Inspection on 04/08/09 for Vicarage Road (62)

This inspection was carried out on 4th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Vicarage Road (62) 06/08/07

Vicarage Road (62) 13/12/05

Vicarage Road (62) 08/06/05

Vicarage Road (62) 27/01/05

Vicarage Road (62) 23/07/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Vicarage Road (62) 62 Vicarage Road Buntingford Hertfordshire SG9 9BA The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Claire Farrier Date: 0 4 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 39 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (20092008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 39 Information about the care home Name of care home: Address: Vicarage Road (62) 62 Vicarage Road Buntingford Hertfordshire SG9 9BA 01763 273191 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : www.grantahousing.org.uk Granta Housing Society Limited care home 4 Number of places (if applicable): Under 65 Over 65 4 4 learning disability Additional conditions: Date of last inspection A bit about the home Care Homes for Adults (18-65 years) Page 4 of 39 62 Vicarage Road is a house that looks like the other houses in the road. It is close to the shops in the town centre. There is a small shop nearby. The home is near to bus routes and the train station. This means that the people who live at the home can get around easily. Everybody who lives at the home has their own bedroom. Nobody has to share a room. Care Homes for Adults (18-65 years) Page 5 of 39 Everyone shares the lounge, dining room and kitchen. The manager can tell people about the accommodation charges for 62 Vicarage Road. The Statement of Purpose and the Service Users Guide tell people about the home. The manager will give a copy the CQC inspection report to people who want to see it. Care Homes for Adults (18-65 years) Page 6 of 39 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 39 How we did our inspection: This is what the inspector did when they were at the care home The last inspection of 62 Vicarage Road was on 6th August 2007. Last year we completed an Annual Service Review, which showed that the home continued to provide good outcomes for the people who lived there. Care Homes for Adults (18-65 years) Page 8 of 39 When we visited 62 Vicarage Road this time, the people who live in the home and who work in the home did not know we were coming. We talked to some of the people who live in the home. We looked at some care plans and other papers. We looked around the home. Care Homes for Adults (18-65 years) Page 9 of 39 We talked with some staff who work at the home. Before the inspection the manager sent us some information about the home. This is called the AQAA (Annual Quality Assurance Assessment). Before the inspection we sent out some surveys to the staff and to the relatives of the people who live in the home. We could not talk to the manager about the inspection because he was on holiday. Care Homes for Adults (18-65 years) Page 10 of 39 What the care home does well The people who we met told us that they are happy in the home. The people who sent us surveys before the inspection all said that the home is good. One person said, They take me to lots of places especially the sea side which I like a lot. When one person was ill, the staff looked after them very well. Care Homes for Adults (18-65 years) Page 11 of 39 What has got better from the last inspection One person has taken part in interviewing people who want to work in the home. The activities co-ordinator makes sure that everyone has holidays that they enjoy. Everyone helped to choose some new furniture. The home has a new vehicle so that people can visit the places that they want to go to. Care Homes for Adults (18-65 years) Page 12 of 39 What the care home could do better The staff do not have enough information and training so that they can support all the people in the home in the best way. Some of the care plans do not have up to date information about peoples needs. Some of the staff work very long hours. This means that they could be too tired to support people in the home and keep them safe. Care Homes for Adults (18-65 years) Page 13 of 39 People who are thinking about moving into the home do not have enough information to help them to decide if the home is right for them. People pay their mobility allowance (Disability Living Allowance) to use the homes vehicle. But some people do not use the vehicle very much. People may be harmed because cleaning things are not stored safely in the kitchen. The staff made sure that this was made safe straight away. Care Homes for Adults (18-65 years) Page 14 of 39 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Claire Farrier 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 15 of 39 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 16 of 39 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. Information about the home needs to be made available so that people are able to make an informed choice about using the services. The staff do not have the information and training to meet each persons care needs. Evidence: Three people live in the home and no one has moved into the home for more than three years. One person recently died following a long illness. (See Personal and Healthcare Support for the end of life care that they received.) As no one has moved in recently, during this inspection we did not see any assessments that were carried out before people came to the home. The Annual Quality Assurance Assessment (AQAA) stated, The manager does an assessment of need and to ascertain the aims of the referral for their future needs and wishes. We try to build in flexibility in the referral procedure to ensure the candidate has all the information they need to make an informed choice. We very rarely use the assessment procedure as we are a small home and the residents live here as their permanent address. In the next 12 months it is our aim to fill the current void before the end of 2009 following the above mentioned procedure. We will actively seek feedback on