Inspection on 05/05/09 for The Old Rectory

This inspection was carried out on 5th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old Rectory 09/05/07

The Old Rectory 02/05/06

The Old Rectory 14/12/05

The Old Rectory 13/07/05

The Old Rectory 16/12/04

The Old Rectory 14/04/04

The Old Rectory 12/07/02

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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: The Old Rectory Stubb Lane Brede East Sussex TN31 6ES     The quality rating for this care home is:   two star good 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: Michele Etherton     Date: 0 5 0 5 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 37 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 37 Information about the care home Name of care home: Address: The Old Rectory Stubb Lane Brede East Sussex TN31 6ES 01424882600 01424882066 old-rectory@craegmoor.co.uk 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) : Parkcare Homes Ltd care home 16 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 16 The maximum number of service users to be accommodated is 16. 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 The Old Rectory is registered to accommodate thirteen adults with learning disabilities in the main house, and three adults in the cottage. The property is set in extensive grounds close to the village of Brede near Rye. Whilst Brede offers some amenities the village of Westfield approximately two miles away is used for shops and post office facilities. The main property is a three-storey building and service users accommodation is now on all floors. The cottage is adjacent to the main house, is detached with all three bedrooms having en-suite facilities and a private garden area. The properties are owned by Parkcare Homes Limited, which in turn is owned by Craegmoor Healthcare Limited. The current scale of fees range from £581 to £1250 Care Homes for Adults (18-65 years) Page 4 of 37 Care Homes for Adults (18-65 years) Page 5 of 37 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: two star good 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 reader should note that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term service user to describe those living in care home settings. For the purpose of this report, those living at the Old Rectory are referred to as residents. A key inspection of this service has been undertaken that has taken account of information received about and from the service since the last inspection. This includes an Annual Quality Assurance Assessment (AQAA) form submitted by the service manager, this was completed to a good standard, and told us most of what we needed to know and illustrated current and future plans for service development. No surveys were received from staff or residents to inform our judgments of the Care Homes for Adults (18-65 years) Page 6 of 37 service. Our inspection of this service has also included an unannounced site visit to the premises on 5th May 2009 between 10:15 am and 17:40 pm. During our visit we were accompanied for some of the time by an expert by experience and their supporter who spent time with residents and staff and we have included their findings within this report. During the site visit we were able to meet and interview five staff, the maintenance person, five residents and the manager. We also undertook a tour of the premises and examined a range of documentation; this included four resident support plans, associated risk information, staff recruitment, training, and supervision files. Medication, accident and complaint records were also examined. Whilst some residents we met had limited verbal communication others were able to express their views and were willing to write these down or speak with us. In general residents spoke positively about the home but would like to see improvement in some areas. We are advised that there are currently no complaints or adults safeguarding alerts open. In arriving at our judgment of this service we have considered the overall risk and impacts of any shortfalls identified to residents and overall compliance with regulation. What the care home does well: What has improved since the last inspection? Care Homes for Adults (18-65 years) Page 8 of 37 The AQAA tells us that since the last inspection the following documentation has been updated, Statement of Purpose, user guide, activity planners, menu information Working relationships with other professionals have developed further. Improvements have been made in ensuring confidentiality is maintained. The AQAA informs us that care plans have been modified to provide a more consistent approach towards being more person centered and that staff have received training in this. Improvements have been made to the recording and management of complaints and adult safeguarding alerts including the timescales for reporting these matters to relevant agencies Two shower areas have been upgraded and some areas of the home redecorated. All staff have been offered infection control training Additional training has been provided to staff in respect of managing challenging behaviour, medication, autism, rectal diazepam. The frequency of staff supervision has been maintained. Residents are benefiting from increased continuity in staffing. What they could do better: The site visit highlighted that the environment of the home has suffered as a result of a lack of sustained maintenance and upgrading and this is now overdue. The expert by experience reported that: Although the home was tidy, it looked old, tired and the plaster was stripped off around the pipes upstairs and from the wall in the dinning area. There were two bathrooms and two shower rooms upstairs that looked shabby and in bad condition. One of the shower rooms looked flooded with