Care Home: 1 St Anne`s Road

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What the care home does well Staff get to know people before they move in. This helps to make sure that the home can look after people if they go to live there.Each person is treated as an individual and with respect for their dignity and rights.People receive personal support in a way that suits them.People who live here can choose what they want to do. They are supported to do as much for themselves as they can.This includes cooking, cleaning and managing their medication.People can keep in touch with family, friends and their local community.They live in a comfortable homely place.People enjoy the meals they have and often help at mealtimes in some way.Their complaints are heard and acted upon.There is a small group of staff who work at the home. They are friendly. What has improved since the last inspection? In our last report, we did not ask the home to improve anything. We asked in the AQAA how the home thought they had improved in the last year, but they did not tell us. What the care home could do better: The home must make sure that people`s care plans are up to date, so that people will get the right support from staff to meet their different needs.This includes support to help them stay healthy.If people need help with their benefits and other money, someone who does not work for the home should help them with this if possible.People should be enabled to follow more of their interests or hobbies.The home should take action to make sure that it is a safe, pleasant and hygienic place for people to live in.People would be better protected from harm if staff knew more about how to report any safeguarding concerns.Staff need more training and support to make sure that they can look after people properly.The manager also needs to have training regularly, so that she can keep the home running well.The home should do more to make sure it is run in the best interests of the people who live there. Key inspection report Care homes for adults (18-65 years) Name: Address: 1 St Anne’s Road 1 St Anne’s Road Exeter Devon EX1 2QD 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: Rachel Fleet Date: 2 2 0 4 2 0 1 0 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. 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 Care Homes for Adults (18-65 years) Page 2 of 42 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 42 Information about the care home Name of care home: Address: 1 St Anne’s Road 1 St Anne’s Road Exeter Devon EX1 2QD 07071780795 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Alias Choice Limited Name of registered manager (if applicable) Mrs Hazel May Gibbons Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 5 5 care home 5 learning disability Additional conditions: Date of last inspection 2 5 0 4 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 42 A bit about the care home 1 St Annes Road is owned by Alias Choice Limited. Mr Chris Brown is the representative for the company. The home offers personal care and support for 5 people over 18 years old, who have learning disabilities. It does not offer nursing care. Care Homes for Adults (18-65 years) Page 5 of 42 The home is in the city of Exeter. It looks like the other houses around it. It is close to local bus routes and shops. The home supports people to go out on their own if they can do so safely. Most people at the home do not have a physical disability, so there are not many adaptations. The home has 2 floors. People living there must be able to manage stairs because there is no lift. Care Homes for Adults (18-65 years) Page 6 of 42 There is a kitchen, dining room, a lounge and a laundry area on the ground floor. Everyone has their own bedroom upstairs. No-one has to share a bedroom. There is also 1 bathroom with handrails and a toilet. And a shower room. People living at the home share daily living tasks such as cleaning and cooking. People are supported to do their own washing. Care Homes for Adults (18-65 years) Page 7 of 42 The home has a car park and another area outside where some people go to sit. Fees vary depending on peoples individual needs. The weekly fee is £700 2000. Fees do not include personal items, hairdressing, some activities, taxis and use of public transport. You can get general information about fees and fair contracts from the Office of Fair Trading website at www.oft.gov.uk Care Homes for Adults (18-65 years) Page 8 of 42 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 9 of 42 How we did our inspection: This is what the inspector did when they were at the care home The inspection was carried out by 1 inspector. In this report the term we will be used, as the report is written on behalf of the Care Quality Commission. The inspector was at the home from 11 am to 6 pm on Thursday 22 April 2010. We spoke to 4 of the 5 people who lived in the home. One person was out for the day. Care Homes for Adults (18-65 years) Page 10 of 42 Someone who lived at the home showed us around the home. We talked with the member of staff on duty and the manager. We looked at the care records of 3 people who lived in the home. We asked to see other records that would help to tell us how the home is run. Surveys we sent to the home were returned from 3 people at the home and from 2 staff. Care Homes for Adults (18-65 years) Page 11 of 42 Before our visit, the home completed an Annual Quality Assurance assessment (AQAA). This is a form for telling us how the home is meeting the needs of the people that live there. What the care home does well Staff get to know people before they move in. This helps to make sure that the home can look after people if they go to live there. Care Homes for Adults (18-65 years) Page 12 of 42 Each person is treated as an individual and with respect