Inspection on 05/11/09 for The Yellow House

This inspection was carried out on 5th November 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 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Yellow House 14/11/07

The Yellow House 19/01/06

The Yellow House 12/08/05

The Yellow House 11/01/05

The Yellow House 04/08/04

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Insight - Eastchurch

Southfields

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: The Yellow House 154 - 158 Sackville Road Hove East Sussex BN3 7AG     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: Nigel Thompson     Date: 0 5 1 1 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 35 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 35 Information about the care home Name of care home: Address: The Yellow House 154 - 158 Sackville Road Hove East Sussex BN3 7AG 01273727211 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Gwen Wells-Brown care home 15 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 15 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Learning disability (LD) Date of last inspection Brief description of the care home The Yellow House is a privately owned care home that is registered to provide care and support for up to fifteen adults aged between 18 to 65 years who have learning disabilities. The home is run as a family type home. The home is comprised of three semi-detached houses, which have been converted for there current use. Accommodation is provided over two floors and includes fifteen single rooms some of which have en suite facilities. The home is close to local transport and communal facilities. The fees range from £460.00 to £630.00 per week. Additional charges are payable for hairdressing and chiropody services. 15 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The last inspection of this service was undertaken on 14 November 2007. This key unannounced inspection, involving two Inspectors, took place over four hours in November 2009. It found that the majority of the National Minimum Standards that were assessed had not been met or only partially met and the overall quality of care provided was poor. Following concerns received regarding the mangement of the home, the purpose of this inspection was to assess compliance with the requirements of the previous inspection and to generally monitor care practices at the home. On the days of the inspection there were twelve residents living at the home. Care Homes for Adults (18-65 years) Page 5 of 35 The inspection involved a tour of the premises, observation of working practices, examination of the homes records and discussion with two members of staff, the manager and the proprietor. As part of the inspection process two residents relatives were also spoken with. The self assessment document, the Annual Quality Assurance Assessment (AQAA) had been returned by the manager, as required, prior to the inspection. However, it had not been completed adequately and contained gaps in the details requested and information which subsequently was found to be either misleading or inaccurate. The focus of the inspection was on the quality of life for people who live at the home. Care Homes for Adults (18-65 years) Page 6 of 35 What the care home does well: What has improved since the last inspection? What they could do better: There is a sense from both the physical environment of the Yellow House and certain institutionalised management and care practices, evident within the home, that the service has not developed or progressed over recent years. The admission policy and procedures must be reviewed to ensure that no person is admitted to the home unless their needs and aspirations are appropriately assessed. It is also important that prospective residents have accurate information to make an informed choice on where to live. Some major concerns were identified regarding the lack of consultation and involvement of residents in many decision making processes within the home. As discussed during the inspection, residents must be consulted on and have the opportunity to participate in all aspects of daily life. As an example, there is currently no evident link between activities arranged for residents and their recreational interests identified in individual care plans. It is also important that care plans, including risk asessments, are developed with the involvement of the individual resident and regularly reviewed to reflect their changing needs and circumstances. Residents should be provided with adequate facilities and opportunities to be involved in the choice and preparation of their own food. Professional advice should be sought regarding the provision of specialist diets, including meeting the dietery requirements of residents with diabetes. To improve social interaction and communication, current arrangements for mealtimes should be reviewed, enabling residents and staff to eat their evening meal together. Shortfalls were identified regarding the current unsatisfactory storage arrangements for medicines. Also, as discussed, details in individual Health Plans should be fully completed and information be accurate and up to date, reflecting changing needs and circumstances. An accessible complaints procedure must be implemented for residents, their relatives and other persons acting on their behalf. Residents must also be protected by improved staff recruitment procedures and relevant training and up to date policies relating to safeguarding vulnerable adults. Care Homes for Adults (18-65 years) Page 7 of 35 Infection control procedures are unsatisfactory and current arrangements for dealing with soiled linen are inadequate and unaccepatable. To enhance the comfort and homely feel of The Yellow House, it is recommended that the extensive use of wood effect floor covering should be reviewed. By her own admission, the manager has undertaken very little training to update her skills, knowledge and awareness of recent legislation and current practices. The current quality assurance system must be reviewed and extended to seek the views of residents, their relatives, stakeholders and other visitors to the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 35 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. Admission policies and procedures do not ensure that residents are only admitted on the basis of a full needs assessment, undertaken by people competent to do so. Due to certain inaccurate and out of date information currently made available, prospective residents cannot always be sure that the home