water appearing to have extended beyond the room, wetting the carpet in the corridor. The paint looked stripped off from many walls of the home. A resident said I would like my bedroom wallpapered I saw no information on the walls presented in easy read format with pictures. We found when we examined medication records that changes to medication administering details were being added by different staff with no clear audit trail as to who had made changes and where the authorization to do so had come from, this is unsafe practice and could place residents at risk we have therefore issued a requirement for improvements in medication recording. Some recommendations have also been made for improved practice particularly in areas where the home has previously demonstrated good outcomes e.g activities, Care Homes for Adults (18-65 years) Page 9 of 37 menus and recording of resident food intake. There has been a noticeable deterioration in some areas of home routines and this may be attributable to the increasing absence of the present manager on other projects, it is hoped that the appointment of a new manager whose sole responsibility will be the improvement and development of the Old Rectory service will halt any further reduction in service quality and address those areas identified for improvement. Although we found the AQAA to be completed to a good standard the findings from our site visit highlighted some discrepancies between what the AQAA reported and what was actually happening currently e.g AQAA makes clear there has been a re-allocation of key workers and yet some of the staff on duty with whom we spoke are still to be assigned as keyworkers. It is important that in reporting information within the AQAA the accuracy can be clearly evidenced through the staff and resident feedback and documentary evidence. 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 10 of 37 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents benefit from an assessment of their needs prior to admission. Care must be taken to ensure that health needs are appropriately supported from time of admission, and the staff team are fully apprised of what support they should be providing. Residents have information about the service and the costs they must pay, but would benefit from separate accessible terms and conditions information to advise them of their rights and responsibilities. Evidence: Prospective residents receive an assessment of their needs prior to admission to ensure these can be met by the home, some residents we spoke with remembered visiting the home before deciding to come and live there. There is anecdotal and documentary evidence that important health information had not been well communicated to the home or acted upon at the time of admission of a resident that could have had serious consequences for the resident concerned, there is a need for the home to ensure that where prospective residents are admitted the Care Homes for Adults (18-65 years) Page 12 of 37 Evidence: home makes sure they have a full understanding of the current health needs and that any support systems are in place at time of admission thus ensuring the resident is not placed at risk. There is information available to residents about what financial costs they are expected to contribute towards. There is no established terms and conditions document provided in an accessible format, detailing their rights and responsibilities as residents of the home. Whilst it is understood that there are varying degrees of ability within the resident group, a standard accessible version should be produced initially to inform residents with limited literacy skills, and this is a recommendation. Care Homes for Adults (18-65 years) Page 13 of 37 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed support plans inform staff about individual resident needs and preferences in their daily routines,opportunities for residents to make decisions and choices need improvement. A responsible risk taking strategy is in place and risks are routinely reviewed and updated Evidence: Support plans viewed are detailed and reflect personal resident preferences staff spoken with confirmed they discuss residents daily routines but would seem to have little input into the development of plans or the changing of plans this would seem to be the role of senior staff, care staff who are not acting in a senior position had little understanding of person centered planning,this was contrary to information supplied in the AQAA that advised that all staff had received training in person centred planning, neither staff feedback or the training matrix viewed was able to sufficiently evidence this. Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: The expert by experience who accompanied us reported: Staff communication and training We saw one of the support workers disappearing into the garden, with a service user who appeared agitated. He seemed to be trying to calm him down. The second staff member said that his colleague was having one to one with the service user. Good I asked a support worker about how she communicates with residents who are non verbal. She said, I use MAKATON with some. I know what a particular gesture means. We also use pictures to help them make choices I asked the residents if they felt supported by staff: A resident said, I and my wife used to live in a flat, but people didnt leave us alone. They broke our windows and called us names, so I asked my social worker to put us in a residential home. I am much happier here. My key worker is a lovely decent person. She helps me out. Not Good A resident said Sometimes I get a bit disappointed and annoyed with staff. They make jokes sometimes and I dont realize they dont mean it All the service users I talked to said that the home was