for their dignity and rights. People receive personal support in a way that suits them. People who live here can choose what they want to do. They are supported to do as much for themselves as they can. Care Homes for Adults (18-65 years) Page 13 of 42 This includes cooking, cleaning and managing their medication. People can keep in touch with family, friends and their local community. They live in a comfortable homely place. Care Homes for Adults (18-65 years) Page 14 of 42 People enjoy the meals they have and often help at mealtimes in some way. Their complaints are heard and acted upon. There is a small group of staff who work at the home. They are friendly. Care Homes for Adults (18-65 years) Page 15 of 42 What has got better from the last inspection What the care home could do better The home must make sure that peoples care plans are up to date, so that people will get the right support from staff to meet their different needs. Care Homes for Adults (18-65 years) Page 16 of 42 This includes support to help them stay healthy. If people need help with their benefits and other money, someone who does not work for the home should help them with this if possible. People should be enabled to follow more of their interests or hobbies. The home should take action to make sure that it is a safe, pleasant and hygienic place for people to live in. Care Homes for Adults (18-65 years) Page 17 of 42 People would be better protected from harm if staff knew more about how to report any safeguarding concerns. Staff need more training and support to make sure that they can look after people properly. The manager also needs to have training regularly, so that she can keep the home running well. Care Homes for Adults (18-65 years) Page 18 of 42 The home should do more to make sure it is run in the best interests of the people who live there. 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 Rachel Fleet CQC South West Citygate Gallowgate Newcastle upon Tyne NE1 4PA Care Homes for Adults (18-65 years) Page 19 of 42 03000 616161 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 20 of 42 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 21 of 42 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. The home has good procedures for ensuring it will be appropriate and suitable to meet the needs of those who choose to live there. Evidence: There have been no admissions to the home since our last inspection. However, the manager described what would be full but gradual assessments and introductions to the home over time, for any prospective residents. These would be recorded and would take place before agreement on admission was made. She also said the home would find out the persons individual wishes and goals, and speak to any previous carers, care managers, etc. The manager was clear that the wellbeing of anyone already living at the home would be carefully considered in relation to the needs of any prospective residents, to ensure that they would not be adversely affected by any new admissions. Care Homes for Adults (18-65 years) Page 22 of 42 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 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 to make choices and to take risks in their daily lives that will enhance the quality of their life. However, information about individuals needs and related care is not always sufficient to ensure they will consistently receive the support they need to meet their diverse needs. Evidence: When asked in our survey what the home does well, one person wrote Cares for and manages clients individual needs. Staff surveyed felt they were given up-to date information about the needs of the people they supported. Some care plans we read included very individualised assessments of peoples needs. Where someone had communication needs, it was clearly stated what they were able to do for themselves, their preferences, how staff were to assist them, and what decisions they could make for themselves, for example. Two peoples care records included their strengths or skills, although we discussed with the manager that it would have been positive if these were also listed for 1 person who had higher physical needs than others. Care Homes for Adults (18-65 years) Page 23 of 42 Evidence: We noted that since our last key inspection some care plans had been reviewed only yearly. The National Minimum Standards for adults recommends this is done 6 monthly. We found that the assessments of peoples needs alongside the care plans did not always reflect individuals current needs - such as changes in someones mobility. Goals had been considered and recorded with each person. These had not then been evaluated sufficiently to show how people were progressing (or otherwise) towards their goals, however. But it was positive to see evidence that people had been involved in the planning of their care. There was no care plan to show how people we case-tracked were to be enabled to enjoy the range of activities they preferred. Although we saw they enjoyed some of their interests, they were not given as much opportunity to enjoy a variety of activities outside the home. The manager told us that prior to Christmas 2009, people had enjoyed a wider variety of outings, but weather more recently had not been so suitable. Aware of this fact, we had chosen to look at care records for the month prior to our visit, when the weather had been better. One person did not have a care plan relating to their health needs, and no guidance for staff should the person be taken seriously ill or need resuscitation as to what action they should take. We noted that peoples independence was promoted. People we spoke with felt they were sufficiently allowed to make decisions about their lives. There was often clear guidance for staff about their response should someone