stating We need someone to give us direction. We need a full time manager so we can improve the service and get things done.The temporary management cover for the home is provided by another manager based in Watford for half a day per week. This situation is both unacceptable and impractical. The organisation must provide appropriate management support to this service. The area manager is also new and at the time of this inspection had only been in post for one week. There was limited information to confirm that staff meetings are held regularly, with minutes from only three meetings from January 2009 to April 2009 being available. Although staff recruitment records were unable to be inspected due to the staff on duty unable to access this confidential information. However the AQQA stated that Recruitment is carried out to a high standard as seen by staffs personal records. Also the Annual Service Review carried out in April 2008 did not highlight any information provided by the home that caused concern in relation to selection and recruitment of staff. Care Homes for Adults (18-65 years) Page 23 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can not be assured that the service is currently managed to protect the best interests of the people living at Sybden. Evidence: This service is currently without a registered manager in post and due to the lack of leadership and direction for the staff team the outcomes for people using this service are poor. The current service does not currently meet the standards in the following areas, care planning, risk assessment, activities, environment , staffing and management. There was inadequate evidence on the day to confirm that an effective quality assurance system is in place to monitor, evaluate and improve systems and services to the five people living at Sybden. Fire records were up to date and personal monies for two people were checked and reconciled against the individual ledger. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: Medication systems were accurate and a reconciliation of prn (only when required) paracetamol was checked and found to be correct. Regulation 26s were not up to date. These are required by legislation to ensure the provider is aware of the performance of their services. Quality assurance systems should be both formalised and further developed before the next inspection takes place, to include both service user feedback and also to incorporate the views of outside professionals and families and carers. We had a lengthy discussion with the newly appointed area manager at the end of this inspection in order to feedback the concerns of the inspector and outcomes for service users. The area manager has since actioned the issue relating to the risk assessment on the front gates and states we have also commenced identifying specific training needs, and will be putting a training programme in place. We found that a pictorial service user questionnaire is not in place and this would help to ensure that people have the opportunity to be more involved in the running of the service. We found that the current complaints procedure does not ensure people using the service have a clear pathway to making their feelings and concerns known. The current arrangements for daytime activities and day care provision provides people with only limited opportunities to take part in meaningful activities either within the home or within the local community. This was confirmed on the day by limited entries within peoples care plans and also by staff spoken to on the day who stated we just dont have time to do anything with people in the day except take them with us on the daycare run. On the day of this inspection neither of the Statement of Purpose or Service User guide could be located by the staff on duty. Care Homes for Adults (18-65 years) Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 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 7 15 Care plans must reflect all aspects of the person care needs and these care plans must be reviewed regularly. Care plans must be signed by either the service user or their Representative. To ensure the service meets the individual needs of each person in order to keep them safe and protected. 30/06/2009 2 9 13 Individual risk assessments 30/06/2009 must be in place to ensure that any risk presented is assessed and control measures put in place to protect the person using this service. To ensure people using this service are protected and kept safe at all times. 3 12 16 People using this service must be provided with a meaningful daytime activities programme. 30/06/2009 Care Homes for Adults (18-65 years) Page 27 of 30 To ensure peoples holistic needs are being met. 4 22 22 The service must have a 26/06/2009 complete and detailed complaints system in place to ensure that people have a pathway to raise issues and concerns and that these are acted upon. To ensure peoples views are listened to and responded to effectively. This process must also be accessible and visible around the home. 5 35 18 Staff must be provided with the appropriate training to ensure the best possible service is provided to the people living at Sybden. To ensure people are cared for in the most effective way. 6 36 18 Staff must receive 30/06/2009 appropriate supervision to ensure they are supported in providing a high standard of care to people living within Sybden. To ensure people have the underpinning knowledge to care and protect people. 7 37 8 The service must provide a suitably qualified and competent manner to run this service both effectively and safely. To ensure that the service users are provided with an 30/06/2009 31/07/2009 Care Homes for Adults (18-65 years) Page 28 of 30 effective and well run home in order to maintain and protect the welfare of the people using this service. 8 39 21 There must be a system in place to ensure that service users have the opportunity to express their concerns and views regarding the service they are receiving. To ensure people living at Sybden are consulted and their views are listened to. 9 41 17 The service must ensure that all documentation, policies and procedures relating to the health and welfare of the people using this service are maintained and reviewed regularly to ensure that people are provided with the best possible care. To protect the health and welfare of people using this service. 30/06/2009 30/06/2009 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 29 of 30 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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