Care Home: 1 Beech Close

Similar services:

• Kings Lane (32)
• Pemdale
• Coopers Mill Ltd
• Bramley Avenue (73)
• Paradise Lodge
• Grangewood
• Upaya Ananda
• Newton Court (1-2)

What the care home does well One survey was completed by a relative of one of the people who lives at 1 Beech Close. The relative wrote, "Everyone looks after (name) well. His room is always lovely and clean and he is very happy now". The staff who wrote to us also had some good things to say, especially about the training and supervision they are offered, and about how some of the staff support the people who live here very well. Good information about the home is available, written in a way which most people using the service could understand. Good assessments of people`s needs have been carried out, and people have agreed a statement of terms and conditions (contract) with the home. Care plans are written in a person-centred way and give staff good guidance on how each person wants to be supported. The staff make sure people see healthcare professionals if they need to, and they look after people`s medicines. People know that staff will listen to any complaints they might have, and staff told us they know what to do if they think someone is suffering from abuse. Staff are recruited well and receive regular supervision. Five permanent staff have been awarded a National Vocational Qualification (NVQ) in care, and staff have been able to go on a range of training courses. Tests of the fire alarm system are done regularly, and people`s views on the quality of the service being offered are sought. What has improved since the last inspection? Although we feel the new manager has worked hard, the staffing situation at the home has not helped the home to move forward as we would have hoped. Nevertheless, 5 of the 6 requirements we made last time have been met, or almost met. People`s healthcare needs are documented; Medication Administration Record (MAR) charts are completed correctly; and all staff have had training in relevant topics including Safeguarding Vulnerable Adults (SOVA). What the care home could do better: We received 6 surveys, a telephone call and an email from staff who all wanted to raise concerns with us that they felt unable to raise with the manager or the provider. We have asked the provider to investigate the issues. Although this investigation is not complete, this level of concern indicates that the management of the home is not yet good enough to give people living at the home the quality of life they deserve. One requirement we made last time has not been met. There are still not enough staff on duty to make sure people`s needs are met. We are disappointed that the improvements which we saw at our last inspection, in the range and amount of activity offered to people, have not been maintained, and that people are not being supported to do much, either in the house, or in the community. Staff told us people are bored. Key inspection report Care homes for adults (18-65 years) Name: Address: 1 Beech Close 1 Beech Close Dunstable Bedfordshire LU6 3SD     The quality rating for this care home is:   one star adequate 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: Nicky Hone     Date: 1 6 1 0 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 30 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 30 Information about the care home Name of care home: Address: 1 Beech Close 1 Beech Close Dunstable Bedfordshire LU6 3SD 01582708999 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Affinity Trust. Name of registered manager (if applicable) William Damien Rees Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care home Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning Disability - Code LD Date of last inspection Brief description of the care home 1 Beech Close is a home for up to six adults with learning disabilities. Affinity Trust (previously known as TACT UK Ltd ) has managed the home since March 2008. The bungalow is owned by MacIntyre Housing Association (MHA), which is responsible for the maintenance and upkeep of the building. The bungalow is situated approximately one mile from Dunstable Town Centre. It shares a site with three other Affinity Trust registered care homes and a resource centre which is managed by the NHS. The bungalow has six single bedrooms, two lounges, a dining room, kitchen, laundry and bathing facilities. There is a fair-sized, enclosed garden to the rear of the property, Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 6 1 3 1 1 2 0 0 8 Brief description of the care home with adequate parking to the front and side of the building. The home provides its own transport. Care Homes for Adults (18-65 years) Page 5 of 30 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 peterchart Poor Adequate Good Excellent How we did our inspection: For this inspection we (the Care Quality Commission) looked at all the information that we have received, or asked for, since the last key inspection of 1 Beech Close. This included: - The AQAA (Annual Quality Assurance Assessment) that the manager completed and sent to us in September 2009. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living at the home. It gives the manager the opportunity to say what the home is doing to meet the standards and regulations, and how the home can improve to make life even better for the people who live here. The AQAA also gives us some numerical information about the service; - Surveys which we sent to the home to give to people who live here: We received 2 replies. One had been completed by staff, and one by a relative as people who live at 1 Beech Close are not able to complete a written survey themselves; Care Homes for Adults (18-65 years) Page 6 of 30 - Surveys which we sent to the home to give to the staff: we received 6 replies. We also received an anonymous telephone call and an anonymous email from staff; - What the service has told us about things that have happened in the home. These are called notifications and are a legal requirement; - Any safeguarding issues that have arisen; - Information we asked the home to send us following our visit; and - Any other information we have received about the service offered to people at 1 Beech Close. This inspection of 1 Beech Close included a visit to the home on 02/10/09. No-one who lives or works at the home knew we were going to visit on this day. We spent time talking to the people who live here, the manager, and some of the staff. We looked round the home and spent time observing what happens. We also looked at some of the paperwork the home has to keep including care plans, risk assessments, medication charts, and records such as staff personnel files, staff rotas, menus and fire alarm test records. The surveys we sent did not reach the home until after our visit, so we gave people until 16/10/09 to get them back to us before we finished the inspection. A new manager, William Rees, started working at the home in January 2009, and was registered with the Commission in March. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: We received 6 surveys, a telephone call and an email from staff who all wanted to raise concerns with us that they felt unable to raise with the manager or the provider. We have asked the provider to investigate the issues. Although this investigation is not complete, this level of concern indicates that the management of the home is not yet good enough to give people living at the home the quality of life they deserve. One requirement we made last time has not been met. There are still not enough staff on duty to make sure peoples needs are met. We are disappointed that the improvements which we saw at our last inspection, in the range and amount of activity offered to people, have not been maintained, and that people are not being supported to do much, either in the house, or in the community. Staff told us people are bored. Care Homes for Adults (18-65 years) Page 8 of 30 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 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available about the service and assessments are carried out so that people know the home can meet their needs. Evidence: 1 Beech Close has produced a statement of purpose and service user guide. The service user guide gives good information about the home. It includes pictures and symbols, is written in large print, and uses easy-read language (most of the time), so is suitable for most of the people who live here. We found a copy of the guide on the records we looked at. The service user guide tells people what they can expect from the home, and what the home expects of them, so would give useful information to anyone thinking about moving here. All the people who live at 1 Beech Close have lived here for a long time. On the records we looked at we saw that assessments had been completed at the end of 2008 for all aspects of peoples support needs (including housing, compatibility, quality of life and so on). These assessments have been done and are on-going as the social services department try to work out the best way forward to meet each persons Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: future support needs. Each person (or their representative) has signed a statement of terms and conditions (contract) with the home, which gives as much information as possible about the cost of the care part of the service, what it covers, and what else people have to pay for. People also have a licence agreement with the housing association, which details the rent they pay, and any service charges. In the reports we wrote following our last 2 inspections of this service, we wrote about one person whose needs were not being managed well, and whose needs were detrimental to the lives of the other people who live here. We recognise that this persons needs are now being managed better, but staff told us, and we saw evidence during our visit, that he still has a negative impact on the other people he lives with. Social workers have assessed that this persons needs would be met better in a different setting, but so far the Council has failed to find suitable alternative accommodation. Care Homes for Adults (18-65 years) Page 12 of 30 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. Support plans are person-centred, based on assessed needs, and give good guidance to staff on the support people want. Some of the ways people were supported to make decisions are not now happening regularly, and there are not enough risk assessments carried out. Evidence: We looked at the records the home keeps about 2 of the people who live here. Each file was well organised and gave good, clear details about the person and the support they need. All the records had been written in a person-centred way, using I. The files contained some risk assessments with guidelines for staff around a few of the activities of daily living. These are a good start but need to cover all the risks each person could encounter. Some of the risks had been incorporated into a support plan with goals, assessments and guidelines, for example about accessing the community, and sharing a vehicle. These had been developed using pictures and symbols. In the AQAA, the manager recognised that these need to develop further and he plans to do this in the next 12 months. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: There was some evidence to show that people are supported to make decisions about their lives. However, all the staff changes over the past few months, and the times when there have not been enough staff have meant that some of the ways people are supported to make decisions, for example meetings with their keyworker, have not happened as regularly as they should. Each person has a communication passport so that staff know the best ways to communicate with that person. Staff write good daily notes which give a clear picture showing what the person has done, what sort of a day he has had, what he has eaten, and so on. Care Homes for Adults (18-65 years) Page 14 of 30 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. There are not enough opportunities for people to take part in leisure activities and outings so that they can lead full and stimulating lives. Evidence: At our last visit we were impressed with the efforts staff had made to make sure people were leading busy, fulfilling lives, and the range and amount of activity had improved. It was therefore even more disappointing at this visit to find that there is little or no activity for much of the time. Staff write good daily records and these showed clearly that one of the people whose file we looked at rarely goes out. He had some problems with medication in the summer which affected the way he behaves, and community access has decreased since then. According to the records he had done little, other than listen to CDs and watch TV, for some time. This person has been advised to go for a walk every day, for health reasons, and although the manager said this happens, there was no evidence on the records, and he did not go Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: out on the day we inspected. Records for the second person we looked at showed that he does a little more than the first person, but it was still a very limited range of activities. For example, walks, church and shopping. The manager told us that there are extra staff on Sundays so that the 2 people who want to go to church can go. However, staff told us that these people cannot always go to church as some staff refuse to take them. Each person is meant to have an activity planner which they complete with their keyworker to show what they would like to do each day for the week ahead. On this persons file, the planner was dated March 2009, and showed a limited range of activities. A planner on the board in the office showed set activities, such as Bob the music man on Mondays, and swimming once a week for 3 people, plus household chores such as shopping, cleaning, laundry and so on. One of the people who lives here loves football. Staff told us that in December 2008 a member of staff was appointed as his keyworker so that they could go to football together. Staff said that this had not yet happened, and the man had not been to any football matches this year. In last years report we wrote The home asked an Occupational Therapist for advice on activities they could offer one person. The OT suggested horse-riding or using a trampoline. The manager said these activities had not been arranged yet. However, this person now leads a very busy and active life. He has shown by his behaviour that he prefers to be away from the home, so he goes out at least twice every day. These activities had still not been arranged, and this person does not go out as much as he did then. In July the home held a meeting for parents/relatives and so on. Staff took people out for the day in 3 groups of 2 people, rather than one big group of 6 which had happened previously. 3 people have had a holiday this year: 2 went to Havens, and one person went on his own with 2 staff to a caravan. Staff told us there had been a big outing to the seaside when all 6 people had gone together. Each person has a My File in their room. The ones we saw were very person-centred and included lots of pictures, photographs and symbols to illustrate the way the person likes to lead their life. They included evidence that each person has a keyworker who meets with them on occasions, although not so much recently, to talk about what they want to do, what they like to eat, where theyd like to go and so on, as well as checking that the person is happy. The manager said that staff are working Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: towards looking at each persons hopes and dreams, and setting goals to help people get there. People are encouraged as far as possible to help with the household chores, however, staff said that some people are very reluctant to do anything. Most people do something to help get their own breakfast and clear away afterwards. Breakfast is a choice of cereals, porridge, toast, and so on and each person eats when theyre ready. At lunchtime people choose what they want to eat and when. The main meal of the day is eaten in the evening, when one meal is cooked and everyone eats together. Each person chooses some of the meals which make up the menu, and a board in the dining room has pictures of what the meal for the day is. One of the staff told us that s/he enjoys cooking and taking the guys shopping. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported with their personal care in the way they prefer, but some health needs could be documented better to make sure they are met. Medicines are handled well with fewer errors being made. Evidence: On one persons file we found a Health Action Plan (HAP). This had been started but not kept up to date: the manager said that health appointments are recorded on separate sheets in another part of the file. On the second file, the HAP was in place and there was evidence that different aspects of this persons health are checked regularly. For example, blood sugars, sight, teeth, hearing, nails and so on. This persons weight has been recorded monthly. Each person has a medication file, and medications are kept in a small locked cupboard in the persons bedroom. The files contain good information and guidance for staff on how each person prefers to take their medication, what medicines they are taking, and when they should be offered when needed medicine. Each person has agreed that they want staff to look after their medication. We checked one persons medication and all was in order. Medication Administration Record (MAR) charts are Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: completed well. There have been a number of medication errors reported. The manager said a lot of work has been done, including re-training all staff, to prevent mistakes. He said there were 3 months when no mistakes were made, then a member of staff made an error on her last day at work. One member of staff has made 2 errors: this staff member will not be allowed to administer medication until they have been re-trained and their competence assessed. There have been no further errors. Care Homes for Adults (18-65 years) Page 19 of 30 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. People know that their concerns will be listened to and acted on, and that staff are trained to keep them safe from harm. Evidence: The procedure telling people how they can complain if they want to, and to whom, is clearly set out in the service user guide. A folder is kept for any comments made about the home and it is clear that parents and families are comfortable with raising any issues, and in thanking the staff when things go well. In the AQAA the manager told us that 9 complaints had been received and resolved, none of which were upheld. A number of compliments had been recorded and relatives had sent cards or letters expressing their gratitude for, and satisfaction with, the service their relatives receive. Following the inspection we received 6 surveys from staff, an anonymous telephone call and an email, all raising concerns about some aspects of the service being offered. We have asked the provider to investigate the issues raised. According to the training records, and staff we spoke with, all staff have had Safeguarding of Vulnerable Adults (SOVA) training and would know what to do if they suspected any abuse was going on. In the AQAA the manager wrote that 25 safeguarding referrals had been made to the SOVA team in the past 12 months. These mainly related to medication errors, and to incidents between people who live at 1 Beech Close. Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: When we arrived we noted that there is a sign informing visitors that the garden gate is now kept locked. The manager explained that one person had left the home on his own on 2 occasions, but is not safe to do so. The home applied for a Deprivation of Liberty safeguarding authorisation for this person, and for the one other person who lives here who might wish to go out of the gate. Authorisations were granted for both people: for one on the grounds that it was in his best interests that he doesnt go out alone; and for the other that he can unlock the gate if he wants to leave, so the lock does not deprive him of his liberty. We advised the manager to check with the fire authority that they consider this to be safe. All the people who live at 1 Beech Close need support with their money. A small amount of cash is kept for each person in the safe. A sealed pouch system is used so that the cash and balance are checked to be correct each time money is taken out or put in: the manager checks the maths as well as the balances, regularly. We looked at the records for one person and they were accurate. People pay for all their activities, including the transport, and the home pays for any staff expenses. Care Homes for Adults (18-65 years) Page 21 of 30 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. This home offers a comfortable, homely, clean and well-maintained home for the people who live here. Evidence: When we looked round, the home was tidy and clean, and smelt fresh. New flooring has been laid in the 4 bath/shower rooms and staff are still working with people to personalise their rooms. We saw that the rooms are all very different. One of the people who lives here has his room decorated, including pictures, curtains, duvet cover and so on, with his football teams colours. Another person wants nothing in his room at all. There is still a problem with one person who goes into other peoples rooms and re-arranges or puts away anything left out. The staff are working hard with this person about this issue and have succeeded in letting him know that he cannot just walk into the office, or into other peoples bedrooms. Care Homes for Adults (18-65 years) Page 22 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are recruited, trained and supervised well, but there are often not enough staff on duty to make sure peoples needs are met. Evidence: One of the staff we spoke with said Its good here. I enjoy so many things - going out, supporting the guys to go out, cooking; and another said Staff work well as a team, especially in the mornings to get everything done. Staff who returned our survey also had some positive things to say: Everyone does the basic care. Others do work very well and interact, involve in activities and take clients into community, give choice; and another wrote Some staff who enjoy what they do, work twice as hard to fulfill individuals needs and this shows by the relaxed and happy working environment which they live in. Unfortunately, both of these staff added that not all staff work as hard, or care as much for the people who live here. Several staff who contacted us raised some issues about some of the other staff (see