make a decision that might cause them difficulty or hardship. However, sometimes information had not been carried forward into current care plans - such as guidance on specific verbal responses to people being replaced with the more general phrase To be reassured. We discussed with the manager that although the home has a system for identifying and managing risks to individuals welfare, the actual risk was not always identified, which could hinder appropriate management of the situation. A multidisciplinary decision was recorded in one case. We understand that Mr Chris Brown acts as agent for at least one person who lives at the home. We looked at records of personal monies received and expenditures for people we case-tracked. Balances shown correlated with the money being held for them, and receipts were available for checked entries. We noted that 2 signatures were not always recorded for expenditures made from peoples monies, which the manager said she would address with staff. People we asked confirmed that they could access their money easily, etc. Care plans we read included whether people handled their own personal money or needed help. The manager confirmed everyone had at least some involvement in shopping for themselves. Care Homes for Adults (18-65 years) Page 24 of 42 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. Each person living at the home is treated as an individual, and with respect for their independence, dignity and rights. They are enabled to keep in touch with family, friends and the community around the home, but more could be done to enable them to follow their personal interests. They enjoy the meals provided, being involved in some way in mealtime arrangements. Evidence: Peoples individual interests were listed in their care records. We found during our visit that people were enabled to enjoy some of these activities. Some particularly enjoyed taking a role in housekeeping duties, such as laying tables, doing their laundry, cooking or washing up in turns around mealtimes. Three enjoyed doing some baking during our visit, supported by staff. They were each asked what they would like to make, and were enabled to do so. Staff chatted with them, guided them, encouraged them to discuss what they were going to do next, and taught them what to do when individuals were uncertain. Care Homes for Adults (18-65 years) Page 25 of 42 Evidence: Two people sometimes went to church, independently. Others told us that they sometimes went out for a walk or to a disco in the evenings, but also indicated there were other activities outside the home that they wished they could undertake. One person told us they had not been to the pantomime unlike in previous years. We found from care records that some people had gone out in recent weeks only or mostly to the supermarket with staff. The manager told us that people went food shopping together so that they could discuss what meals they wanted to eat. They had not been on more social or recreational outings in that time, and all went together as a group. We were told this was because of staffing levels. The manager said, however, staffing arrangements did allow for someone to remain at the home if they wished to, while others went out. She also said that people were encouraged to go out, but sometimes chose not to even when offered an outing they had requested. We were told that peoples friends had occasionally joined them for a meal at the home, and people within the home clearly enjoyed having the company of their peers. Others told us they went, with staff, to visit their relatives, or were enabled to keep in touch by post or phone. Staff told us someone had gone away to visit relatives approximately 2 months before our visit. Asked in surveys what the home could do better, one person wrote Communication with family. People told us they liked the meals at the home, and that they were consulted about menus. One said the lunch eaten during our visit - toad in the hole - was one of their favourite meals, and that they had had sweet & sour the day before. The manager said that people go with staff to do the grocery shopping so they are able to choose what they will eat. Some told us they were able to make themselves a drink when they wanted, or made them for others. We saw a bowl of fresh fruit in the dining area, which people said they helped themselves to. Care Homes for Adults (18-65 years) Page 26 of 42 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 receive personal support in a way that they find acceptable or which suits them. Their healthcare needs are not always clearly identified and planned for, but they are supported to manage their medication as much as possible. Evidence: Most people living at the home did not need physical assistance with their personal needs. People we spoke with told us they felt staff encouraged them to be independent. We observed that they got on well with staff, chatting with them about their plans for the day, what they wanted to eat, etc. Staff used sign language with one person, and acknowledged the persons signed responses. People felt they were given privacy, including to use the homes phone if they wanted to. We noted that staff knocked on peoples doors before entering their room. We saw staff monitored people discretely to ensure their wellbeing without unnecessarily affecting their daily life. Staff we spoke with described care and support they gave to individuals, which was as reflected in peoples care plans. They also showed some knowledge of equality and human rights matters, including in relation to deprivation of individuals liberty. Care Homes for Adults (18-65 years) Page 27 of 42 Evidence: Peoples weight was monitored, and they felt staff looked after their health needs. They told us about health professionals who supported them, and