reasonably alright but,It could be better one of them commented. Residents we spoke with in the cottage confirmed they are involved in their care plans and discuss these with staff. I asked if staff involve residents in their own Person Centered Planning (PCP). The staff member didnt know anything about PCP. She said, I would like to go on PCP training We are advised that the company is currently implementing a major training programme for staff in respect of person centred planning and currently 35 of staff at the home are trained. Support plans viewed highlighted a range of goals established for each resident, however daily records failed to provide supporting evidence that goals were being worked on with residents as part of their daily routines and there appeared no clear system for measuring frequency or achievement in these areas other than through monthly reviews we would recommend that daily records make clear when an activity Care Homes for Adults (18-65 years) Page 15 of 37 Evidence: is linked to a goal. A key work system is in place but this would seem to be in a state of flux in view of some recent staff turnover only one staff member spoken with seemed aware of who they were key worker for currently. One said they were no longer a key worker as they were leaving and another reported they were still undergoing induction. If the home is to continue with the key worker system then Residents need to be given the choice of who their key worker is likely to be and should be informed of this at the earliest opportunity so they can begin to develop a trusting working relationship with that staff member. Residents opportunities to make more decisions and choices for themselves could be improved upon and a review of some established regimes around bed times and meal choices is overdue. Risk information was noted in place and this and care plans content are reviewed monthly in conjunction with care plans,we noted evidence of a recently developed risk assessment in response to an incident involving a resident. Care Homes for Adults (18-65 years) Page 16 of 37 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. Residents are under stimulated and bored and staffing is not used effectively to support them with activities residents lack information about their daily routines and choices, Evidence: Whilst it is clear that some of the more able residents lead a more varied and interesting lifestyle and experience positive outcomes e.g independently accessing the INTERNET and enrolling on an open university course, participating in work experience,we noted a number of residents sitting around and generally under stimulated during the day despite their being a number of staff available. We observed a resident approach the manager and ask whether it would be OK if they went out with a staff member on the bus, when informed that they didnt need to ask Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: they indicated they had asked on several occasions previously to other senior staff but nothing had been done. We found daily records failed to reflect or evidence what activities residents were participating or the frequency of these. There is an activities co-coordinator but on Tuesdays his time is taken up with a resident who attends a specific activity,we did not note staff undertaking any in house activities with residents during the course of our visit. Although we found lots of picture prompts around the building in bathrooms and other areas there is a lack of information in accessible formats for residents to view in respect of which staff are on duty, the menu, what activities are on offer to them personally or for groups, communication boards were not visible in resident bedrooms to inform them about their day. We asked an expert by experience to visit the home with us and engage with residents primarily to find out about their experience of life in the home they reported that: All the resident I talked to said they had access to their money and the key for their bedrooms which allows them to maintain their privacy. A resident said I have my key to my bedroom and my own money Residents are involved in decision making about the running of the home through regular monthly service user meetings. I asked residents if they are given the choice of when to go to bed and when to wake up, all of them said that they go to bed at 10pm. Support worker No.1 said, They cant choose to go to bed after 10pm. They have to be in bed by 10 oclock because they need plenty of sleep, but they get up whenever they want to I asked residents if they choose their own meals,a resident said Sometimes Support worker No1 said, No, we have a set menu, but we review it Support worker No 2 said, Residents choice of meals is very limited. They are always given cereal for breakfast with no other choice. They could be given a different breakfast other than serial such as eggs or something else for a change. The food is the same. It does not change: Morning: cereal, almost every lunch: Sandwiches, the dinner is a cooked meal. I saw no picture menu in easy read format on the walls of the kitchen. This does not allow residents to make choices about their meals. However, it seems that residents can choose not to eat certain meals from the set menu. A resident said, I dont like eating rice and curry, so staff make me a separate meal. Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: I asked the service users I talked to, whether they are active helping with the cooking, cleaning, washing and other household tasks: A resident wrote I help with peeling the potatoes; loading the dishwasher and washing up We saw her clearing up the cups after some residents finished drinking their teas and washing the cups afterwards in the kitchen. Another resident said I mess myself sometimes, so I wash my own pants. He also said, In the mornings, I help myself with the cereal for breakfast. A resident said, The staff do all the housework I asked the three residents whether they go out to do activities. One resident wrote, trips to the pub; shopping; swimming. Another resident said On Saturdays I go shopping, I go to pub or swimming. Sometimes we go on holidays. Last week, I went to a friends house for dinner. A resident said last year we went on holiday to Blackpool. All the residents I talked to, only mentioned a few limited activities that they were regularly engaged in. A resident said I would like some games in this home like a snooker table. Staff need to help service users, where possible, to engage in a wider range of leisure activities and personal development learning activities. A resident said I would like to play Piano to take my mind off things, but they dont have it here. May be It costs a lot Staff need to support individuals to choose and develop interests both within and outside of the home and to be actively involved in the community. A resident said I miss meeting the public. One resident said, I watch TV a lot and dose off. I read books. I get bored sometimes. Another resident commented It is boring living in this home. Meeting people is what I miss. Here, I am like a prisoner in my own home. So I get bored, depressed and I could lose my temper and I dont want that. When I used to get out, I was a nicer person and calmer. Now, I am not what I used to be. I dont go to pub or see pictures. So I have no activities. I used to go out with a staff member but it was stopped. Every time I asked, they said no, we dont have enough staff Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: We have checked the concerns this resident has raised in respect of reduced activities, and it would seem that there has been a reduction related to lack of personal finances to continue with some of the more expensive activities; alternative options are being sought but delays in progressing this are partly due to inconsistencies in the residents motivation to participate. Residents are supported and enabled by home staff to maintain regular contact with relatives and or friends In addition to the lack of choice and variety in their daily meals food records are not routinely maintained or in sufficient detail to ensure that residents are eating a healthy and balanced diet this was discussed during the site visit with the cook and the manager and documentation was implemented immediately to rectify this omission. A food probe is not currently in use this was reported to the manager who has ordered a replacement. The current cook has been moved into the post from the care staff and although has received food hygiene training will need additional training to ensure that residents requiring specialist diets can be accommodated. Care Homes for Adults (18-65 years) Page 20 of 37 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. The physical personal and mental well being of residents is generally well supported, and respect paid to individual resident preferences in regard to the gender of staff who support them. Improved recording is needed in regard to the support provided to residents in managing their health conditions and also in regard to handwritten changes on medication records Evidence: A key worker system is in place but at the time of our visit key working arrangements were being revised with three out of four staff spoken with not currently allocated to a specific resident. Staff spoken with had a good understanding of individual residents daily routines and their knowledge is supported by detailed support plan information and guidelines, which can be referred to, resident preferences in respect of the gender of staff who support them is recorded. Residents are supported to access routine health care appointments, and health action plans are in place. One resident we spoke with had requested a dental appointment and this has been organized other residents were attending dental appointments Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: during the course of our visit. The manager reported that weights are being routinely recorded separate to records within the support plan although this information was not viewed on this occasion. We have noted that daily records viewed failed to evidence that a resident with diabetes is being provided with snacks high in carbohydrate during the course of every day despite this being recorded within the care plan, discussion with individual staff highlighted an awareness and understanding of the need to provide additional snacks dependent on blood sugar readings, but this is not made clear within daily record entries to evidence that the resident is being supported to manage their diabetic condition safely and minimizing the impact on their daily life and behaviour. We examined medication administration records on this occasion, these indicated that medication is being appropriately received and recorded into the home, there are no omissions in the medication administration to residents, however we noted a number of handwritten entries and changes to the MAR record, in discussion with the manager not all of these are by the same person or the staff member responsible for receipt of medication therefore there is a risk of error and we require the provider to ensure that all handwritten entries and changes are signed and dated by the staff member making the entry or change. Care Homes for Adults (18-65 years) Page 22 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place that safeguard residents Evidence: An accessible complaints procedure has been developed to inform residents, a resident representative speaks with residents and conveys any issues they may have to the my