Inspection on 14/12/09 for White Windows Cheshire Home

This inspection was carried out on 14th December 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

White Windows Cheshire Home 13/01/09

White Windows Cheshire Home 04/01/07

White Windows Cheshire Home 07/02/06

White Windows Cheshire Home 25/08/05

White Windows Cheshire Home 17/02/05

White Windows Cheshire Home 30/09/04

Similar services:

Snydale Care Home

Staveley Birk Leas Nursing Home

Fairmount Nursing Home

Currergate Nursing Home

Brookfield

Castlethorpe Care Home

Elmleigh Convent

Woodlands Respite Care Centre

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: White Windows Cheshire Home Fore Lane Sowerby Bridge West Yorkshire HX6 1BH     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: Paula McCloy     Date: 1 4 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: White Windows Cheshire Home Fore Lane Sowerby Bridge West Yorkshire HX6 1BH 01422831981 01422836645 carole.davies@LCDisability.org www.lcdisability.org Leonard Cheshire Disability care home 25 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) : Number of places (if applicable): Under 65 physical disability Additional conditions: Date of last inspection Brief description of the care home White Windows is owned and managed by the Leonard Cheshire organisation which is a registered charity. The establishment is registered to provide accommodation and and both personal and nursing care for up to 25 adults with a physical disability. The home is situated in Sowerby Bridge with easy access to the town centre of Halifax. The property, a stone built period residence is well maintained both internally and externally. All bedrooms are for single occupancy and highly personalised to reflect the residents interests and tastes. Lounges are spacious and comfortable and furnished and fitted to a good standard. Externally there are well maintained gardens and grounds which are fully accessible for wheel chair users. 1 3 0 1 2 0 0 9 25 Over 65 25 Care Homes for Adults (18-65 years) Page 4 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The charges at White Windows are calculated on an individual basis according to individual peoples care and support needs. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. We inspected the home in January 2009 and at that time it was assessed as being an adequate service. This inspection was carried out to assess the quality of care provided to people living at the home. Care Homes for Adults (18-65 years) Page 5 of 32 The service completed an annual quality assurance assessment (AQAA), which provided us with information about the service. We have used some of that information in this report. The inspection process included looking at the information we have received about the home since the last key inspection. One inspector also visited the home unannounced. This visit lasted over six hours and included observing care practice, looking around the home and checking various records the home has to keep. We spoke to 5 people living in the home, 10 members of staff and the manager. This inspection found that there were some poor outcomes for people using the service. Following our visit, we met with the new area manager who is looking at ways to make immediate improvements to the service. Care Homes for Adults (18-65 years) Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Peoples social, educational and occupational needs must be assessed prior to admission. This will make sure that the home is sure they have the resources in place to meet these needs before people move in. Care plans must identify clearly what peoples needs are and what action staff must take to meet those needs. This will make sure that peoples needs are met consistently. Staff must make sure that people are able to make their own decisions and that addition support is arranged if necessary. This will make sure that people are able to have control over their own life. Care plans must also show that peoples social, educational and occupational needs are being identified and planned for. This will make sure that people lead an active and fulfilled life. Arrangements must be put in place to make sure that mealtimes are properly organised and that staff are available to support and assist people with their food intake. This will make sure that people get their meal in a timely fashion and that they receive a nutritious diet that is appropriate to their individual needs. Staff must make sure that peoples health care checks are kept up to date. This will make sure peoples health care needs are met. All complaints must be documented and responded to in line with the homes complaints procedure. This will make sure complaints are dealt with properly and people are informed of the outcome. Staff must make sure they follow the adult protection procedures and report incidents of abuse. This will make sure the home are taking the right action and people are kept safe. The organisation must ensure that the providers monthly visit reports demonstrate Care Homes for Adults (18-65 years) Page 7 of 32 their full assessment of the standards of care and conduct of the home. This will make sure any shortfalls are picked up and dealt with at an early stage. 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 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can get written information about the service, they can also visit so they can see for themselves if they think it is suitable. Staff need to make sure that peoples social care needs are assessed, so people can be sure these will be met. Evidence: There is a service user guide available. This means that people can get written information about the home and the service it offers if they are thinking of moving in. One of the nurses will go and assess anyone thinking of moving into White Windows. This is to make sure that the home can meet peoples needs before they move in. These assessments need to take better account of how the home will meet peoples social care needs and occupation/educational needs. We found very little evidence that peoples needs in these areas are being planned for properly. People can visit the home themselves to look around and see for themselves if they think it is suitable. Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are not planning peoples care properly. This means that they are not receiving the care and support they need or want. Evidence: We looked at two care plans because we wanted to see what individual needs had been identified and what action staff have to take to meet these needs. We found that the care plans were not up to date, lacked detail and that it was difficult to find important information quickly. There were no plans in place to show that peoples social care or educational/occupational needs had been identified or how they were going to be met. One care plan took approximately 60 minutes to read, this was because it was not easy to quickly find relevant information. We spoke to two members of staff who agreed that for any new members of staff or agency staff it would take them a long time to find out from the care plan exactly what care and support was required. Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: During our visit and through discussion with staff there were two examples they gave of peoples decisions being influenced or overridden by others. Staff must support people to make decisions about their own lives and should involve independent advocacy as necessary. We found risk assessments on peoples care plans were in relation to their health care needs. There were no specific risk assessments for any other activities they may be undertaking. We did find a risk assessment for one person about using the transport and the need for the wheelchair to be clamped but this hadnt been reviewed since January 2008. In September 2009 there was an incident when someone fell out of their wheelchair whilst using the homes transport and sustained injuries, it would seem essential that this particular risk assessment was brought up to date. Staff need to make sure that risk assessments are put in place as necessary to make sure people that can lead as independent lifestyle and that they are safe. Care Homes for Adults (18-65 years) Page 13 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples opportunities to be involved in the local community are limited. There are practices in the home that are institutional and not respectful of the people living there. Evidence: There are some people living at the home that enjoy a range of activities and are involved in going out on trips, to day centers and college. The home also organise trips out shopping and visits to places of interest. For other people their opportunities for personal development seem to be very limited. We spoke to two people living in the home. They told us that evenings and weekends are boring. There are no activities on offer or trips out and they spend their time watching TV. Staff we spoke to also agreed that there was a lack of activities at these times. Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: People told us that trips out are usually on a Thursday, because that is when most people are at home. This shows us that there is a lack of any person centered approach to keeping people occupied and stimulated. One persons care plan stated that they like to go to the pub, listen to music and have a sing song. We asked them if they could do this at White Windows they said no. We also saw that someone living at the home was performing some personal care tasks. We asked the manager about this and she told us this person wants to help. We do not think this is appropriate and the home should be looking with this person at suitable voluntary work or employment to keep them occupied. We made the following observations about meals and meal times: Breakfast At 9:20 am there were people eating in the dining room but no staff. A volunteer came in who was escorting people out to their day activity on the bus. She was shouting across the dining room wheres the nurse, wheres the nurse. Then continued to tell people she needed her because someone that was going out hadnt had their tablets. At 9:20 am there were two bowls of cereal on one table. The people that the cereal was for didnt arrive in the dining room until 9:50am. This shows us that people are not provided with choices on a day to day basis. At 10:00am staff started to assist two people who had been in the dining room since before 9:20 am with their breakfast. The emergency alarm was activated, staff who where helping these people immediately left the room and did not explain to people what was happening. Although on their return they apologised to the individuals, they continued to have a conversation about the alarm between themselves, excluding the people they were assisting. We were also told there was no emergency, and the alarms were being tested but staff had not been informed of this. The dining room is very large and impersonal. The process at breakfast was very institutional, not person centered and showed a lack of respect for people living in the home. There were periods when no staff were present to supervise, which is leaving people at risk. At lunchtime the meal was better organised and staff were present in the dining room. However, we did see examples of poor practice and lack of respect for the people living in the home. For example there were three staff doing the drinks trolley, Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: chatting to each other and another member of staff was standing up whilst assisting someone with their meal. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health care and personal support needs are not being met. Evidence: We spoke to the new deputy manager and one of the nurses about the care plans. They agreed that information is difficult to find, that they lack detail and are not up to date. The deputy manager has recently updated moving and handling plans and put measures in place to make sure that peoples blood sugar levels are monitored at the required frequency. There are currently 22 people living in the home and all of the care plans need to be reviewed with the individual and rewritten. We could see from the care plans that people are seeing various health care professionals. But we also saw that people were not up to date with dental or eye checks. For example one person had not been to the dentist since September 2008. As part of the review of the care plans staff also need to look at these issues. We also found that nutritioal risk assessments were not up to date. One person had been assessed in July 2009 as a cause for concern and another person as being at risk of malnutrition. These assessments had not been reviewed and there were no Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: care plans in place to show what action staff needed to take to prevent people becoming malnourished. One persons continence plan hadnt been reviewed since March 2009 there was no indication in the records if the plan was working or not. The deputy manager in post who has recently completed an audit of medication. We looked at the medication records and found that people were getting their medication regularly and at the right times. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are not being dealt with properly and people living in the home are not being kept safe. Evidence: The complaints procedure is in the Service User Guide and everyone living in the home has their own copy of this in their care plan. This means that people know how to make a complaint if they need to. We talked to one person living in the home who told us that they had made a complaint but nothing had been done. We found a record of this complaint but no information about what response had been made to the complainant. They also told us that there were two other issues they were unhappy about but didnt bother complaining as they didnt think anything would get done. It is important that people living in the home are able to raise any concerns they may have and are confident that appropriate action will be taken to resolve any problems. The staff we spoke to all told us that they had received training in adult protection, which should mean that they are aware of the different types of abuse and about the safeguarding procedures. However, when we looked at the accident records we found two incidents that should have been dealt with using the adult protection procedures. We found two incidents of physical abuse between people living in the home. We were not notified about these incidents and there was no record in the home of how these incidents were dealt with. We were also concerned that the safeguarding issues in Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: those reports were not identified by three different staff who all read those reports. It is important that staff deal with these issues properly to make sure people living in the home are kept safe. Following the inspection we made the necessary safeguarding referrals. The manager does hold money on behalf of people for safekeeping. We looked at the records for three people and found that they were accurate and there were receipts available for any purchases that had been made. However, we did not find anything in peoples care plans about arrangements that had been made with them regarding their financial affairs. This needs to be done so there is clear information about the support people want with managing their money. Care Homes for Adults (18-65 years) Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable, well maintained, clean and tidy. Evidence: The home is situated on Fore Lane in Sowerby Bridge, Halifax. It is set in its own grounds and there is a car park. It is approximately 1/2 mile from all of the local shops and facilities in Sowerby Bridge. The building itself is listed and has many period features. There are three different lounges so people have a choice of where to spend time. These are all well decoated and comfortable. The dining room is very large and impersonal. Staff need to kook at ways of making it fell more welcoming and homely. We looked at some of the bedrooms. All of them had been personalised and looked homely. At the last environmental health inspection the kitchen was awarded 4* for hygiene. This means that the hygiene standards are good. The home was very clean and tidy. People living there and staff told us this is always the case. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: Infection control procedures are in place and the home has its own laundry. Staff we spoke to confirmed that they had received training and knew what they needed to do to stop any risk of cross infection. Care Homes for Adults (18-65 years) Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment procedures are good and staff are well trained. Staffing levels need to be reviewed to make sure peoples needs are met. Evidence: When we visited there were twenty two people living in the home. In the morning there was one nurse and six care staff on duty. Staff told us that twenty one people require two staff to attend to their personal needs. This level of dependence was confirmed on the information the manager gave us on the annual quality assurance assessment (AQAA). When we asked people living in the home and staff what would make the service better they all said more staff. Staff also commented on the high levels of staff sickness in the home and the high use of agency staff. Although the home try and use the same agency staff it means that it is difficult for people living in the home to get to know staff well and get good continuity of care. From our observation staff work in a very task orientated way and didnt spend any time with people unless they were caring out a caring duty. The manager needs to look at staffing levels, the dependency of the people living in the home and the way that staff are deployed to make sure that there are enough staff on duty to meet peoples needs. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: The home uses a number of volunteers who escort people to various activities and trips out on week days. When we talked to staff they told us that social activities was not part of their role, however, this means when the volunteers are not available at weekends there is very little opportunity for people to take part in social activities. To make sure people have a full and active lifestyle, social care must be seen as an essential part of the staffs role. The recruitment procedures at the home are good. We looked at three staff files and found that all of the necessary checks had been completed. This means that people are being checked to make sure they are suitable and safe to work with vulnerable people. We talked to staff about training. They told us that they get annual updates on moving and handling, first aid, fire safety, health and safety, infection control and food hygiene. They all said that they had good opportunities to