Complaints and Protection section of this report). Staffing has been quite an issue for the home. The manager said that in the 9 months that he has been in post there have been a lot of staff changes. A number of staff who had worked at this home for a long time, were resistant to the changes that needed to be made and decided to leave. Some new staff have been appointed and there are Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: some bank staff, but the manager said it is difficult to cover shifts, especially at short notice. He said there have not been adequate staff recently to make sure there are enough outings, and to make sure that things like keyworker meetings take place. The home strives to have 4 staff on duty during the day, and there is one waking night staff and one person sleeping in. Even with 4, the staff struggle to get people out. However, staff told us that there have been a number of occasions when there have only been 3 staff. At these times, no-one is able to go out. One of the staff on duty on the day we visited was very new. He was working alongside experienced staff and starting his induction. The bank staff we spoke with said s/he has had induction in each of the 4 Beech Close bungalows when s/he first worked in each of them. We looked at the personnel files of two members of staff. All the information the home has to have before the staff member can be employed (such as two references, a Criminal Record Bureau (CRB) check, proof of identity and so on) were in the file. The home also keeps a pro-forma for each member of the bank staff which confirms that all the required information is held on their personnel file at the organisations head office. One of the staff said there has been loads and loads of training. S/he has done a wide range of courses, including all the mandatory training (moving and handling; food safety; fire safety awareness; first aid; infection control; and SOVA). Her training also included communication; autism; medication; citrus; and report-writing). One of the bank staff told us he too has received all the necessary training, including working with people with dementia. Staff files included copies of training certificates. In the AQAA the manager wrote that 5 of the 11 permanent staff have been awarded a National Vocational Qualification (NVQ) in care. The manager told us that at present staff meetings are being held weekly, for an hour, over the handover period. Permanent staff receive supervision regularly, but there is no formal system in place for bank staff to be supervised. Care Homes for Adults (18-65 years) Page 24 of 30 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 management of this home is not effective enough to make sure that the people who live here have a good quality of life. Evidence: The manager, William Rees, took up the post in early January 2009 and he is registered with CQC. One of the staff said The manager is OK - Ive never heard anyone complain. We get good support. Another person considered that perhaps the manager is not strong enough. We recognise that there have been problems with staff leaving, however the manager must still make arrangements to make sure the home continues to operate in the best interests of the people who live here. The homes quality assurance system includes using written surveys for the people who live here, and for their relatives. Staff have also been asked for their views. All responses are put together into a report by head office. The manager said that in a recent survey, relatives had expressed concern about the future for the people living Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: at 1 Beech Close. Some of the systems the home uses to ensure the people who live here are included in decisions about their lives, such as the keyworker meetings, have not been taking place so regularly recently. We looked at some of the records the home has to keep. As well as other records we have discussed in other sections of this report we also noted that regulation 37 notifications are sent to CQC; regulation 26 reports of visits made to the home by the provider were available; and tests of the fire alarm system are carried out weekly as required. Tests of the emergency lighting must be done at least monthly. All staff must be involved in a fire drill at least once a year. The manager said all staff have received training (or are booked onto courses) in all the topics relating to health and safety, that is moving and handling; first aid; fire safety; infection control; and food hygiene. Staff we spoke with confirmed this. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R 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) There must be an adequate number of staff on duty to meet the needs of the residents. This requirement is carried forward from the inspection in August 2007 -it was partly met. 31/07/2008 Care Homes for Adults (18-65 years) Page 27 of 30 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 14 16 People who live here must be offered more opportunities for activities and outings. So that people lead full, satisfying lives and are not bored. 15/11/2009 2 33 18 There must be enough staff on duty. So that peoples needs are met. 15/11/2009 3 37 12 The management of the home must improve. So that the people who live here have the best possible quality of life. 15/11/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 36 A formal arrangement should be set up to ensure that bank Page 28 of 30 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 staff receive regular supervision. Care Homes for Adults (18-65 years) Page 29 of 30 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 30 of 30 - 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!