the success of us implementing this procedure. The AQAA stated that the Statement of Purpose and Service Users Guide have been Care Homes for Adults (18-65 years) Page 17 of 39 Evidence: updated during the last year, and that all residents have a copy of their contracts and are given updated service user guides and statements of purpose when they are updated. We did not see these documents on this occasion, and we have not seen them during the last two inspections.The files that we saw of the people who live in the home did not contain either copies of their contract agreements or the Service Users Guide. For this reason we are unable to assess whether they provide sufficient information that is required so that people can make an informed choice about moving to the home. The staff who we spoke to said that they do not have sufficient information and training to enable them to meet the needs of the people who live in the home. All the people in the home have a learning disability, and the AQAA stated that one person has mental health needs. The training records not available to show that the staff are fully trained to meet these needs, and the staff who we spoke to said that they are waiting for some essential training that was postponed due to the needs of the person who was terminally ill (see Staffing). The staff were not sufficiently aware of the needs and risks for certain conditions (see Personal and Healthcare Support). Care Homes for Adults (18-65 years) Page 18 of 39 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. The people who live in the home are not fully involved in decisions about the use of their disability benefits to pay for the homes vehicle. The care plans are person centred, but have not been fully updated to ensure that they provide the staff with appropriate information to enable them to meet each persons individual needs. Evidence: The Annual Quality Assurance Assessment (AQAA) stated, Residents contribute to our annual Quality Assurance report, Granta do a resident survey annually, we have a quarterly newsletter, residents have regular meetings and we have a Resident rep who attends meetings and also sits on interview panels. Granta has a policy on involving residents in the organisation that includes tenant involvement groups, consultation on all decisions and policies, involvement in recruitment interviews and involvement in their care plans. One person told us how they have been involved in training for recruitment, and then in interviewing people who apply to work in the home. We looked at the files of two people, which show what care is provided for them and how it is recorded. The care plans are written in a person centred format, which shows that people are involved in making decisions about their care and their lives in the home. Entries are written in the first person and describe the persons personal Care Homes for Adults (18-65 years) Page 19 of 39 Evidence: preferences. The care plan for communication includes how to understand each person, and what behaviours or signs each person may use to make their views known. The AQAA stated that what the service does well is that care plans are individualised to suit the needs of each resident. In the next 12 months they plan, to develop formalised person centred plans, including things like circles of support and recording how we support residents chose their activities and holidays etc. The care plans that we saw have been reviewed regularly, but in some instances they are not updated following changes. For example, one person has been prescribed with Warfarin during the last year. There are particular concerns that staff should be aware of (see Personal and Healthcare Support), but the care plan and risk assessments do not provide information on these. There are a large number of risk assessments in each persons file. Many of them are general risk assessments, and not particular to, or in some cases relevant to, each person. Examples of these are risk assessments for using cleaning materials, fire risks, and risks for using the iron. The individual risk assessments cover each persons behaviours and activities, for example, getting lost and road awareness, going to the local shops. These are clearly written, with good details of the risks involved and the measures needed to enable the residents to manage the risks safely. However one person has a risk assessment for absconding, which is an inappropriate term for leaving the house unsupervised. Everyone in the home has their own bank account, and the staff support them as needed to manage their finances. Good records are kept that show what each person spends and saves. One person looks after their own cash and bank statements, and goes on their own to the bank. There are good procedures in the care plan and risk assessment for ensuring that this person can do this safely and independently. However in one respect people do not have full control of how their own money is spent. Each persons Disability Living Allowance (DLA) is paid straight to Granta for use of the homes vehicle. In the care plans that we saw, it was recorded that the family member of one person had agreed that this was in their best interest. In the other care plan, the person is recorded as saying, I dont mind this because I can go where I want. But there is no formal agreement that each person has agreed that their money should be used in this way. There is also no record or accounts to show how each persons money is used for their benefit. The weekly activity programmes for each person do not indicate that they use the homes vehicle to the extent that they contribute towards it. One person rarely uses the vehicle. This person likes to walk to the local shop, and uses their bus pass to travel to the nearby towns. The daily records show that this person has used the homes vehicle six times in the last two months, and only three of these were possibly for social activities. The other person is recorded as using the homes vehicle on seven occasions in the last two months, most of which were to visit