undertake further courses that are on offer. There are 60 of the care staff that have completed their National Vocational Qualification (NVQ) in Care. This means that they have been assessed as competent to do their job. We spoke to one member of staff who had started working at the home recently. They had never worked in a care home before. They told us that their induction training had been very good and that they worked with an experienced member of staff for a week until they felt confident about working alone. This means that staff are being given the training to do the job. Care Homes for Adults (18-65 years) Page 24 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not being managed in the best interests of the people living there. Evidence: The registered manager is a nurse who also has a management qualification. This means that she has been assessed as being competent to manage a care home. The home completed an Annual Quality Assurance Assessment (AQAA), after we sent them a reminder letter. We received it prior to our inspection. This gave us information about the service they provide. The home carries out an internal quality audit every year, surveys are sent to people using the service and their relatives to find out their views about what is being provided. We were told that surveys have been sent out this year, but the information from them has not been collated yet. It is important that the results of the surveys is made available to people so they know what action the manager is going to take as a result of the comments they have made. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: Residents meeting are held we saw the minutes from the most recent meeting that was held in November 2009. People were given a lot of information about changes and about various Christmas activities. The manager needs to make sure that these meetings give people the opportunity to discuss the service they receive and get their comments. This will make sure people have a real opportunity to shape the service they use. Monthly monitoring visits are also undertaken by various people. These visits take place to check that the home is being managed properly and is being run in the best interests of the people living there. However, we are concerned that the home the monthly visits are not picking up some of the major issues that have been highlighted in this report. Examples of these are: Care plans are not up to date and do not give enough information about what peoples needs are or what action staff have to take to meet peoples needs. Staff work in an very task orientated way and are not always respectful. Complaints and adult protection issues are not being dealt with properly. Staff are not being deployed and supervised properly and peoples needs are not being met. This has resulted in poor outcomes for people living in the home. There were no apparent health and safety issues observed during this visit. In the annual quality assurance assessment (AQAA) the manager told us that all of the safety checks on equipment and services were up to date. Care Homes for Adults (18-65 years) Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 4 14 Peoples social, educational and occupational needs must be assessed prior to admission. This will make sure that the home is sure they have the resources in place to meet these needs before people move in. 15/01/2010 2 7 12 Staff must make sure that people are able to make their own decisions and that addition support is arranged if necessary. This will make sure that people are able to have control over their own life. 15/01/2010 3 7 12 Care plans must identify clearly what peoples needs are and what action staff must take to meet those needs. 26/02/2010 Care Homes for Adults (18-65 years) Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will make sure that peoples needs are met consistently. 4 12 12 Care plans must also show 26/02/2010 that peoples social, educational and occupational needs are being identified and planned for. This will make sure that people lead an active and fulfilled life. 5 17 12 Arrangements must be put in place to make sure that mealtimes are properly organised and that staff are available to support and assist people with their food intake. This will make sure that people get their meal in a timely fashion and that they receive a nutritious diet that is appropriate to their individual needs. 6 18 13 Staff must make sure that peoples health care checks are kept up to date. This will make sure peoples health care needs are met. 7 22 22 All complaints must be documented and responded to in line with the homes complaints procedure. 08/01/2010 26/02/2010 08/01/2010 Care Homes for Adults (18-65 years) Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will make sure complaints are dealt with properly and people are informed of the outcome. 8 23 13 Staff must make sure they follow the adult protection procedures and report incidents of abuse. This will make sure the home are taking the right action and people are kept safe. 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 08/01/2010 1 9 Staff need to make sure that risk assessments are put in place as necessary to make sure people that can lead as independent lifestyle. Staff need to be more aware of how they behaviour impacts on people living in the home. This will make sure that staff always behave in a respectful way. Mealtimes need to be improved. This will make sure they are a social occasion for people. Peoples care plans should contained details about peoples personal preferences regarding their personal support and preferred routines. This will make sure people receive the care and support in the way they want. The manager needs to look at staffing levels, the dependency of the people living in the home and the way that staff are deployed. This will make sure that there are enough staff on duty to meet peoples needs. 2 16 3 4 17 18 5 33 Care Homes for Adults (18-65 years) Page 30 of 32 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 6 39 Ensure that the providers monthly visit reports demonstrate their full assessment of the standards of care and conduct of the home. This will make sure any shortfalls are picked up and dealt with at an early stage. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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