Care Home: 10 Love Walk

What the care home does well The people who live at the home have relaxed and warm relationships with the staff. Many of the staff have worked at the home for a long time and this gives consistency. There is very little use of temporary staff and low staff turnover. Some previous residents have been assisted to move to new accommodation more suitable for their needs. Residents` spiritual needs are well attended to, they attend church, a spiritual adviser visits the home and there is a regular Bible study group. The meals are good, they are designed to take account of residents` preferences, nutritional, cultural and religious needs. The cook is very familiar with the residents and their likes and dislikes and she takes them into account when preparing the meals. Relatives told us that they are welcomed to the home when they visit. What has improved since the last inspection? Most of the previous requirements have been met. This means that the following improvements have been made. The service user guide now has the correct information to help potential residents to make an informed decision about whether the home will be suitable for them. People who are thinking about living at the home and are suitable to do so now receive confirmation that their needs can be met there. Staff have now received training in safeguarding issues, fire safety, moving and handling and specific health conditions. Some redecoration has been done. These areas of the home look brighter and more attractive. The fire risk assessment has been reviewed and the Registered Manager understands that this must be an annual exercise. Care plans now reflect residents` health care needs and describe how they will be met. There are improvements to the system to carry out assessments to see if a person may safely look after their own medication. Soiled protective clothing is now disposed of with regard to hygiene and infection control. What the care home could do better: There are two requirements carried forward from our last inspection and we have made five new requirements and six recommendations. One of the requirements carried forward from last year concerns the need to improve the television reception in the home. Although some improvements have been made (assisted by a satellite device) the reception remains erratic in some areas of the building. We require that staff who have not recently received training in infection control strategies are trained in these issues. We also require that residents` bedrooms are included in the repair, redecoration and refurbishment programme. We recommend that the redecoration of the communal areas is done in a way that minimises the institutional feel of the building, and that residents` artwork is dispalyed in a manner that promotes the value of the work. One of the new requirements concerns the need for emergency lighting to be checked each month to be sure it will work in an emergency. We also recommend that staff are reminded of the need to ensure the building is adequately secure when windows and doors are open for ventilation purposes. The remaining two requirements and four recommendations all concern the systems for the management of medication which at the time of our visit did not reach the required standards. There are aspects of recording of administration of medication and of prescribers` instructions which give concerns about the medication system. Although we were shown a monitoring system which had been introduced to improve these systems our judgement is that it is ineffective as the faults that we found had not been detected. Since the key inspection a CQC Pharmacy Inspector has carried out a random inspection of the home`s arrangements for managing medication. It was found that improvements have been made since our first visit. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 10 Love Walk Love Walk, 10 London SE5 8AE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alison Pritchard     Date: 2 4 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: 10 Love Walk Love Walk, 10 London SE5 8AE 02077033001 02072524958 love-walk@missioncare.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mission Care care home 22 Number of places (if applicable): Under 65 Over 65 0 physical disability Additional conditions: 22 The maximum number of service users who can be accommodated is: 22 The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Physical disability Code PD Date of last inspection Brief description of the care home 10 Love Walk is a 22-bedded care home for people with a range of physical disabilities. It is located in a quiet residential road in Camberwell. The home is situated close to local shops, public transport and services and has a small car park. The home was purpose built and each of the bedrooms is single and has a large en-suite toilet /bathing facility. There is a lift to enable residents who use wheelchairs to access the first floor. In late June 2009 there were 22 residents and no vacancies at Love Walk. The cost of placements at the home is between £620 and £775 a week. Mission Care, a Christian organisation, runs the home. Mission Care also runs nursing homes for older people in the Bromley area. Care Homes for Adults (18-65 years) Page 4 of 32 Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This inspection was unannounced and carried out over two days in June 2009. On the second day the inspector was joined by an expert by experience for part of the inspection. Experts by experience are people who visit a service with an inspector to help them get a picture of what it is like to live in or use the service. The inspector and expert by experience spoke with residents, staff and visitors. We also gathered the views of health care professionals through surveys. We are grateful to everyone who assisted by talking to us and completing surveys. The CSCI has access to information gathered through notifications from the home. In addition, a document called an Annual Quality Assurance Assessment (AQAA) was completed by the Registered Manager and sent to us. The document provides Care Homes for Adults (18-65 years) Page 6 of 32 information about how the home is addressing the National Minimum Standards along with factual information about the operation of the home. All of this information has been taken into account in compiling this report. The residents, Registered Manager and staff from the home helped us with the inspection visits, they were helpful and courteous throughout the process. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 32 There are two requirements carried forward from our last inspection and we have made five new requirements and six recommendations. One of the requirements carried forward from last year concerns the need to improve the television reception in the home. Although some improvements have been made (assisted by a satellite device) the reception remains erratic in some areas of the building. We require that staff who have not recently received training in infection control strategies are trained in these issues. We also require that residents bedrooms are included in the repair, redecoration and refurbishment programme. We recommend that the redecoration of the communal areas is done in a way that minimises the institutional feel of the building, and that residents artwork is dispalyed in a manner that promotes the value of the work. One of the new requirements concerns the need for emergency lighting to be checked each month to be sure it will work in an emergency. We also recommend that staff are reminded of the need to ensure the building is adequately secure when windows and doors are open for ventilation purposes. The remaining two requirements and four recommendations all concern the systems for the management of medication which at the time of our visit did not reach the required standards. There are aspects of recording of administration of medication and of prescribers instructions which give concerns about the medication system. Although we were shown a monitoring system which had been introduced to improve these systems our judgement is that it is ineffective as the faults that we found had not been detected. Since the key inspection a CQC Pharmacy Inspector has carried out a random inspection of the homes arrangements for managing medication. It was found that improvements have been made since our first visit. 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 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good arrangements for helping potential residents to find out if the home is an appropriate placement for them. Assessments are carried out so that there is clarity about whether the persons needs can be met at Love Walk. Evidence: At the last inspection in June 2008 the Registered Person was required to make changes to the statement of purpose so that it reflected regulatory changes. The necessary changes have now been made. A checklist has been created to make sure that people who may be interested in coming to live at the home are given the opportunity to find out if the placement will be suitable. Assessments from placing social workers are obtained and an assessment carried out by senior staff from Love Walk. As required at the last inspection potential residents are now given, prior to their admission, written confirmation that Mission Care has assessed that their needs can be met at Love Walk. Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans reflect residents assessed needs and there is good attention given to needs arising from their race, religion, ethnicity and other equalities issues. Risk is well assessed. Evidence: We looked at three care plans. We found that they had been completed in more detail than on our previous visit and more closely reflected the needs identified in the persons assessments. Senior staff in the home had audited the care plans and identified areas where improvements were necessary. This is a useful way of ensuring that residents needs and wishes contained in the documents. Residents signatures on the plans and on minutes of monthly key work meetings confirmed their involvement in the care planning process. The care plans that we saw included information on needs arising from equalities issues, including gender, race, age, disability, ethnicity and religion / faith and Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: sexuality. A format called GRADERS is used to record these aspects of need. The home has employed a member of bank staff who shares the linguistic background of one of the residents. This assists in meeting this residents linguistic needs. Some of the residents we met on our previous visit to the home have been assisted to move to placements more suitable for the needs and wishes. There are other residents, currently living at the home, who have expressed their wish to move to different living situations. We discussed with the Registered Manager how they might be assisted to achieve these goals and we believe that she is commited to helping them achieve their personal goals. Residents forum meetings are held every month. The residents are able to contribute their views about a range of issues and raise concerns with the group. A Director of Mission Care attends the meetings along with the Registered Manager. Residents have the opportunity to be involved in the recruitment and selection of staff. We saw a range of risk assessments designed to manage aspects of behaviour which could be risky for the resident themselves, or for other people. The documents we saw were appropriate and comprehensive. Care Homes for Adults (18-65 years) Page 13 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a range of activities provided. The frequency of activities has increased in response to resident feedback. Further discussion with residents about the development of weekend activities would be beneficial. Consultation with residents about the menu is underway. Residents benefit from meals that take into account their nutritional needs, their cultures, religions and preferences. Evidence: Although there is currently no designated Activities Organiser a range of activities has been arranged. During the inspection we had the opportunity to observe a cultural day when items from residents and staff members countries of origin were shared and discussed, a range of foods from the different countries were sampled and music from the different countries was played. This was a positive and interesting activity and residents said that they enjoyed it. One resident smiled broadly when music from Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: her country was played; another shared information about jellied eels and staff showed clothing and other items from their cultures. We noted that two of the residents had been assisted into the room and where they were seated did not enable them to participate as fully in some parts of the activity as they might otherwise have done. This was raised with the Registered Manager, she said that she would address the issue to ensure that staff take further account of individual needs in such situations. There has been a