Inspection on 22/09/09 for The Willows

This inspection was carried out on 22nd September 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

The Willows 25/09/08

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

Key inspection report Care homes for adults (18-65 years) Name: Address: The Willows 30a The Finches Bexhill-On-Sea East Sussex TN40 1UF     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Caroline Johnson     Date: 2 2 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: The Willows 30a The Finches Bexhill-On-Sea East Sussex TN40 1UF 01424732935 01424751641 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Hastings and Rother Primary Care Trust care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 6. 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 Willows is a purpose built bungalow situated in a quiet residential area of Bexhillon-Sea, with nearby access to local amenities, bus and rail routes. The home is registered to accommodate six adults with learning disabilities, some of whom also have physical disabilities and a visual impairment. Accommodation is provided in six single bedrooms that are decorated and furnished to reflect individual tastes and interests. Communal space is provided by way of a lounge and kitchen/dining room. There is also a large conservatory that has been furnished as a sensory room. Bathroom and toilets offer the appropriate adjustments and facilities to meet the needs of the people who live there. The home has an attractive garden to the side of the Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 6 2 5 0 9 2 0 0 8 Brief description of the care home property and off road parking is available at the front of the home. The registered providers are the Hastings and Rother Primary Care Trust (PCT). The PCT also manages nine other homes within the Hastings, St Leonards and Rother area. Fees for the service range from 1331 to 1366 pounds per week for a block contract. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: For the purpose of this report the people living at the Willows will be referred to as residents. As part of the inspection process a site visit was carried out on 22 September 2009 and it lasted from 10:45am until 16:30pm. The registered manager facilitated the inspection. During the visit there was an opportunity to meet with and observe the majority of the residents in their surroundings. Time was also spent talking with staff generally in the course of their duties and time was spent with two staff members in private. Two care plans were examined in detail. Other documentation seen included:- staff rotas, training, menus, health and safety, quality assurance and leisure activities. Following the inspection a warning letter was sent to the provider advising them that we are concerned with the management of this home. We requested a detailed action plan asking they to advise us of how how they intend to effectively monitor the home to ensure that standards in three of the outcome areas improve. Care Homes for Adults (18-65 years) Page 6 of 32 Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 8 of 32 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective resident are now given clearer information about the home and what is on offer but this document needs to be kept up to date to ensure that all changes are included. Evidence: There is a detailed statement of purpose in place but this now needs to be updated to include the changes that have occurred in relation to the Registered Social Landlord, changes to the provision of day care and to include the up to date address for the CQC (Care Quality Commission). Within the past few months the Registered Social Landlord gave notice of termination of their contract and they no longer carry out this role. The Trust are currently looking for a new housing association to take on this role and there are interim arrangements in place until this can be arranged. There have been no new admissions to the home since the last inspection. The terms and conditions/licence agreements have not been updated since the new owners took Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: over the home over eighteen months ago. It was reported that there are still a few issues to be resolved and it is hoped they will be out for consultation in the near future. As required at the last inspection the home now keeps a record of all correspondence received or entered into on behalf of residents. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide detailed information about the needs of the residents but they must be updated as and when needs change to ensure that everyone is kept up to date and individual needs are met. Evidence: Two support plans were examined in detail on this occasion. In each case the information provided was person centred and included very detailed advice and guidance for staff to follow to ensure that each individuals needs could be met. In addition to the support plans that staff use on a daily basis there is a reference folder in place for each resident. Documentation relating to risk management is mainly stored in this file. Person centred planning (PCP) meetings are held regularly and there was evidence that planning is carried out in advance of meetings and that detailed minutes are kept of the outcome. Where there are actions recommended as a result of a meeting a timescale for achievement is set. In the support plans examined it was noted that Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: recording of achievement of actions is often not detailed until the next meeting is due. It was therefore not possible to say if the recommendations made had been addressed. This was discussed with a staff member who then showed the support plan that they have responsibility for updating and it was evident in this plan that these records were up to date. It was noted in relation to one individual that there was no support plan in place in relation to health changes that had occurred during the course of the year between reviews. See health section. A wide range of risk assessments have been carried out but records seen showed that in some cases it was over a year and others over nine months since they had been reviewed. Risk assessments are not person centred and there was no evidence that risk assessments are drawn up in relation to individual residents as and when changes in needs occur. There is no evidence in place to demonstrate that the home is effectively monitoring the quality of the care plans and ensuring that they include up to date information at all times. A good practice recommendation was made at the last inspection relating to the need to ensure that support plans provide more detailed information about the support provided to residents and the outcome. In addition it was recommended that the home find ways of demonstrating more clearly the choices and decisions made by residents. It was evident in the record keeping that some staff write more detailed records than others but overall there has been some improvement in this area. A good example seen showed that a staff member recorded that a resident enjoyed the freedom of being out of their wheelchair for a period of time during their sensory activity. However, it didnt state how the enjoyment was expressed or how staff knew that the resident enjoyed this. No progress has been made in relation to recording choices/decisions made by residents. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are not offered opportunities to participate in varied, interesting and stimulating activities. Evidence: Since the last inspection the day care provider used by the Trust that had been contracted to provide each resident with a minimum of three sessions a week has been given notice and no longer provides a service. There was evidence that staff have been advised to go ahead and arrange more person centred activities for individuals and a staff member spoken with described some of the activities that one particular resident has tried and some that they hope to try in the future. There is a weekly plan on display in the dining room. It was noted in the staff meeting minutes that staff were advised not to record household tasks as activities but that these activities should be in addition to planned activities. This had improved and Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: there was less reliance on recording household tasks as activities. However, in each of the planners seen there was a heavy reliance on in house activities such as sensory activities. In relation to one resident it was noted that the last three planned pub trips had been crossed out and the alternatives were a sensory session, meal preparation and one to one interaction. For the whole week there was one reason given as to why a particular activity had not taken place and this was due to staff shortages. In relation to the second resident, although a number of activities were crossed out and an alternative was provided there were no reasons given as to why they did not take place as planned. In the support records there are details of the actual support provided to residents and details of the activities that took place. A staff member spoken with stated that where possible they try to stick to the weekly planner. They said that prior to speaking with me they had read a few paragraphs of a book to a resident as one of their activities. When asked how they know which book is being read to a resident it was reported that the resident has several books and they choose one. There are no records kept to indicate which book is being read to residents so it is therefore possible that the same few paragraphs are being read to residents and that books are never concluded. There is no internal auditing in place to monitor the quality of the day activities currently provided to residents. At the time of inspection two of the residents were away on their annual holiday. As the home is located close to the seafront in Bexhill residents have very regular walks on the seafront. They are also taken on house shopping trips and personal shopping. Other activities include meals out and in-house sensory sessions. Staff stated that they take residents to the local park, on day trips and to local events such as the French markets. Residents have regular opportunities to observe daily living tasks being carried out in the home. There is a four-week menu in place. The main meal is served in the evening. Menus seen looked varied and well balanced. There is a pictorial menu alongside the menu but the pictures are very small and would not easily assist residents in making a choice. If an alternative to the main meal is served then this is recorded. Occasionally residents have brunch on a Sunday and a take away meal on a Friday. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lack of clear guidance in relation to the management of some of the residents healthcare needs and poor systems to ensure that all staff with responsibility for administering medication are competent to do so could place residents at serious risk of harm. Evidence: The arrangements in place for the management of medication in the home were examined. It was noted that there had been a number of medication incidents logged in previous months. These incidents put together show that there were problems in either the checking in of medication/ administration of medication and/or stock control. It was also noted that invasive medication was administered to a resident on one occasion unnecessarily. The manager had not reported the incidents to the Commission or to Social Services as a safe guarding alert. The PCT had picked up on these issues some time later and had asked for a review of the medication procedures to be undertaken but there was no recognition that this should have been a safeguarding alert or that the matters should have been reported to the Commission. The manager advised that some staff have had extra training on medication and that he would do a learning and performance action plan for these staff. Given that the last Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: incident occurred in July it would be expected that this action would have been taken before now. There is a new procedure in place for checking in and regularly monitoring the medication used. All medication was in order at the time of inspection. Each of the residents has a health action plan in place and this is reviewed periodically. Records showed that recommendations made are not always signed off as having been completed until the time of the next review so it was not easy to track if the recommendations had been achieved by the timescales set. In each of the support plans there is an accident and emergency form in place that can be taken, as required, should a resident need to be taken to hospital. However, although the format is in place in each of the files seen they had not been completed. Following the inspection the registered provider confirmed that completed forms are included in each residents health action plan. The home ensures that residents are supported to attend a range of healthcare appointments as required to meet their individual needs. It was noted that the scales used to monitor each residents weight is broken and the last recorded weight was in October 2008. The manager stated that they have been trying to resolve this since January but to no avail. Staff observed in the course of their duties were friendly and caring in their approach and there was a relaxed atmosphere in the home. Since the last inspection one residents health needs had increased for a period of time. Whilst events were clearly documented retrospectively in their health action plan it was noted that no assessment of changed needs, support plan or risk assessments had been carried out in relation to the changed needs and the support to be provided. The support plan that was in place had been signed by the manager and dated in September 2009 saying that there had been no changes since the previous review. There were detailed guidelines in place in relation to exercises that should be carried out with one resident on a daily basis. These guidelines had been reviewed by the manager on 20/09/09. However, it was noted in other records that the exercises were stopped for a period of time and there were no records in place advising that they should be resumed. Staff spoken with were not clear what the position was. A requirement was made at the last inspection of the home that an assessment of needs/wishes of residents in relation to dying and death be carried out. No progress had been made in relation to achieving this requirement. There were a number of factors more recently that prevented this being carried out however discussion was Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: had about how this could be progressed. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in place ensure that anyone wishing to make a complaint can do so. Evidence: The manager advised that the last complaint received was in 2004. There is a detailed procedure in place to ensure that anyone wanting to make a complaint can do so. A simplified version of the complaint procedure is also on display in the home. There is also a detailed procedure in place on adult protection and prevention of abuse and a flow chart showing the steps to be taken should abuse be suspected is on display in the office. Records showed that the majority of the staff team have completed training on this subject and where this is not the case then training has been booked for staff to attend a course. Since the last inspection the arrangements in relation to the management of disability living allowance payments have changed and the new procedures are working well. It was noted that payments still owed to residents as a result of the changes have yet to be repaid. Care Homes for Adults (18-65 years) Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and decorated to a good standard. Evidence: The home is well maintained and decorated to a good standard. All communal areas were seen during he inspection and they appeared homely and comfortable in design. Requirements made at the last inspection in relation to the shower and the homes fire risk assessment have been addressed. Temporary arrangements have been put in place to deal with any maintenance issues that occur and the manager advised that the new system is working well and all tasks reported are addressed speedily. It was however reported that the leak in the conservatory is still a problem and that it cannot be mended. This is only ever a problem if there is extremely heavy rain. All areas seen during the inspection were clean and there were no odours apparent. It was reported that one of the bedrooms has recently been refurbished and another room was being done. The manager advised that most of the residents have had new easy chairs and one resident is due to get one in October. Care Homes for Adults (18-65 years) Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The majority of the staff team are well trained to meet the needs of the residents and arrangements are in place to update training for the remaining staff. Staff would benefit from regular supervision. Evidence: It was reported that the home has 1.6 vacant staff positions (whole time equivalent). The PCT are currently in the middle of a recruitment drive and second stage interviews are due to be held shortly. On the rota seen during the inspection it was noted that there are regularly two to three agency staff working a shift each day. On the afternoon of the inspection there were two agency staff working alongside the manager. One of the staff members was an employee of another home within the PCT and both workers carry out regular shifts within the home. Recruitment records were not examined on this occasion as they are not held within the home. The homes staff training matrix was not up to date but it was noted in the homes communication book that the manager has recently booked staff on a wide range of courses to be held over the coming months. Five of the staff team have completed a National Vocational Qualification (NVQ) at level 2 or above. Three staff are doing level three and another two staff are due to start in October. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: Records showed that the staff team have not received regular supervision. Arrangements are being put in place to ensure that this area improves. See management section. Care Homes for Adults (18-65 years) Page 23 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not being managed effectively and the operation of this home does not safeguard the interests of residents and staff and urgent attention is required to ensure their health, safety and welfare. Evidence: The registered manager, Mr Iswaraj Sunnassee, is a qualified nurse holding the RNMH qualification. He is assisted by a deputy who is also a qualified nurse and a senior staff member who holds NVQ level three. The manager advised that the management team were depleted in numbers for a number of months and that now that they are back in place the systems for ensuring the smooth running of the home should improve. Staff spoken with during the inspection described the manager as approachable and very supportive. A good practice recommendation was made at the last inspection that the home should review the handover system between each shift. The manager advised that this has been carried out. There is a formal system in place to ensure that staff are aware of the location of medication and to ensure that all money in the home is accounted Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: for. Staff also stated that they read through the communication book and diary to be updated with events in the home along with a verbal feedback from the staff on duty. There is no written record that agency staff have read through care plans and therefore when there are two agency staff on duty as on the day of inspection this could mean that staff are heavily reliant on the information provided from the previous shift. There is a what good support looks like section in each of the care plans that would provide agency staff with this information. A member of the senior management team visits the home once a month unannounced and a report is written detailing the findings. Records were seen in relation to the last two visits. The first was carried out on 20 August and there were very detailed findings including forty three actions to be carried out as a result of the visit. This visit included an examination of documentation relating to the month of June. The second visit was carried out over two days in early September. As a result of this visit there were fifty five action points. This visit included an examination of records from July and August. On each report there was an instruction that an action plan be drawn up by the manager detailing how the actions would be addressed and a timescale for achievement of each action was also stated. There was no evidence that an action plan had been drawn up. The manager advised that he had only just received both reports. However, it was noted that the timescales set in the first report had passed and the timescales for the second report were almost due. In relation to issues like supervision