a family member and to shop. This evidence does not indicate that each persons benefit money is used cost effectively and to enable them to be as independent as possible. During the last key inspection in August 2007 we saw that each persons file had a copy of the notes taken when it was agreed that the mobility Care Homes for Adults (18-65 years) Page 20 of 39 Evidence: allowance should be used as a part contribution towards the cost of the mini bus. There was no evidence of this on this occasion, and no evidence that the process of each individuals decision about the use of their benefit money complies with the Mental Capacity Acts five key principles for decision making. Care Homes for Adults (18-65 years) Page 21 of 39 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are supported to live full and active lifestyles, and to develop their skills for independence. Evidence: Vicarage Road has the atmosphere and ethos of being the home of the residents. The staff encourage them to make their own choices of what they want to do. The Annual Quality Assurance Assessment (AQAA) states, Residents are highly supported to make decisions about how they wish to live their lives and the activities they want to do. Individuals are encouraged to pursue independent activities but also the chance to spend time with their peers. There are many day trips which are discussed at resident meetings. This are either individual, in pairs or in groups depending on the choice of the individual. Each person has an individual activities planner that shows what their interests are. One person likes to go out independently, to the local shop or to the town, and also to attend social activities at the local church. Another person likes to shop, particularly for magazines, and visits a family member every week. Most people attend a day centre Care Homes for Adults (18-65 years) Page 22 of 39 Evidence: most days. One of the support workers is also the activities organiser. She ensures that everyone is able to take part in their individual choice of activities in the home and in the community. One person who completed a survey for the inspection said that what the home does well is, Takes me to lots of places especially the sea side which I like a lot. All the staff who returned surveys said that there is a good range of activities in the home. One person said, Daycare is good. Residents go out for trips, meals out. Residents are well cared for. The staff who we spoke to said that activities have been restricted over the last few months due to the terminal illness of one of the people in the home. The manager recognised this in the AQAA, We have had one resident who has been increasingly unwell over the past 12 months with cancer, sadly they died last month. This has had a large impact on the other people we support and the staff team as a whole. All the residents take part in the routines of the home. They are encouraged to clean and tidy their rooms and to take some responsibility for their own laundry. One person came home from the day centre and made a cup of coffee with minimal supervision. This person said that they make their own sandwiches, and their favourite is cheese and pickle. Care Homes for Adults (18-65 years) Page 23 of 39 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The procedures for recording information in the care plans and for administering medication do not ensure that everyone has the care and medication that they need in a safe and effective way. Evidence: The care plans that we saw contain good details of each persons care needs. They are written from each persons point of view, and say how each person likes to be supported with their personal care and healthcare. A good relationship was observed between the staff and the residents. People are encouraged to be as independent as possible, and they are supported to visit professionals such as the GP, dentist and chiropodist. The healthcare records seen included references to hospital visits, and contact with GPs and other health professionals. The Annual Quality Assurance Assessment (AQAA) stated, A resident sadly died in June 2009, and this was handled very sensitively. The resident wished to stay at home which we were able to accommodate, getting support from Isabella Hospice home care and support from the district nurses. The other residents were supported by ourselves and by outside professionals. All staff and residents were offered counselling and added support. The staff who we spoke to said that they were all involved in providing twenty four hour care for this person in their last days. Extra staffing was provided so that there could be a member of staff awake in the home during the night, and the Care Homes for Adults (18-65 years) Page 24 of 39 Evidence: district nurses and MacMillan nurses provided full nursing support. Some activities for the other people in the home were affected for a short while due to the extra attention that this person needed, but all missed outings and activities have now taken place (see Lifestyle). Staff training did not take place during the last months due to the extra time and care that the staff gave, and this has not yet been reprovided (see Staffing). Medication is supplied in blister packs and is stored in a locked cabinet in the kitchen. We looked at the medication records for the two people who we case tracked. All administration of medication was correctly recorded, and a daily check is made of medication that is in its original packaging. Homely remedies, such as paracetamol and Lemsip, that are bought over the counter and not supplied on prescription, are stored in a separate box in the medication cupboard, and a record book records when and why any of the remedies is given. The procedures for recording and monitoring medication are generally good. However the medication policy that we saw in the home is for Medication Administration in the Community (Domiciliary Care), and is not applicable to care homes. One member of staff has not had training in administering medication. This person showed