the support they had from staff to attend appointments. One person thought they might be due an eye test. It was not clear from the care records we looked at when people last had certain routine health checks, although they had had footcare recently. Staff thought it should be in individuals care plans and that senior staff would know when people had last seen a GP or dentist, etc.; they also showed us a diary where such appointments were recorded. The manager told us she was intending to contact an optician, to begin providing a service at the home. We asked whether some people could go to an optician, rather than be visited at home, which she said she would consider. One person came to find staff to ask for their medication when it was due. They said they were happy with how staff managed their medication for them. Another also said they were satisfied. They knew what their medications were and what they were for. The home receives medication in blister packs from the pharmacist. The people we casetracked were prescribed little medication. One persons care plans included information relating to their consent to have medication. Records of medications received into the home and returned to the pharmacy were seen. We found medication that had been prescribed in 2008 and which was not being used. The manager said she would ensure these unwanted medications were returned to the pharmacist without delay. Care Homes for Adults (18-65 years) Page 28 of 42 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. If people have concerns or complaints, they are listened to and the home acts to try to put things right. People are protected from harm, although they would be more fully protected if staff knew more about local safeguarding procedures. Evidence: Surveys we received indicated people felt they were treated well, but also that they knew how to make a complaint. People we met at the home told us they would speak to Hazel Gibbons or her deputy if they had a complaint or if something was wrong. As also reflected in surveys we received, they felt they were listened to. And although they hadnt had to complain before, they felt Hazel or Mr Brown would sort out any problems if they had to complain. They said that staff helped to sort out any issues between individuals living at the home. They did not think they had a copy of the homes complaints procedure, and one said it would be useful if they had contact details for Social Services. The manager told us that if anyone living at the home indicated that they wished to complain about something, she went through the complaints procedure with them to ensure they knew what to do. She added that people often subsequently changed their mind about making a complaint, however. Hazel Gibbons confirmed the home has not received any complaints in the last year. We have not received any either. Care Homes for Adults (18-65 years) Page 29 of 42 Evidence: The manager told us she would contact care managers and relevant other agencies if she had safeguarding concerns, although she was not aware of Care Direct and their role. She told us she had undertaken the local authoritys training on the Mental Capacity Act 2007. Staff we spoke said they would feel able to speak up if something were wrong at the home, or they thought abuse was occurring. However, they were not fully aware of local procedures for reporting safeguarding concerns to relevant external agencies. Care Homes for Adults (18-65 years) Page 30 of 42 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although people have homely accommodation, systems are not in place to ensure all areas will be pleasant and hygienic. Evidence: Some people kindly showed us around the home. They told us they liked their rooms, and thought the facilities at the home were satisfactory. They and staff felt that minor repairs were attended to quickly enough. One person said they were going to speak to the manager about having their room decorated in a different colour. Bedrooms were very personalised, with peoples interests, lives to date, and connections with family or friends reflected in their personal effects, pictures, etc. The shower room had just been put out of use, while a leak was attended to. The manager told us there were plans for a new shower room. She said she would bring the damaged kitchen floor to Mr Chris Browns attention. We noted the bathroom had mildew-like stains on the ceiling, the ventilator did not seem to be working, and the inside door handle was broken. We were told that there were no records of planned or routine maintenance. The fire authority had visited the home in February 2009 and were satisfied with their findings. The fire log book showed equipment checks regularly recorded in recent months. Care Homes for Adults (18-65 years) Page 31 of 42 Evidence: People told us they sometimes sat outside in the car-parking area, or used an area on the other side of the home next to the road. These areas had little to make them attractive. The manager said the home had placed some pot plants in one area, but these had been vandalised. One of the people who lived at the home showed us appropriate hand-washing facilities in the kitchen. It was positive that those who later did some cooking were encouraged by staff to wash their hands and put on their aprons before starting. There was a nailbrush and tablet soap in the bathroom, which the manager confirmed were for shared use. There was no liquid soap or paper towels around the home for staff to use. The kitchen flooring was cracked. These are issues which can affect standards of hygiene in the home. Responses in returned surveys varied when we asked if the home was fresh and clean, ranging from always to sometimes. Staff told us there were no disposable aprons available, although there were disposable gloves