voice meetings. As those residents with communication difficulties are unlikely to use the complaints procedure themselves consideration should be given as to how the complaints procedure can be made more accessible to them with perhaps staff being proactive in determining when incidents occur whether this would have precipitated a complaint from a more able resident and applying the same to less able residents and investigate accordingly. The Commission has not received any complaints but has received two expressions of concern from neighbors in respect of noise from one particular resident of the home when in the garden, the homes complaint records indicate that one client complaint has been received and three from neighbors, the home has addressed all the complaints and whilst they cannot fully address the issue of noise they have tried to compromise without inflicting undue restrictions on the resident concerned or impacting on their overall quality of life. Staff spoken with have an understanding of adult safeguarding and confirmed they Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: receive regular training in this area, a training matrix confirms all staff have received updated training. Staff are confident in working with more challenging residents and feel they have received adequate induction and training, detailed guidance is also provided to inform staff about the type of interventions they should be using with individual residents, a minor holding technique is used for one resident and this is documented in their support plan and reviewed regularly. Financial systems ensure that resident monies are appropriately managed and we checked the balances of four residents against records held and found these to be accurate. The Company ensures auditing of financial records is undertaken regularly and the manager confirms she undertakes spot checks also. Residents are safeguarded by a robust recruitment procedure which minor improvements would enhance. Care Homes for Adults (18-65 years) Page 24 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home environment is in need of a sustained programme of upgrading and residents should be actively consulted and involved in this, improvements to infection control procedures are needed and to promote good hand washing amongst residents and staff. Evidence: There is evidence of some upgrading and redecoration of some areas of the home this would seem to be reactive and peicemeal rather than as part of a sustained and ongoing programme of upgrading and maintenance to address the deteriorating condition of the Home and external environment. The absence of a maintenance person for some time has meant a lack of sustained input to address minor works and the overall condition of the external area of the home. We met a new maintenance person who informed us that they had been in post six weeks and were awaiting a contract of employment they confirmed they would be undertaking some works a priority being the installation of radiator covers which we noted supplies of in an empty bedroom The majority of bathroom shower and toilet areas are in need of upgrading, two Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: recently refurbished walk in shower rooms have been created and are a good resource for residents, however the finish on one is not satisfactory leading to water from the shower traveling out of the room onto the carpet instead of down into the drain, we found the carpet outside of the shower room to be sodden and this was also pointed out to us by a resident who is concerned. As a first floor shower room there is a danger of leaks to the floor below and wooden floorboards and joists beneath. We drew this to the managers attention at the site visit who indicated this would be pursued and put right, it is important that the home manager undertakes routine tours of the home for health and safety purposes to ensure that such issues are picked up quickly or that staff are actively reporting these matters. One toilet we viewed had a broken ceiling light which would make it difficult for residents to see at night, another toilet we visited had no toilet seat and the toilet frame around it was old and rusty, another toilet had no toilet paper or hand towel available but a number of clean bath towels were stored in the bathroom and at risk from cross infection,we discussed these shortfalls with the manager who agreed to ensure these matters were addressed either immediately or as part of the upgrading of the home. We viewed the majority of resident bedrooms with permission and found these to be spacious and reflective of residents personal interests and tastes, residents have been helped by staff and relatives to personalize their space and the quality of most furnishings were to a satisfactory standard, however we noted the quality of some bedding and towels and flannels to be in a poor state, this has been brought to the attention of the manager during the site visit who has agreed to replace these items and began ordering replacements immediately. The home is spacious and bright and communal rooms are pleasant however we found that sofas within the main lounge to be in an unsatisfactory condition with missing seating and some damage to springs in other sofas, the manager informed us that replacement settees are already on order, they have tried to remove the most severely damaged sofa but one resident has objected and clearly this needs to be arranged in conjunction with the arrival of the new furniture. Whilst the garden to the front of the home is in a reasonable condition and accessible to residents, there is a noticeable lack of weeding and this is beginning to impact on the general appearance, the rear garden and that adjoining the cottage primarily for the benefit of cottage