is able to meet their individual care and support needs. Evidence: On the day of the inspection the manager confirmed that there were twelve residents living at The Yellow House. She added that there has been one person admitted to the home since the last inspection. However the placement evidently did not work out, for reasons of suitability and compatibility with other service users. As a consequence, and following several reviews involving her social worker, the individual was asked to leave and actually moved out in September. No admission procedure was made available for inspection and in residents files examined there was no evidence of any pre-admission assesment having been carried out. Information is made available to prospective residents, including the Statement of Care Homes for Adults (18-65 years) Page 10 of 35 Evidence: Purpose and Service User Guide. Both documents, although basic in format and fairly brief in content, had evidently been reviewed in September 2009. However despite this it was noted that contact details for the CQC had not been updated. As discussed with the manager, the Statement of Purpose is unsatisfactory and must be amended and improved in accordance with Schedule 1. The annual self assessment (AQAA) was returned to the CQC on 22 September. It was hand written and there were many gaps in the details provided.During the course of the inspection certain information provided in the AQAA were subsequently found to be misleading or inaccurate, including: .....individual needs are being met and are constantly reviewed to ensure this is always the case. However there was no evidence to support this statement, either through discussions with residents or from examination of individual care plans. Care Homes for Adults (18-65 years) Page 11 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Unsatisfactory and inconsistent care plans are not always developed in a person centred manner, nor are they reviewed effectively to reflect an individuals changing needs or circumstances. There are also shortfalls in the information provided and residents do not currently benefit from opportunities to develop and fulfil their goals and aspirations. Evidence: The manager explained that since the last inspection the home has changed the care planning format in order to make them easier to read and understand. Three individual care plans were looked at in depth. The manager said that each person has a quick read plan and a person centred plan although two person centred plans could not be found. All three of the quick read plans were found to use negative and in some instances disrespectful language, particularly in reference to giving an overview of each persons background. There was no information about where the person had lived before, their Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: likes and dislikes, their personal achievements or what was important to each person. A brief overview of healthcare needs was included within the quick read plans, although again this was very brief and failed to provide staff with guidance about what they need to do to support that person. Whilst there was evidence to show that one person had written their likes and dislikes in respect of food, staff had recorded on the next page that they have no likes or dislikes, but food should be suitable for a diabetic. One person centred plan was seen, the one that could be found. Whilst photographs of close friends and family members had been included at the front of the plan, other information within it was minimal e.g. likes and dislikes, activities, activities of daily living and healthcare needs, although staff had taken the time to write within the plan what things make the person happy. This had been written in the first person, I would like to own my own computer. Go on an IT course. I would like help to go out and buy a new computer. However there was no evidence to show how staff would support the person to meet their needs and wishes, or indeed if any of this had been achieved. Neither the quick read plan, nor person centred plan had been dated therefore it was not possible to know whether or not the information contained within them was current. This was the same for most records viewed. Separate daily records are kept. Again, these are brief and only include information such as where each person had been during the morning and afternoon. Risk assessments including personal hygiene, eating and drinking, sexuality, road safety, fire safety, accessing the community alone, night safety and behavioural issues are all kept together in the same file and were found to be identical for each resident. Those seen were brief, not tailored to individual needs and all reviewed annually stating no change. There were no risk assessments in place for a person with epilepsy, although some consideration had been given to the risks associated with diabetes. Care Homes for Adults (18-65 years) Page 13 of 35 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 opportunities to access the local community and participate in meaningful social activities are restricted by staffing levels and inadeqaute resources. They are not involved in many decision making processes and choices available to them are limited. Evidence: Care records seen were out of date in respect of most activities of daily living including activities and lifestyle choices. For example, one persons care plan said that they attend a day service each week, but when speaking with that person and staff it emerged that they had not been for over 10 months and was now at home each day. There was no reference to this or guidance for staff to follow in order to ensure that this person had structured daily activities within or outside of the home. Minimal activities were seen on the day, although residents said that they do Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: sometimes play games and that last week staff helped them to make Christmas decorations, in October. One person said we dont usually get out. A residents relative, spoken with as part of the inspection process, commented about the positive impact of day services. My daughter can be lazy and not easy to motivate but I think she has the opportunity to do what she wants. Having said that, if it wasnt for the wonderful day centre she attends, Im sure that she would sit around far more than she does. Residents said that staff plan and prepare all meals and food and that drinks and mealtimes are always given at set times, 10am, 12pm, 2pm, 6pm and 8pm. They said that lunch is