it was noted that all staff have had either one or two supervisions this year. There was an expectation recorded that all supervisions should be up and running by the end of September. However, it was noted that, at the time of the inspection, none of the staff team had received a supervision in September. There was an urgent recommendation that a fire drill be held, a date was arranged but the drill was not held. Another recommendation was made that the frequency of staff meetings be increased and it was noted that a meeting was held at the beginning of September. There were very detailed minutes kept of the outcome. It was noted that many of the areas referred to in the first monthly report were highlighted in the minutes. However there was very little evidence that this was being transferred into record keeping generally. An example of this is that staff were told to put forward requests for aromatherapy to head office and to state why they thought residents would benefit from this. It was reported that this has been done verbally but there was no written record that this has happened. Records showed that there were three incidents of theft in the home, one in December Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: 2008 and two in March 2009. It was reported that the PCT called in their security officer to investigate the incidents as it was not clear if the items had been stolen or just mislaid. The Police were not notified of the incidents, the matter was not referred to social Services as a safeguarding alert and the Commission were not informed. The manager advised that money/valuables that had been taken from residents would be paid back to the residents. However, this has yet to be done. It is concerning that the monthly visits are being carried out retrospectively and that incidents (theft and medication errors) were still not dealt with appropriately once they had been picked up via this procedure. Last year the PCT introduced a new format for carrying out quality assurance monitoring. Questionnaires were sent to the relatives of the residents and two returns were received both last year and this year. Results of these surveys were positive. As residents have complex needs and are unable to give verbal feedback a system was introduced to look for evidence that their individual needs were being met. A member of the senior management team visited the home and along with support from staff assessed the quality of residents lives from a range of aspects. As a result of the exercise, where appropriate, recommendations were made to the home to ensure that there was more detailed recording kept. In addition timescales were set to achieve any recommendations made. The system itself is excellent and it was therefore disappointing to note that there was no evidence recorded that the recommendations made had been addressed. In addition in relation to residents, the quality assurance system has not been carried out this current year April 2009 to March 2010. Despite there being systems in place to audit and monitor the quality of the care received by residents via care planning, medication systems and the outcomes of day activities these are not being carried out effectively by the manager of the home. Information provided in advance of the inspection along with information recorded in the monthly visits undertaken by the PCT show that the home is ensuring that the equipment used by the home is tested and serviced at regular intervals. In advance of the inspection a range of surveys were sent to the home to distribute to residents, staff and any visiting professionals. Three resident surveys were returned and in each case they had been completed on behalf of the residents. As the residents concerned have no verbal communication the views expressed as those of the person completing the form and not the residents. In each case the comments and the tick system used was exactly the same. Care Homes for Adults (18-65 years) Page 26 of 32 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 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Regulation 15(1,2b) The registered person must ensure that care plans include up to date information about the assessed needs of the residents and how they are to be met. Care plans must be updated as needs change. Residents must know that their assessed and changing needs are reflected in their care plans. 20/11/2009 2 9 13 Regulation 13(4a,c)The registered person must ensure that risk assessments be reviewed and where appropriate new risk assessments put in place following a change to the needs of residents. 20/11/2009 Care Homes for Adults (18-65 years) Page 28 of 32 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 The risk of accidents and harm happening to residents and staff must be minimised. 3 12 16 Regulation 16(2mn) The registered person must ensure that residents are given regular opportunities to participate in meaningful and fulfilling activities. Residents must enabled access to a variety of activities in line with their individual assessed wishes/needs. 4 19 13 Regulation 13(1b)The registered person must ensure that the health care needs of residents are assessed regularly seeking professional advice as needed and that where appropriate a plan of the care to be provided must be included in support plans and reviewed at regular intervals. Residents physical and emotional needs must be met. 5 20 13 Regulation 13(2) The registered person must having consulted with their pharmacy and general 19/11/2009 20/11/2009 06/11/2009 Care Homes for Adults (18-65 years) Page 29 of 32 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 practitioners put in place a system for ensuring that medication is ordered, stored and administered and recorded correctly at all times. In addition all staff designated to deal with medication must be appropriately trained and competent to do this work. Residents must be protected by the homes policies and procedures for dealing with medication. 6 36 18 Regulation 18(2) The registered person must ensure that all staff receive regular supervision. Residents benefit from well supported and supervised staff. 7 37 10 Regulation 37(1e) The 30/10/2009 registered person must ensure that any event in the home that affects the well being of a resident must be reported to the Commission without delay. Residents must benefit from competent and accountable management of the home. 20/11/2009 Care Homes for Adults (18-65 years) Page 30 of 32 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 8 37 10 Regulation 10(1) The Registered Person must having regard to the size of the care home, the statement of purpose and the numbers and needs of the residents, manage the home with sufficient competence and skill by monitoring and auditing the care that the home provides. The service must be run in the interests of its residents. 20/11/2009 9 42 9 Regulation 17(2) Schedule 4 20/11/2009 para 9(a,b) The registered provider must ensure that all monies owed to residents are paid to them. The welfare of residents must be promoted. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!