residents, is not currently accessible owing to the length of the grass, the manager reports that the role of the new maintenace person also includes a responsibility to maintain the garden and it is hoped some of their time can be spent on making the rear garden accessible, and some thought should be given to involving Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: residents more in the maintenance of the gardens if they wish to do so. A fire extinguisher was freestanding on the floor on a top floor landing and needs affixing to the wall for safety reasons.Staff we spoke with confirmed that fire drills are being undertaken and all fire equipment and servicing is being conducted in a timely manner, however when we viewed the records for the cottage we found some predating of the records and have raised concerns with the manager about this. We noted also a fire door wedged open to the stairs in opposition to the homes fire risk assessment, the manager reported this is due to a resident who has a wish to keep the door open, it was agreed that the installation of a door guard would enable the door to be kept open safely with its release only when the alarm is activated and this should be pursued along with the updating of the fire risk assessment once it is in situ. The home is generally clean and tidy but improvements are needed to ensure infection control procedures are followed and residents supported to maintain good hand washing. The expert by experience who accompanied us during the site visit reports that: Bedrooms were personalized with many of service users favorite and personal items. I saw Dr Who and Harry Potter posters on the wall of a residents bedroom wall. Each room had a TV and music player and other items which made them look homely. Although the home was tidy, it looked old, tired and the plaster was stripped off around the pipes upstairs and from the wall in the dinning area. There were two bathrooms and two shower rooms upstairs that looked shabby and in bad condition. One of the shower rooms looked flooded with water appearing to have extended beyond the room, wetting the carpet in the corridor. The paint looked stripped off from many walls of the home. A resident said would like my bedroom wallpapered I saw no information on the walls presented in easy read format with pictures. I asked the residents if they chose the decoration and colors for their rooms and the home. They said that it was already decorated when they moved in. All the residents I talked to said that they wanted their rooms redecorated with a color of their choice. Care Homes for Adults (18-65 years) Page 27 of 37 Care Homes for Adults (18-65 years) Page 28 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures need further strengthening to ensure residents are protected, programmes of mandatory traiing and supervision of staff are well supported and sustained. Evidence: We noted from an examination of staff meeting minutes that some concern has been raised previously by staff regarding levels of staffing at the home. We spoke with five care staff during our visit and none reported that they found staffing levels to be an issue for them. The manager confirmed that both the manager and deputy are counted into the available staff numbers on duty each day, which in addition to the activities organizer can be as many as eight staff. The AQAA informs us that the home has achieved 50 trained staff and aspires to attain 80 in the near future, the home uses a number of overseas staff recruited through an agency and they work for a limited period of one or two years so staff turnover happens regularly, the manager reported that they have managed to recruit some new staff who are local which means residents will benefit from better continuity in staffing. As a result of staff turnover the number of qualified staff falls and rises at present only seven of the nineteen staff including the deputy have achieved NVQ level Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: 2 or above, a programme of qualification training is in a place and a further six are currently completing this, once achieved will provide a 70 qualified staff level. There is a robust recruitment and induction programme in place and we examined files of four newer staff the content of all was compliant with schedule two of the Care home regulations 2001 although one was still to have a current photo. We also found that whilst comprehensive interview records are maintained these do not make clear that gaps in employment and verification of reasons for leaving previous care roles have been explored and this was discussed with the manager. Staff confirmed that whilst CRBs were awaited they were not allowed to work unsupervised with residents or undertake personal care, and our examination of records confirms that two staff are currently awaiting the return of their CRB application which would appear to have been subject to unknown delays and which the service is pursuing with the criminal Records Bureau, the provider is reminded that except in exceptional circumstances which should be discussed with the commission no staff member should be commencing work at the home until a full and satisfactory CRB has been received. We are advised by the manager and staff that prospective staff have to undertake a literacy assessment and evidence of this was noted in files viewed. Those recruited through agencies are still required to attend for interview and are not automatically accepted as suitable, staff spoken with confirmed they received an initial five day induction before commencing work which provided them with mandatory skills training they attend for a further three days to complete the induction programme which incorporates the common induction standards for care staff. the home maintains