me the medication, but said that they assist with administering it, but they do not administer themselves. Staff must not handle medication unless they have received appropriate training. (See Staffing.) One person has Warfarin, which is properly recorded in a separate anticoagulant therapy book, and checked by the anticoagulant nurse. The current prescription means that tablets have to be broken in half. The second half is placed in an unmarked container in the medication cupboard, which is unsatisfactory and may cause a risk of people receiving the wrong dosage or the wrong medication. The home must consult the pharmacist about the recommended procedure to ensure that variable dosages of medication such as Warfarin are handled safely. There is no care plan or risk assessment for this person with regard to the anticoagulant therapy and use of Warfarin. The monthly care plan reviews all state, No change, with no mention of the changes needed when anticoagulant therapy started. The staff need to be aware of the risks of bleeding caused by knocks and bruises, but there is no information on this in the home. The staff who we spoke to were aware of the need for the person to have the correct dosage of Warfarin, but they were not fully aware of the risks, what they should look out for, and when they should seek medical advice. Further advice can be found at www.npsa.nhs.uk/nrls/alerts-and-directives/alerts/anticoagulant. There are no controlled drugs currently stored in the home. However morphine injections were kept in the home for the person who was terminally ill, which the community nurse administered. The staff said that this was kept in a separate box in the medication cupboard. However this does not comply with the requirements for storing controlled drugs securely. If controlled drugs are kept in the home a properly secured controlled drugs cabinet must be installed. Care Homes for Adults (18-65 years) Page 25 of 39 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are encouraged and supported to make their views and concerns known, and appropriate procedures are in place to ensure that they are protected from abuse and neglect. Evidence: The Annual Quality Assurance Assessment stated, We have a very robust complaints procedure. The project prides itself on having an honest and frank relationship with residents, family and other health care professionals. The home has a satisfactory complaints procedure in place that is available to all residents and their relatives. The complaints procedure is in an easy read pictorial format for the people in the home. The staff encourage people to make any concerns known, and these are recorded. There have been no recorded complaints in the last two years. The home has appropriate procedures for safeguarding vulnerable people. The staff who we spoke to were aware of the safeguarding procedures, and of their responsibilities for whistle blowing. Everyone has training on safeguarding vulnerable people as part of their induction, and annual refresher training. The homes Vulnerable Adults at Risk policy was agreed by a list of stakeholders, including Hertfordshire Social Services. It includes clear definitions of different types of abuse, and the procedure to report any allegations direct to Social Services. A standard missing person protocol is in place for each person in the home. It was followed when one person was missing from the home in October 2008. The Care Homes for Adults (18-65 years) Page 26 of 39 Evidence: notification of this incident showed that a full risk assessment was carried out, and actions have been taken to ensure that safeguards are in place. Another person goes out unsupervised, and there is a care plan and appropriate risk assessments in place (see Individual Needs and Choices). But the protocol for this person has not been individualised to meet their specific needs, and it does not specify at what stage concerns should be raised if the person does not return home when expected. Care Homes for Adults (18-65 years) Page 27 of 39 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 provides a comfortable and well maintained environment for the people who live there, and the staff maintain a good standard of cleanliness and hygiene. Evidence: The building is an ordinary semi-detached house, furnished and decorated in domestic styles that produce a homely, comfortable environment that allows the residents to relax and feel very much at home. The residents all have their own rooms, arranged and decorated to reflect their particular interests and tastes. The lounge, dining room and kitchen are domestic in style and are comfortably furnished and well equipped. The home has an enclosed garden a patio area, lawn and flowerbeds. The Annual Quality Assurance Assessment (AQAA)stated that the back garden could do with an overhaul to make it more decorative. Also that staff were discussing with the residents their choice of carpet or flooring for the dining room and hallway. The home appeared to be clean and generally well maintained, and the staff follow appropriate procedures to maintain hygiene and prevent the risk of infection. The AQAA stated, We recently had a visit from environmental health who concluded that our standard of hygiene would warrant a five star rating however the service presented to low a risk to be part of the graded system. We saw this report while we in the home. Care Homes for Adults (18-65 years) Page 28 of 39 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. The staff work very long shifts, which may affect the quality of their work. The lack of regular supervision and essential training for some staff means that they may not have sufficient knowledge and support to enable them to work safely with the people who live in the home. Evidence: The Annual Quality Assurance Assessment (AQAA) stated, What we do well is that staff are committed and dedicated. They share goals and aims and are highly united in their aspirations to provide an excellent service to the residents. We received surveys from three members of staff, and