which they used when providing personal care. They confirmed that they occasionally had soiled laundry to deal with, which they told us they rinsed out by hand which also is not good practise. The AQAA indicated there was an action plan to deliver best practise in prevention and control of infection, but the manager told us she did not know what this was. The AQAA also stated that only 1 staff had received training in prevention and control of infection. The manager has told us that since our visit to the home she has contacted the Environmental health Department and Health Protection Agency. They have provided her with relevant infection control advice and information, and she is taking action to address issues raised during our visit. Care Homes for Adults (18-65 years) Page 32 of 42 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. Although people are supported by a stable staff team, they cannot be assured that they will receive safe and appropriate care because of a lack of staff training and development. Evidence: When we arrived at the home, Hazel Gibbons was on duty with one other member of staff, to support the 5 people living at the home. People told us that staff were always available when they wanted them, although we found that opportunities for activities were limited by the usual staffing levels. Staff rosters showed that two staff worked each day, with one staff on duty overnight. Staff confirmed that extra staff were rostered for specific occasions - such as when someone was going to visit their family for the day and needed staff to accompany them. Staff spoken with and surveyed felt there were enough staff to meet peoples individuals needs. Those surveyed also felt they had enough support, experience and knowledge to meet peoples diverse needs. The current weeks roster had not been updated to show staff changes that we were told about. The manager said she would ensure this was done in a timely way in future. The manager, staff member and people who lived at the home confirmed that there have been no new staff appointed since our last inspection. Hazel Gibbons described Care Homes for Adults (18-65 years) Page 33 of 42 Evidence: appropriate procedures for recruitment of staff, except she was not aware of the need to explore any gaps in individuals employment history. Besides obtaining required documentary evidence, the manager said that people who lived at the home would be involved in recruitment by meeting with the individual and later being asked for their opinion of them. Prospective staff would be informed of the need to undertake required training if they were appointed. Staff told us they had not had any training or updating in the last year, which the manager confirmed, adding that the last training attended had been in 2008. She told us that 4 staff were considering taking higher levels of a recognised care qualification than they currently held. Of the 9 staff, 6 have a nationally recognised care qualification, but all staff need to keep up to date with best practise. We had found that the home was not using best practise with regards to infection control, and that not all staff knew local safeguarding procedures. We asked to see staff training records but were told by the manager that there werent any. Care Homes for Adults (18-65 years) Page 34 of 42 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a risk to the wellbeing of people who live at the home because of a lack of attention to matters that promote their health and safety and the quality of the service provided. Evidence: Hazel Gibbons, the registered manager, has several years of experience as the homes manager, and has obtained a recognised care management qualification. She showed full knowledge of each persons care and support needs during our visit. Comments made by people living at the home and by staff as well as our observations during this inspection showed us she was available to them and listened to them. However, she told us she had not attended any recent training or updating, and we found evidence that good practise was not always being followed at the home - as reflected elsewhere in this report. After our visit to the home, she informed us that she had attended some seminars but could not recall at the time what they were about. She agreed to send us further details, but we have not heard anything further on this matter. There was no-one living at the home who was subject to a deprivation of liberty authorisation, and we did not find that anyone was having their liberty deprived without Care Homes for Adults (18-65 years) Page 35 of 42 Evidence: an authorisation. We showed Hazel Gibbons a copy of the homes AQAA and discussed with her the lack of information in it, especially the self-assessment. The section on the environment was blank, for example, as was a section on Equality and Diversity. The lack of information in the homes AQAAs has been identified in the homes last 2 Annual Service Review reports. The manager said she had given information to the Responsible Individual and he had submitted the AQAA to us. Under Our plans for improvement in the next 12 months in the self-assessment section of the AQAA, To intensify quality assurance process was written. The manager could not explain what this meant in practise, however. We asked if there was a development plan for the home, or any plans for the future. She said that holidays were being planned for some people, but as peoples needs had changed recently this was having to be reviewed. We asked about other quality assurance processes such as use of surveys by the home, or meetings for people who lived there. The manager told us that no surveys had been sent out in the last year, but there had been a residents meeting. People living at the home confirmed that these took place. They