always sandwiches, prepared by staff, and that all residents eat together in the dining area, whilst staff have their meals in the quiet lounge. On the day of inspection, residents said that staff used to ask them what they would like for lunch and dinner but that this has not happened for some time. One person has diabetes. They commented that they are always given either fruit or yoghurt for dessert after each meal, which they find boring. It was of concern to note that no information about their diabetes had been recorded within their care plan, nor had the staff with support from a healthcare professional taken the time to consider alternative sweets that may be appropriate. One person commented Staff decide our meals for us. Another person commented that all residents are usually in bed by 10pm each evening. Residents and staff commented that care staff do the vast majority of housework and daily living chores including laundry, cooking, making drinks and cleaning. This means that residents are not being supported to learn new and maintain independent life skills. According to a large poster in the dining room, residents are not allowed to use the homes main telephone, to make, receive or answer calls, although staff said that they are encouraged to use the pay phone. Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: Care Homes for Adults (18-65 years) Page 16 of 35 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. Residents do not recieve adequate support in respect of their personal, emotional and health care needs. Medication is generally managed appropriately, however the current arrangements for the storage of medicines are unsatisfactory. Evidence: A Health Action Plan, HAP, was incorporated within the person centred plan, although as previously mentioned those seen were brief. From discussions with staff and residents and through examination of relevant documentation, including individual care plans, there is an evident lack of staff guidance. Consequently, residents are at potential risk as their health and personal care needs are not being met in a structured and consistent manner. Two residents have epilepsy, and although staff said that it is well controlled, there was no other information available within records examined, such as how long the individual had been seizure free for, what sort of seizures had been experienced or what staff need to do in the event of a seizure occurring Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: Two residents in the home evidently have diabetes. Although a risk assessment was in place for this, there were no clear guidelines in place about what staff need to do in the event of a person becoming hypo or hyper. There was no evidence to show that staff sought professional advice about how to manage such specialist diets, bearing in mind individual needs, wishes and choices. One resident has a permanent stoma bag in situ, which care staff are required to change daily. Staff spoken with said that only those who have received training in this are permitted to change it. There were no records or guidelines in place for staff to follow or record that it had indeed been changed or that any problems had been identified e.g. infection, which staff said does happen occasionally. The manager confirmed that only staff who have received appropriate training are directly involved in administering medication. This was suported through discussions with members of staff and by the relevant medication policy and training records that were examined. All residents are registered with local GPs and have access to other health care professionals, including physiotherapists, psychologists and occupational therapists, as required. It was noted, in care plans that were examined, that all appointments with, or visits by, health care professionals are recorded. Concerns were raised during the inspection regarding the storage of medication. The current arrangements are totally unsatisfactory. One drawer of a filing cabinet contains the Monitored Dosage System, MDS, blister packs, however the remaining drawers are completely disorganised and filled with random packets of tablets and other medication, many out of date. This is in stark contravention of the homes own policy on Handling and Storage of Medication which clearly states Each residents medication must be grouped together within the cupboard either in rows or in separate containers. The manager confirmed that, following risk assessments, no residents currently self administers their own medication. However, it was stated in one persons plan that Staff hold and administer .....s medication with her agreement but she is able to manage it for herself when she is away on holiday or at her mothers. This suggests that some residents within the home are able to manage their own medication but that the home does not support this when they are at home, therefore not promoting independence. Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: Care Homes for Adults (18-65 years) Page 19 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. With no accessible complaints procedure in place, residents, visitors and staff cannot be confident that their concerns will be listened to and acted upon. Residents are not always protected by the homes policies and procedures and staff training relating to safeguarding vulnerable adults. Evidence: It was noted that there is currently no accessible complaints procedure in place, for the benefit of residents, their relatives or other visitors to the home and the manager was unable to provide such a document for inspection. In the Policy and Procedures file it was noted that a complaints procedure (undated) was actually guidance notes for staff regarding action to be taken on receiving a complaint. This had evidently not been reviewed for many years and contained refernces to the National Care Standards Commission, NCSC, (the regulatory body that predated the Commission for Social Care Inspection, CSCI. In line with the majority of the homes policies, the complaints policy is required to be reviewed and updated. A Safeguarding policy made available for examination was found to contain much of the necessary information, but it did not cross reference or link with the Multi Agency Policies & Procedures. Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: Training records examined indicated that all staff have recently received relevant training and this was suported through discussions with staff. A concern was raised in respect of how the home safeguards vulnerable adults, despite many staff having recent training in this. Through discussions with the manager it emerged that a person no longer living at the home had recently disclosed to member of staff alleged abuse. It was of concern that this was not reported in line with local safeguarding policies and procedures and that the Manager had made an assumption that due to their history of allegations that the allegation was untrue. Care Homes for Adults (18-65 years) Page 21 of 35 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. Residents benefit from a safe and reasonably comfortable environment. However the extensive wood effect floor covering throughout is more functional than homely. Residents are at potential risk from unsatisfactory infection control procedures. Evidence: There has evidently been little change in the physical environment since the previous inspection and with the generally well maintained decor and good quality furniture and furnishings it continues to provide a safe and comfortable environment for residents. Many of the residents rooms have been personalised, with pictures, family photographs and other possessions and small items of furniture, to reflect individual taste, choice and interests. Residents, spoken with during the inspection, were generally satisfied with the home and their individual room. Im very happy with my room, it has everything that I need. Of note is the extensive use of wood efffect floor covering throughout the home, including corridors and communal areas. The proprietor explained that this is primarily Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: an infection control procedure and is in response to the problem of incontinence. From discussion with the manager, it is evident that currently only one resident in the home suffers with incontinence. In such circumstances the floor covering in her room is therefore reasonable and appropriate. However the extensive use of the same wood effect floor covering throughout the majority of the building is unnecessary, it detracts from the comfortable and homely environment and creates an institutionalised appearance. Concerns were raised in the cluttered and untidy laundry room regarding the unsatisfactory level of infection conrtrol. Current arrangements for dealing with soiled linen are inadequate and unaccepatable. Despite the identified and previously documented issue of incontinence within the home, the laundry room has no sink or sluice facility. When asked how soiled linen is dealt with prior to putting it in the washing machine, a member of staff replied: We either run it under the showere or rinse it in the bath. However, standards of hygiene in other parts of the home were very different and much improved. A recent inspection by the Environmental Health Office resulted in the catering areas, kitchen, dining room and food stores, being awarded a maximum five stars under their Scores on the doors scheme. Care Homes for Adults (18-65 years) Page 23 of 35 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. Residents in the home benefit from a stable staff team but are at potential risk from inconsistent and inadequate staff recruitment policies and procedures. Evidence: Staff turnover at the Yellow House is very low and the stable and dedicated staff team remains able to meet the assessed, individual and collective needs of residents within the home. All new employees are provided with a job description and staff spoken with demonstrated a sound understanding of their individual role and responsibilities. All new staff receive induction and foundation training, the Common Induction Standard, which is compatible with Skills for Care, formerly TOPSS, and is flexible and compatible with an individuals level of relevant experience. Mandatory training is ongoing and is recorded in individual staff files. This was confirmed through discussions with staff and supported by training records examined, There is plenty of training here. The manager confirmed that all but one member of care staff hold the National Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: Vocational Qualification, NVQ, level 2. The recent introduction of occasional one to one staffing within the last year has enabled more residents to be supported out in the community. Formal supervision is provided for all care staff on a regular basis. This was evidenced by supervision records examined and through discussions with staff, spoken with during the inspection, who acknowledged the benefits of effective supervision and confirmed feeling valued and supported by the manager: Supervision is very useful and the manager is always very supportive. It is evident, from discussions with members of staff that the manager also operates an open door policy, with staff feeling confident and able to discuss any issues at anytime. Certain concerns were highlighted relating to the recruitment of staff. Although, as previously documented, turnover at the home is low, in three separate recruitment files that were examined some procedural shortfalls were identified. In each of the files it was noted that only one reference had been obtained, instead of the statutory two. To compound this unsatisfactory issue, in one of the files the sole reference was provided by the proprietor and in another case by the manager, of the Yellow House. Care Homes for Adults (18-65 years) Page 25 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been a lack of progress at the Yellow House as the manager does not undertake necessary periodic training to develop, maintain and update her knowledge, skills and competence. With inadequate quality monitoring systems and unsatisfactory controls in respect of health and safety, the service is not operating in the best interests of the people who live there. Evidence: The manager has been in her current post for 8 years and completed the Registered Managers Award (RMA) in 2005. However, by her own admission, she has undertaken very little interim training to update her managerial skills, knowledge and awareness of recent legislation and current practices. As previously documented, there were a number of issues identified during the course of the inspection that should clearly have been addressed through more effective and efficient management, including the unsatisfactory storage of medication, inconsistent care planning systems and documents not able to be located. Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: However, whilst a number of shortfalls were identified, the manager was cooperative throughout the inspection and appeared keen to develop the service to improve outcomes for residents. Quality monitoring procedures within the home are currently inadequate. Although satisfaction questionnaires have been developed to obtain feedback from residents realtives, it ws noted that no questionnaires had been sent out since January 2008. The manager confirmed that the health, safety and welfare of residents and staff remains of paramount importance within the home. Staff training is provided in many aspects of safe working practices, including moving and handling; food hygiene; fire safety and first aid. All staff training is recorded. COSHH assessments and guidelines are in place. Regular fire drills are undertaken and recorded. Temperature regulators are fitted to all hot water outlets, accessible to residents. All accidents, incidents and injuries are recorded and reported, as required. Care Homes for Adults (18-65 years) Page 27 of 35 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 28 of 35 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 1 4 It is required that all information made available to prospective residents and their relatives, including the Statement of Purpose and Service User Guide, be accurate and up to date, in acccordance with Schedule 1. Prospective residents must have accurate information to make an informed choice. 29/01/2010 2 2 14 It is required that the 29/01/2010 admission procedure be reviewed to ensure that no person is admitted to the home unless their needs and aspirations are appropriately assessed. No admission procedure was made available for inspection and in residents files examined there was no evidence of any pre- Care Homes for Adults (18-65 years) Page 29 of 35 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 admission assesment having been carried out. 3 6 15 It is required that all care plans including risk asessments be developed with the involvement of the individual resident and regularly reviewed to reflect changing needs and circumstances. There is no evidence of how often and by whom care plans including risk assessments are reviewed. 4 8 12 It is required that all residents be consulted on and have the opportunity to participate in all aspects of daily life. Residents should be, as far practicable, enabled and supported to make decisions regarding their day to day living. 5 14 16 It is required that residents 29/01/2010 have acces to, and choose from, a range of appropriate leisure activities. There is no clear or direct link between activities arranged and the recreational interests identified in care plans. 29/01/2010 29/01/2010 Care Homes for Adults (18-65 years) Page 30 of 35 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 6 17 16 It is required that residents 31/12/2009 be provided with adequate facilities and opportunities to be involved in the choice and preparation of their own food. Residents are not involved in meal preparation. 7 19 13 It is required that, as discussed, details in individual Health Plans should be fully completed and information be accurate and up to date, reflecting changing needs and circumstances. Residents emotional and health needs are met. 31/12/2009 8 20 13 It is required that satisfactory arrangements are in place for the handling and safekeeping of medicines within the home. Residents must be protected by robust medication procedures. 31/12/2009 9 22 22 It is required that a 31/12/2009 complaints procedure be implemented to consider concerns made by residents, their relatives and other persons acting on their behalf. Care Homes for Adults (18-65 years) Page 31 of 35 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 There was no evidence of a complaints procedure in place for residents, their realtives or other visitors to the home. 10 23 13 It is required that residents 31/12/2009 be protected from potential abuse by appropriate staff training and relevant and up to date policies and procedures, relating to safeguarding vulnerable adults. Residents are protected by robust policies and procedures for responding to suspicion or evidence of abuse. 11 30 16 It is required that the 31/12/2009 premises are kept clean, hygienic and free from offensive odours throughout and adequate systems are in place to control the spread of infection. Infection control procedures are unsatisfactory and arrangements for dealing with soiled linen are inadequate and unaccepatable. Care Homes for Adults (18-65 years) Page 32 of 35 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 12 34 19 It is required that the home operates a thorough and robust staff recruitment procedure. Residents are at potential risk from unsatisfactory recruitment procedures and shortfalls in the necessary documentation were highlighted during the course of the inspection. 31/12/2009 13 37 9 It is required that the person 31/12/2009 managing the home has the necessary qualifications, relevant skills and experience for the post and undertakes periodic training to update her knowledge, skills and competence. By her own admission, the manager has undertaken very little training to update her skills, knowledge and awareness of recent legislation and current practices. 14 39 24 It is required that the current quality assurance system be reviewed and extended to seek the views of residents, their relatives, stakeholders and other visitors to the home. 29/01/2010 Care Homes for Adults (18-65 years) Page 33 of 35 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 Basic satisfaction questionnaires are in place but have not been sent out for nearly two years. 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 6 It is recommended that more consideration be given to person centred care planning, through improved staff awareness and relevant training. It is recommended, to improve social interaction and communication, that current arrangements for mealtimes be reviewed and residents and staff eat their evening meal together. It is recommended that professional advice be sought regarding the provision of specialist diets, including meeting the dietery requirements of residents with diabetes. It is recommended that specific staff guidelines and accurate recording sysytems be developed and implemented, regarding the care and support of people with epilepsy and the resident who has a stoma bag. It is recommended that the extensive use of wood effect floor covering be reviewed. 2 17 3 17 4 19 5 24 Care Homes for Adults (18-65 years) Page 34 of 35 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. 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