all were generally positive about the information, training and support that they receive. However no staff said that they meet with their manager regularly, and two said that only sometimes do they have enough support for their work. The staff who we spoke to during the inspection also said that they do not have regular one to one supervision with the manager. However we saw evidence of annual appraisals and the staff said that they can discuss any issues with manager. The manager has recognised this as an area for improvement. In the AQAA he wrote that supervisions need to be more frequent. In the next 12 months the manager plans to draw up a rota to ensure that staff receive monthly supervision. The staff rotas show that two members of staff are on duty during the day, and night staffing is by one person sleeping in. These levels are adequate to meet the needs of the current group of residents. Most shifts include agency staff, and the staff who we spoke to said that occasionally there are no permanent staff on a shift, but this would Care Homes for Adults (18-65 years) Page 29 of 39 Evidence: only be due to an emergency such as staff sickness. Some members of staff have worked very long hours, up to 62 hours, in the last two weeks. However over a two to three week period, they did not exceed their contracted hours. But the member of staff who sleeps over during the night frequently works a total of 24 hours without a break, with a late shift, followed by the sleepover, then an early shift. This schedule does not comply with the Working Time Directive, and a requirement has been made to address it in the last two inspection reports. The report for the last key inspection in August 2007 stated, Sleep-in staff work a twenty-four hour shift but it is unclear why the rota cannot be changed to enable these staff to go home after the sleep in or to start work the evening before the sleep-in. The proprietor did not send a response to this report, but addressed the requirement made in the report of the key inspection in August 2006, The Society monitors the working time of all staff either via the Working Time Directive Booklet or by monitoring the hours of rest period. The rota does meet resident needs and staff do not report being kept awake, should this happen staff would be able to leave early as usually two staff are on duty. Staff do not work twenty four hours as the time between 10pm-8am is sleep-in time and as such staff respond to emergencies. However the Working Time Directive states that sleep-in hours count towards the working time, as the staff are required to be at their place of work. Also that there should be a break of at least 20 minutes in shifts of six hours or more, and a break of at least 11 hours between shifts. In residential homes this may be taken as compensatory rest the following day. But a twenty-four hour shift does not allow for this. People who work excessively long hours may be too tired to provide a good quality of care for the people who live in the home, and there is a risk of errors due to poor concentration. We were not able to see staff files on this occasion as the manager was away, and therefore it was not possible to check for evidence of robust employment procedure. The surveys from staff all said that CRB checks and references were followed up before they were employed. The staff files were well maintained and contained all the required information when we last saw them in 2006, and there is no indication of any change in recruitment procedures since then. The AQAA and the staff surveys said that there is a good training programme available. The training offered includes all the regular mandatory training on health and safety, safeguarding and administration of medication, and training for specific needs such as epilepsy and challenging behaviour. We saw the training schedules for four members of staff. The fire training scheduled for June 2009 has not taken place, and one person has been waiting for training on epilepsy and medication for 6 months. Training was postponed due to the terminal illness of one resident, who died in June 2009 (see Personal and Healthcare Support). But the training has not taken place in the two months since. The AQAA stated that staff have been undertaking NVQs and have completed their qualifications in the last 12 months. The information in the AQAA showed that two of the four permanent members of staff have a NVQ at level 2 or above. Care Homes for Adults (18-65 years) Page 30 of 39 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not managed effectively, and the lack of supervising and support for the manager and the staff means that there is a risk that people may not receive the care and support that they need. Evidence: The home has not had a registered manager for over four years. Three managers have been appointed in the last four years, but none has been registered by the Commission as a fit person to manage a care service. The current manager was appointed in July 2008. We received no formal notification of the appointment, and the manager has not applied for registration. The Annual Quality Assurance Assessment (AQAA) stated that there are plans for the manager to complete registration with CQC and to complete the NVQ at level 4 in the next year. The manager was on leave during the period of this inspection. However several of the concerns that we have commented on elsewhere in this report are the responsibility of the manager. For example, since the manager started there has been no regular schedule for staff supervision, essential training has not taken place (although the AQAA states that training is up to date), care plans have not been updated, and decisions to use the residents mobility benefit to buy a new vehicle for the home were not made in accordance with the Mental Capacity Act. The AQAA was not completed Care Homes for Adults (18-65 years) Page 31 of 39 Evidence: within the time scale that we requested, and eventually arrived after the second deadline had passed. The AQAA that we requested last year