long standing problem with television reception at the home. In a communal room this has been addressed by providing a new television which has a satellite connection. We are told that there is sometimes poor reception and on one side of the building it is often poor. Efforts to resolve this issue should continue. Other activities that have taken place recently in the home include visits from musicians; art classes; a Bible study group; karaoke; a barbecue; a mens group and a womens group. Both residents and staff expressed their excitement about the development of the garden, especially the production of vegetables that could be used to supply the kitchen. Recent activities out of the home have been a trip on the London Eye; a day trip to Hastings and, on one of the days we visited, a trip to Battersea Park. Photogtraphs of activities are displayed in communal areas. We discussed with residents the opportunities they have to take part in community activities. We heard that not alot goes on at weekends - only going to Church. In discussing this with the Registered Manager she stated that sometimes residents opportunities to take part in activities in the community may be limited by finances, for example they may choose to see a DVD at home rather than visit the cinema because of the costs involved. Further discussion about weekend activities which do not involve significant costs would be useful. During the weekdays some people go to day centres, some to a stroke club. One person particularly enjoys the voluntary work in which she takes part. Some people go out on their own and use public transport. The Registered Manager showed understanding of how such opportunities help to develop self esteem and self confidence. We received one comment that the service could improve if there was more support for residents to follow more activities such as further education and employment. Visitors are able to visit at all reasonable times. We observed that staff welcomed visitors and noted that a relative was invited to stay for a meal. We were told by a relative that the staff are friendly towards them and she felt that the atmosphere was homely. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: We spoke to residents about meals and sampled lunch on the days we visited. We enjoyed our meals, on the first day the lunch was paella, with an alternative fish dish. On the second day the choice was between roast chicken, or fish, both with fresh vegetables, and rice and peas or potatoes. Alternatives were served to suit everyones taste and cultures, for example a lady had curry and rice, another had a plainly cooked meal in keeping with her dietary needs. A relative told us that she was pleased that her relative had been served mango after telling the cook that this was her mothers favourite fruit. She also said that Halal meat has been provided in keeping with her religious needs. Some residents said that they would like to have more curries on the menu. After issues were raised about portion size in a recent survey of residents views a new survey was held specifically about the menus and the residents are involved in the production of a menu which more closely meets their preferences. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are satisfied with the care they are given and have good relationships with staff. There is effective liaison with health care professionals. There are a number of improvements needed to the management of medication. Evidence: We spoke to residents who said that they are happy with the way that their care is provided. A relative also said that she is satisfied with the care given to her relative. Our observation was that residents looked well cared for and staff have good relationships with them. We received feedback from health care professionals. They said that the service seeks advice and acts upon it to manage residents health needs. They also said that the care staff have the right skills and experience to support the residents health and social needs. One of the respondents said that a strength of the home is that they liaise, monitor, oversee, encourage and ensure safety. The care files that we looked at in detail included clear plans and information that Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: assists staff to meet residents health needs. The keyworkers are responsible for drawing up the plans in conjuction with the residents and monthly meetings are held to review goals and progress towards them. We noted that residents had signed some of the documents in the files. Audits of the files are carried out by senior staff and areas where attention is needed are noted so that the shortcomings can be addressed. Our observation was that the care plans had been improved since our last visit to the home a year ago. Staff had received training over the last year in a number of relevant health related issues which should assist them to provide appropriate care for the residents. The health topics in which they have received training include multiple sclerosis; stroke awareness and diabetes. We looked at the arrangements for managing medication. Some of the residents look after their own medication, they are provided with storage facilities and risk assessments of the advisability of this are carried out. We found that the records of returned medication are now in good order, with the pharmacy confirming receipt of items. Although there has been an assessment of the competence of the staff responsible for dealing with medication we found that the medication administration records contained a number of problems. Some of the instructions had been hand written. In these cases it is essential that the instructions are clear so there is no doubt about the prescribers instructions. There were instances where the written instructions were difficult to read, and they had not been confirmed by two members of staff adding their signature. In some cases the code F had been entered on the record - this stands for other and an additional explanation is required. In several cases the additional explanation had not been recorded. No signatures were made on the record to confirm the administration of creams and the use of emollient. This is required. In some other instances the dose had been changed partway through the record. It is recommended that in these circumstances the date of the change and the medical professional authorising the change is noted on the record. This was not always recorded. The medication policy of Mission Care states that in these circumstances the entry must not be changed but must be completely re-written. This policy had not been followed. Although the medication policy is useful it refers throughout to Registered Nurses which, as Love Walk is not a nursing home, is not relevant. The Registered Provider should produce a medication policy which is relevant for the home. Staff should receive management input to ensure that the policy is put into practice. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: Only three members of staff have received training in the last year in the safe management of medication. This includes the three senior staff who have not received this training since March 2006. It is required that updated training is provided and a re-assessment made of the competence of staff to deal with medication. We recommend that the system for the monitoring of medication administration is reviewed as our findings show that it is not effective. We suggest that either the Deputy Manager or the Registered Manager take on this task to ensure that improvements are made. Since we visited to carry out the key inspection a CQC pharmacy inspector has visited the home to carry out a random inspection. It was found at that visit that some improvements have been made in the management of medication in the home. We heard that residents and staff had been provided with sensitive support when long standing residents of the home had died in recent months. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home know how to make a complaint and have confidence that their concerns will be taken seriously. Staff are trained in safeguarding issues and know that issues of concern must be reported so that vulnerable people can be protected. Evidence: People who live at the home confirmed that they knew how to make a complaint and felt confident to do so. Records of complaints showed that people who live at the home have used the procedure, their complaints were investigated and action taken to ensure that there is no recurrence of the issue of concern. Staff demonstrated that they would encourage the use of the complaints procedure if someone who lives at the home has an issue of concern. They also confirmed that if they saw inappropriate practice amongst their colleagues they would report it to senior staff. The Registered Manager has demonstrated awareness of safeguarding issues through the referral of issues of concern (which have not taken place in the home) to the appropriate authorities. All of the current care staff have received training in safeguarding issues in the last Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: two years. This meets a requirement of the last report . While we were at the home, as it was a warm day some of the doors had been left open to allow a breeze through. We had some concerns about this in case people should enter the home uninvited, unknown to people who live there or to staff. We discussed this with the Registered Manager. She informed us that the staff at the home are aware of the risks that this can present and a closed circuit television system monitors key points of the building. She also informed us that people who come to live at the home are reminded of the need to lock their rooms, and each person is provided with a lockable space within their rooms. Nevertheless, we had concerns about security and recommend that staff are reminded of the need for vigilance. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Redecoration and refurbishment have improved some areas of the building, but others remain in need of attention to create a homely and fresh environment. The bedrooms of people who live at the home should be included in the redecoration, repair and refurbishment programme. This staff who have not received recent training in infection control must be trained to ensure the health and safety of everybody who lives and works in the home. Evidence: The home is purpose built and facilities are spread over two floors. Bedrooms are on the ground and first floors of the home. Most of the communal facilities, two living rooms, and a dining room are on the ground floor of the home. On the first floor is a large activity room. A gazebo in the garden has been designated as the homes smoking area. A passenger lift allows access between the floors for the residents. The corridors have hand rails fitted and bedrooms and bathrooms are fitted with necessary aids. Each of the bedrooms has en-suite facilities, on the ground floor there are two Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: additional toilets, one of these is accessible to people who use wheel-chairs. There are discussions about changing one of the bathrooms to be a shower room which will be more suitable for the needs of the person who occupies the room. Some redecoration has been done and these areas look brighter than at our previous visits and more modern than some parts of the building. Much of the decor in the places that have not yet been redecorated is very out of date and showing signs of wear and tear. There are long corridors on the ground and first floor, these, along with their poor decorative state emphasises the feeling of being in an institution. There is art work done by past and present residents in the corridors. The paintings are hung in a long wobbley line along the wall. This does not give as much value to the art work as if they were hung straight. Hanging the paintings in small groups would also help to break up the long space. We were informed that the corridors are to be decorated soon after our visits. Account should be taken of these comments. We visited some residents in their bedrooms. The rooms are big and have ensuite facilities. One the residents said I chose the colour myself, and the curtains. However this was not always the case and another person said I have been here for four years and the room is the same. This was echoed by other residents. One person has a damaged ceiling which we have seen on a previous visit to the home. This must be repaired. There are laundry facilities for the home which residents are able to use independently. The home is cleaned by domestic staff who keep the home satisfactorily clean. There were no unpleasant odours at the time of the inspection. There are three staff who have not received any training in infection control issues and four staff who have not had this training since 2007. These members of staff should receive training so that their knowledge of infection control issues is up to date and appropriate for the tasks they undertake. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough well trained staff to meet the needs of the people who live at the home. Staff recruitment is thorough and safe. The staff team are all trained to NVQ level 2 or above. Additional training in topics relevant for their work is provided. Evidence: The staff team consists of, in addition to the Registered Manager, a Deputy Manager, two senior care staff and eleven care staff. Although the Activity Organiser post is no longer identified as a specific post at the home one member of the care staff team has taken a particular interest in this area. She organised the cultural day mentioned above. She was due to leave her post soon after the inspection. Some residents expressed anxiety about this as we heard that her input has been appreciated by them. Consideration should be given to how the work that she has begun can be continued. This may involve providing training for staff to develop their confidence in this area of work. All but one of the staff , who is to leave her post soon, have achieved NVQ 2 or NVQ 3. Staff told us that the training provided over the last year has been very useful and a range of courses has been available to them. Training over the last year has included understanding addictions; supporting client needs; working with difficult behaviour; Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: mental health awareness; dignity in care and communication skills. The rota showed that generally there are four or five staff on duty in the morning and early afternoon. In the later afternoon and evening there are three or four staff on duty. At night time there are two waking night staff on duty in the home with on call support available from senior staff. A small team of bank staff fill any gaps on the rota when staff are on holiday or otherwise unavailable for work. The recruitment records of a member of staff recruited since our last visits were examined, they were in good order. They showed that the correct checks and references were taken up before the person began work. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management systems are generally good. Representatives from Mission Care now have more involvement in the home. The residents benefit from the opportunities this gives them to raise issues of concern. Health and safety systems are generally effective, although checks of the emergency lighting system need to be made more frequently. Evidence: The Manager was registered under the Care Standards Act in November 2007. She is appropriately qualified and experienced for the role. She has the confidence of staff and residents and the management style in the home is described as supportive and flexible.We heard that the senior staff team work well together. Visits are made to the home by senior managers from Mission Care who now have a higher profile within the home. The reports of the visits showed that they include discussion with residents and staff. We also heard that Mission Care managers attend the Residents Forum meetings. This provides the opportunity for issues of concern to Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: be raised directly with senior staff within the organisation. A survey of residents and their views on the service was carried out in April 2009. This has led to an action plan being devised to address shortcomings in the service identified by the exercise. The majority of health and safety checks are carried out with the required frequency including, checks of the alarm system, extinguishers, fire drills and review of the fire risk assessment. However the last check of the emergency lighting system was recorded as havinbg taken place in late April - two months before our visit. The emergency lighting systems should be checked monthly as they are an essential aid to the evacuation of the building in an emergency. Care Homes for Adults (18-65 years) Page 27 of 32 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 14 16(2)(n) The Registered Person must take action to improve the quality of the television reception received in the home. 01/09/2008 2 20 13(2) The Registered Person must 28/07/2008 ensure that staff confirm the administration of medication by making an accurate entry on the medication administration record. Care Homes for Adults (18-65 years) Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Handwritten instructions on medication charts must be clearly legible and signed by two members of staff. This will ensure that the instructions are clear and accurate. 19/10/2009 2 20 13 The administration of creams, ointments and nuitritional supplements must be clearly recorded. This will demonstrate that they are being given as required. 19/10/2009 3 22 23 It is required that residents bedrooms are included in the redecoration, repair and refurbishment programme. This will ensure that residents personal space is in a good state of repair and reasonably decorated. 30/10/2009 Care Homes for Adults (18-65 years) Page 29 of 32 4 22 13 It is required that staff who 30/10/2009 have not received training in infection control strategies for the last two years are trained in these matters. This will help ensure that there are suitable arrangements to prevent infection and the spread of infection in the home. 5 42 23 The Registered Person must ensure that the operation of emergency lighting systems is checked each month. This will help ensure that the systems are working in an emergency. 26/10/2009 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 2 20 20 The use of abbreviations on medication records must be explained where necessary. The system to monitor the administration and recording of medication should be reviewed so that residents benefit from effective and safe arrangements. The medication policy should be suitable for Love Walk and not refer to Registered Nurses. Staff should sign and date the medication record whenever changes are made to prescribed medicines. They should also refer to the medical professional who made the change. Efforts should be made to minimise the institutional feel of the building through the planned redecoration. As part of this, art work should be displayed with care and in a manner that promotes the value of the work. Staff should be reminded of the importance of maintaining the security of the building, especially during warm weather Page 30 of 32 3 4 20 20 5 22 6 23 Care Homes for Adults (18-65 years) when doors and windows are open for ventilation. This will contribute to the protection of the people who live in the home. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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