individual staff training files and the training matrix is up to date. From our discussions with staff and examination of training records and matrix it is clear there is a well established rolling programme of mandatory training in place, one staff member also reported attendance at an autism course since they had been at the home, staff are working with people with a range of complex needs and will need access to more specialist training to ensure they have the necessary skills and knowledge to work effectively with residents and this is a recommendation at this time. Staff we spoke with confirmed they feel well supported and are provided with regular supervision with their manager, staff meetings are provided for all staff with additional senior meetings held Care Homes for Adults (18-65 years) Page 30 of 37 Care Homes for Adults (18-65 years) Page 31 of 37 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well managed but this will be compromised if day to day management oversight and operational control is not sustained Evidence: The home is generally well managed by the present manager who is experienced and knowledgeable about the residents living in the home, whilst she has a clear understanding of the areas in which the home needs to improve and has a development plan and vision for the home , she is shortly to leave and whilst a replacement has already been appointed, there is a need to ensure that the incoming manager is apprised of the development plan and areas for improvement so that delays in progressing these do not occur. The present manager has spent increasingly less time at the home recently, and this has had a noticeable impact on minor issues not being progressed or resolved resulting in a small but gradual erosion in the quality of service offered to residents e.g the picture menu not being openly available to residents, a food probe reported as missing Care Homes for Adults (18-65 years) Page 32 of 37 Evidence: had not been replaced. Whilst overall monitoring of service quality has identified the big areas for improvement e.g environment it is essential that oversight also takes account of the small omissions which add to the quality of life experienced by residents. This should be addressed by the appointment of a new manager who will be able to provide full time operational control of the home. There is a comprehensive quality assurance programme in place, this ensures auditing systems are in place, and opportunities provided for residents to express their views through a resident representative. The representative informed us that they along with residents from other homes attend a My voice meeting where residents views can be discussed. Residents views are also sought through surveys, an annual quality report is produced, provider visits in compliance with regulation 26 of the care Homes regulations 2001 are being undertaken and detailed reports compiled of these visits were noted, many of the shortfalls in relation to the environment are already known about and action is underway to address these but progress is slow and is reactive rather than provided in a sustained manner. Policies and procedures are produced centrally and the AQAA informs us that some have not been reviewed for some time, being updated only in response to changes in legislation. Some thought needs to be given to ensuring that changes in current thinking and best practice also influence the development of policies and procedures to ensure staff are kept updated, the AQAA tells us that staff have had policy and procedure information disseminated to them over the last 12 months. In view of the complex needs of residents we looked at the occurrence of accidents and critical incidents recorded by the home, we found these to at a low level, and where incidents prompted safeguarding referrals the home had acted appropriately, or could evidence where risk information had been amended to address a newly identified or changed risk. The AQAA informs us that all health and safety servicing and checks have been undertaken and we randomly sampled the electrical installation which we found to be in date. A current employers liability insurance is in place. Care Homes for Adults (18-65 years) Page 33 of 37 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 34 of 37 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 20 13 Handwritten entries and changes to Medication administration sheets must be signed and dated by the staff member making the entry To protect the health and safety of residents 05/06/2009 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 1 5 Information located in various documentation avaialble to residents should be drawn together into a terms and conditions document and provided in an accessible initially to those with limited literacy skills, other versions can be produced for residents with more profound communication difficulties but have capacity to understand the information provided to them Daily records should make clear where activities undertaken are linked to goals A review of residents activities should be undertaken to ensure they are provided with a varied range of in house and external activities in keeping with their own interests, Page 35 of 37 2 3 6 12 Care Homes for Adults (18-65 years) that promote and maintain independence. Improved recording of activities undertaken should be established 4 35 Staff would benefit from access to more specialist training to improve their knowledge and skills, improve understanding and enable more effective working with individual residents with complex needs Care Homes for Adults (18-65 years) Page 36 of 37 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. 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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