also said that Mr Chris Brown visited and they could speak with him about the home. When we asked staff about supervision of their work, they said they had discussions with senior staff (although records were not kept), and there were staff meetings every 2 months approximately or when necessary. When asked in surveys if their manager gave them enough support and met them to discuss how they were working, staff responses varied from regularly to sometimes. The AQAA had not been fully completed regarding maintenance of equipment. We therefore asked for further evidence of maintenance during our visit. We were shown an electrical certificate dated 6/4/10. We asked for evidence of testing of portable appliances, but the manager could not provide any and said she would look into this. Issues relating to infection control are described under the section on Environment, with a requirement made for improvement of infection control systems. Staff we spoke with confirmed they had not had training specifically on infection control, although they had a food hygiene qualification. The home had current food safety guidance available. Two people were able to tell us that they would go out of the home if the fire alarms sounded. However, we noted that there were no individual evacuation plans in peoples care records, and the manager could not locate the homes fire risk assessment to check if the information was included there. She thought the last fire safety update for staff had been 6-8 months prior to our visit, but she couldnt find a record of it or who had attended. She said she intended booking another training session, in the knowledge that Care Homes for Adults (18-65 years) Page 36 of 42 Evidence: it should be attended every 6 months. No environmental risk assessments or records of safety checks were available when we asked to see any. The manager did not know if a risk assessment for Legionella had been carried out for the home. She told us that the hot water temperature was controlled from the boiler in the staff office. She said that one person sometimes opened their upstairs window wide despite window restrictors being fitted, and agreed to ensure that a risk assessment was in place relating to this. We were told that incidents were recorded in peoples notes rather on separate forms. We were also told there had been no accidents, which staff reflected also. One member of staff said they did not have a current first aid certificate. The manager told us she has booked training in relation to this. We advised the manager that she could send us any information she had been unable to find during our visit to us within 48 hours of our visit, for us to consider as part of this inspection. We also asked that she ring us to tell us that she was sending such information. We have heard nothing further from the service since our visit. Care Homes for Adults (18-65 years) Page 37 of 42 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 Care Homes for Adults (18-65 years) Page 38 of 42 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 30 13 18/06/2010 You must make suitable arrangements to prevent the spread of infection within the home, in particular by establishing robust infection control measures, including appropriate procedures for dealing with soiled linen and avoiding cross-infection risks from items currently being shared (such as nail brushes and bars of soap), seeking advice from the Environmental Health Dept. if necessary So that people have a clean and hygienic home. 2 35 18 You must ensure that staff receive training for the work they are to do, including timely updating 17/07/2010 So that people living at the Care Homes for Adults (18-65 years) Page 39 of 42 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 home are supported appropriately and safely. 3 37 10 The registered manager 17/07/2010 must undertake such training as is necessary to ensure she has the skills to manage the care home To ensure the health and welfare of those living at the home. 4 42 13 17/06/2010 You must ensure that unnecessary risks to the health or safety of people who live at the home are identified and eliminated as much as possible, especially with regard to risks from Legionella, scalds, electrical items & falling from a height To promote & protect the welfare of people who live at the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Care plans, and thus also the assessments of peoples needs on which they are based, should be reviewed every 6 months. If someone living at the home requires an appointee or other agent, they should be independent from the service. Page 40 of 42 2 7 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 3 14 You should make arrangements to enable individuals to access a range of appropriate social and community activities in line with their own social interests and hobbies. The health care needs of individuals should assessed and included in care planning, including provision for timely support to have routine health checks. It is recommended that indoor and outdoor areas are maintained and developed to provide people with more pleasant surroundings. Each staff member should have an individual training & development assessment and profile. There should be a staff training & development programme that ensures staff fulfil the aims of the home and meet the changing needs of people who live there. You should have effective quality assurance and quality monitoring systems to measure success in meeting the aims and statement of purpose of the home, with an annual development plan for the home, seeking the views of the various advocates & stakeholders, etc. 4 19 5 24 6 7 35 35 8 39 Care Homes for Adults (18-65 years) Page 41 of 42 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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