was also sent late, and only after a reminder letter and a phone call to the home. These issues should have been noticed in the companys regular audits, and may indicate that Granta does not provide appropriate supervision and support for the manager. Granta has a comprehensive system for quality assurance in its homes (Quartz), which includes annual surveys of residents and their families on different topics and regular audits of the home. The AQAA stated that in the last 12 months there has been a detailed Quartz review looking at all aspects of the service and how they can improve. The home maintains appropriate records for the health and safety of the residents and staff in the home. All the staff have training in moving and handling, fire safety, food hygiene and infection control as part of their induction. We checked the records for monitoring water temperatures, fridge and freezer temperatures and fire safety. Fire drills are fully recorded, including the names of the staff and residents who take part each time. However the homes Fire Risk Assessment has not been reviewed since September 2007. Staff do not always follow the homes policies and procedures, for example concerning safe storage of cleaning substances. We found some items that may be a risk to the people in the home in an unlocked cupboard in the kitchen. These included dishwasher tablets that had the appearance of sweets, stored in an open container, and dishwasher cleaner and rinse aid in plastic bottles that could easily be opened. The staff were aware of the risks, and removed the items to a locked cupboard when they were noticed. Care Homes for Adults (18-65 years) Page 32 of 39 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 1 33 18(1)(a) The staffing rotas show that 31/12/2007 many staff work very long hours and long shifts. The registered person must ensure that sufficient staff are employed in the home in order to comply with the Working Time Regulations and to meet the needs of the residents. Care Homes for Adults (18-65 years) Page 33 of 39 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 Description 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 Description Timescale for action 1 1 6 The Statement of Purpose and Service Users Guide must be made available for the people who live in the home and for prospective residents. 21/11/2009 People who plan to move into the home need accurate information so that they are able to make an informed choice about using the services. 2 6 15 Measures must be put in place to ensure that care plans are reviewed and updated following changes. 21/11/2009 Care plans should provide up to date and appropriate details of each persons needs, so that the staff have the information that they Care Homes for Adults (18-65 years) Page 34 of 39 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 Description Timescale for action need to be able to meet their needs. 3 7 20 The people in the home are 21/11/2009 not fully consulted on the decision that they should contribute their disability benefits towards the running costs of the homes vehicle. All decisions that are made on behalf of a person in the home must comply with the Mental Capacity Acts codes of practice. 4 20 13 Guidance must be requested 21/11/2009 from the pharmacist on the safe handling and storage of variable dosages of medication such as Warfarin. Medication procedures must ensure that people are given the medication that is prescribed for them and that it is stored securely. 5 20 13 Controlled drugs must be stored and recorded in accordance with the Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007, and with Royal Pharmaceutical Society guidelines. 21/11/2009 This will make sure that everyone has the care and Care Homes for Adults (18-65 years) Page 35 of 39 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 Description Timescale for action medication that they need in a safe and effective way. 6 23 13 The missing person protocol 21/11/2009 needs to be individualised to meet each persons specific needs. Clear information is needed so that the staff know how and when to act if any person is missing from the home. 7 33 18 The registered person must 21/11/2009 ensure that sufficient staff are employed in the home in order to comply with the Working Time Regulations. People who work excessively long hours may be too tired to provide a good quality of care for the people who live there, and there is a risk of errors due to poor concentration. 8 35 18 All staff must have training to enable them to meet the specific needs of the people who live in the home, including training in understanding epilepsy and training in administering medication. 21/11/2009 Training ensures that the staff can support and care Care Homes for Adults (18-65 years) Page 36 of 39 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 Description Timescale for action for each person effectively and safely. 9 36 18 Measures must be put in 21/11/2009 place to ensure that each member of staff has formal supervision at least six times a year. Regular supervision provides each member of staff to discuss their work and their training and development, in order to provide a good quality of care for the people in the home. 10 42 13 21/11/2009 All substances that may be hazardous to health must be stored securely at all times. The people who live in the home should be confident that all parts of the home are free from possible risks to their health and safety. 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 20 The medication procedures should provide guidance on good practice for handling, administering and recording medication in a care home. The Fire Risk assessment should be reviewed each year, to ensure that people who live and work in the home are Page 37 of 39 2 42 Care Homes for Adults (18-65 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 protected in case of fire. Care Homes for Adults (18-65 years) Page 38 of 39 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 39 of 39 - 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!