Care Home: 13 Manor Crescent

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What the care home does well People who use the service are provided with information that will enable them to make a choice about living at the home. The needs of prospective residents would be fully assessed to ensure their needs could be met at the home. Care plans are produced from the pre-admission assessments that reflected residents` needs and personal goals. Residents are encouraged to make decisions about their lives and to take risks as part of furthering their independence. Residents are able to participate in activities both in the home and in the wider community. Appropriate relationships are supported and residents` rights and responsibilities are promoted. A variety of food is provided, that is chosen and enjoyed by residents. Personal support provided to residents meets their preferences and their physical and emotional needs are met. People who use the service are protected by the home`s storage and administration of medication procedures. The principles of respect, dignity and privacy are put into practice. People who use the service live in a safe, well maintained, comfortable and homely environment. The arrangements for staffing are satisfactory, ensuring staff have the qualities and training to meet the needs of the residents. People who use the service are protected by the organisation`s recruitment policy and procedures. What has improved since the last inspection? This was the first key inspection since the service registered in June 2009. What the care home could do better: The out of date contact details for the Care Quality Commission should be deleted from the Statement of Purpose. The date the Statement of Purpose and Service User Guide were reviewed should be included on both these documents. Care plans should be user friendly to enable residents to more easily understand the contents. Personal information pertaining to individual residents should be kept in individual care files. The home`s Safeguarding Policy and Procedure must be amended to ensure it states all suspicions of abuse, including those involving members of staff, would be referred to the local Safeguarding Team. The registered person and manager must adhere to the local Safeguarding Procedures when Safeguarding issues arise involving residents or members of staff. The registered manager should discusses the role of the deputy manager with the registered provider, and amend the Statement of Purpose if the home is not being provided with a permanent deputy. The duty rota should be clear and record the exact numbers of staff on duty for each shift. The manager should ensure that all the required recruitment documentation is maintained in the care home. Regulation 37 Notifications must be completed and forwarded to the Care Quality Commission of all events that adversely affects the well-being or safety of any resident. Key inspection report Care homes for adults (18-65 years) Name: Address: 13 Manor Crescent 13 Manor Crescent Byfleet West Byfleet Surrey KT14 7EN     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: Joseph Croft     Date: 1 6 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: 13 Manor Crescent 13 Manor Crescent Byfleet West Byfleet Surrey KT14 7EN 01932343799 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): New Generation Care Ltd Name of registered manager (if applicable) Mrs Rosalyn Sayers Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 4. The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Physical disability (PD) Date of last inspection Brief description of the care home 13 Manor Crescent is a detached bungalow that has been adapted and furnished to accommodate up to four people who have a Learning Disability, and may also have a Physical Disability. The accommodation consists of four single bedrooms with en-suite facilities, communal Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 0 4 4 Brief description of the care home lounge/dining room and an open plan kitchen. There is a laundry room that has a washing machine, tumble drier and ironing facilities. There is a garden and patio area to the rear of the property, and a small garden to the front. There are car parking facilities to the front of the home for four cars. There are good links with the local community and people using the service are able to access community based activities and visit the local shops. The weekly fees range from £1589 to £2848. Care Homes for Adults (18-65 years) Page 5 of 36 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: The quality rating for the service is One star. This means the people who use this service experience Adequate quality outcomes. The Care Quality Commission (CQC) (us,we) undertook an unannounced site visit to the service on the 16th December 2009 using the Inspecting for Better Lives (IBL) process. The site visit was undertaken by Regulation Inspector Mr Joe Croft and took six hours, commencing at 09:55 and concluding at 16:05. The manager assisted throughout the site visit. Also assisting on this site visit was an Expert by Experience. This is a person who either has a shared experience of using services or understands how people in this service communicate. They visited the home with us to help us get a picture of what it is like to live in or use the service. The report written by the Expert by Experience has been incorporated into this key inspection report. Care Homes for Adults (18-65 years) Page 6 of 36 This was the first key inspection since the service registered in June 2009, therefore all the National Minimum Standards were assessed. The inspection process included a tour of the premises, direct observation of practice, sampling of medication records, care plans, risk assessments, health action plans, menu, staff recruitment and training files, and the sampling of some policies and procedures. Formal discussions took place with the manager and two members of staff, and informal discussions took place with two other members of staff during the course of their duties. Due to the complex needs and communication difficulties we were only able to have a limited conversation with one resident with staff support. This resident was able to convey that they liked their bedroom, taking part in cooking, they like to go shopping and watching the television. They stated that they like living at the home and the staff who look after them. Staff were observed interacting with residents in an appropriate manner, were aware of residents communication needs, and called them by their preferred names. Surveys were received from two members of staff and two health care professionals. The manager returned the completed Annual Quality Assurance Assessment (AQAA) when we asked for it, and this, and the surveys, have been used as a source of evidence throughout this report. The inspector would like to thank the manager, staff and residents for their cooperation during the site visit. Weekly fees charged range from 1589 to 2848 pounds. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: The out of date contact details for the Care Quality Commission should be deleted from the Statement of Purpose. The date the Statement of Purpose and Service User Guide were reviewed should be included on both these documents. Care plans should be user friendly to enable residents to more easily understand the contents. Personal information pertaining to individual residents should be kept in individual care files. The homes Safeguarding Policy and Procedure must be amended to ensure it states all suspicions of abuse, including those involving members of staff, would be referred to the local Safeguarding Team. The registered person and manager must adhere to the local Safeguarding Procedures when Safeguarding issues arise involving residents or members of staff. The registered manager should discusses the role of the deputy manager with the registered provider, and amend the Statement of Purpose if the home is not being provided with a permanent deputy. The duty rota should be clear and record the exact numbers of staff on duty for each shift. The manager should ensure that all the required recruitment documentation is maintained in the care home. Regulation 37 Notifications must be completed and forwarded to the Care Quality Commission of all events that adversely affects the well-being or safety of any Care Homes for Adults (18-65 years) Page 8 of 36 resident. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 36 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 36 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. People who use the service are provided with information that will enable them to make a choice about living at the home. The needs of prospective residents would be fully assessed to ensure their needs could be met at the home. Evidence: The service has a Statement of Purpose that includes the information in regard to the aims and objectives and the fees charged. It also includes the details of the manager, the registered provider and their qualifications, staff team, terms and conditions and a summary of the complaints procedure. The Service User Guide includes the information as required, and uses pictures to aid the reader. However, the Statement of Purpose had two contact details for the Care Quality Commission, one of which is correct. A good practice recommendation has been made that the out of date contact details for the Care Quality Commission should be deleted from the Statement of Purpose, and the dates of reviews should be included on these documents. The service has only admitted two new residents, one in July and the other in November 2009. The manager had obtained a copy of the Community Care Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: Assessment from the placing managers. The service had also undertaken their own pre-admission assessments that included information in regard to the health and personal care needs, communication, dietary needs, social activities, self-care , sleeping and medication. The manager told us that the care plans are produced from these assessments. Introductory visits are encouraged. This provides the prospective resident the opportunity to see the home, view the bedroom they will occupy and meet the staff and other residents. Overnight visits would be offered if this was to be beneficial to the prospective resident. The manager told us that they would only admit residents whose needs could be met, and that are compatible to live with residents already living at the home. All placements are reviewed after 6 weeks, and then every six months. The manager told us that staff are provided with all the training required to ensure they are equipped to meet the assessed needs of all residents admitted to the care home. On the day of the site visit the two current residents had not been provided with a written contract between them and the service. However, this was completed before the end of the site visit by the registered provider. The Annual Quality Assurance Assessment (AQAA) informs that the service has devised a full and thorough assessment process to ensure that all prospective residents are suited to the home, and their individual needs are fulfilled. Care Homes for Adults (18-65 years) Page 12 of 36 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 who use the service have care plans that reflect their needs and personal goals. Residents are encouraged to make decisions about their lives and to take risks as part of furthering their independence. Evidence: The care files for both residents were viewed during the site visit. Each file had a care plan for each individual that were produced from the pre -admission assessments. These included information in regard to the personal care needs, mobility, medication, behaviours, community and social participation, spiritual needs and mealtimes. It was noted that neither of the care plans had been signed by the resident or their representative. However, both residents have recently moved into the home, one in July and the other in November 2009. The manager told us that the care plans would be signed at the six month review. Further discussions took place with the manager in regard to making the care plans more user friendly, and the benefits of using pictures and symbols that would aid residents to gain a better understanding of the contents of the care plans. A good practice recommendation has been made in regard to this. Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: We were able to have limited discussions with one resident who told us that they knew they had a care plan. The home has implemented the key worker system. During discussions it was evident that staff were knowledgeable of the care plans. We were told by the staff that they are currently reviewing the care plans on a monthly basis. Staff surveys inform that they are always provided with up to date information about the needs of the residents. Daily notes were maintained that relate to the care plans, and entries were made for each morning, afternoon and evening. The Expert by Experience reports that the care plans were detailed and seemed to be well known and used by staff. It was also stated that the care plans should have symbols and pictures in them to help residents to know something of what they are about. The care files sampled had a personal information sheet that included the residents next of kin, GP details and other personal information pertaining to the resident. During discussions the manager and staff told us that staff support residents to make decisions for themselves such as the choice of menu, clothes they wish to wear and activities and they want to partake in. Staff told us that the emphasis is to enable residents to be as independent as they can. Risk assessments were viewed for the two residents. Risk assessments included slips, trips and falls, scolds and burns, community participation, Epilepsy, drowning and use of transport. Residents were observed undertaking daily chores on the day of the site visit. One resident was doing their own ironing with staff support. Other chores include shopping, laundry and keeping their bedrooms tidy. The manager told us that due to high and complex needs of the current residents they were not having monthly meetings. However, staff are always available to talk to the two residents. The service has a confidentiality Policy date June 2009. However, it was observed that the risk assessments for the residents were kept in one file with the general risk assessments for the home. This was discussed with the manager, and it has been Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: recommended that individual risk assessments and other confidential information pertaining to individuals should be maintained in individual care files. The AQAA informs that care plans are detailed and clear for those supporting the resident. The service promotes independence where possible, and activities undertaken are risk assessed Care Homes for Adults (18-65 years) Page 15 of 36 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. People who use the service are able to participate in activities both in the home and in the wider community. Appropriate relationships are supported and residents rights and responsibilities are promoted. A variety of food is provided, that is chosen and enjoyed by residents. Evidence: Residents living at the home are white British, and they are supported by a multi cultural staff team of male and female staff. The AQAA informs that Equality and Diversity is incorporated through treating residents equally and fairly. Staff at the home endeavour to assist residents to enjoy a full and active life and ensure that they access and become a part of the local community. Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: Both the current residents are Christians, however, only one had shown an interest in attending their place of worship on one occasion. Residents are supported to participate in a range of activities according to their needs, preferences and wishes. Each resident has a copy of their weekly activities in their care plans. Activities included trampolining, shopping, swimming, walks, music, free time and external trips outside of the home. During discussions the manager and staff told us that residents are accepted as part of the community, and regularly go to the local shops and use the community facilities. The Expert by Experience informs that there are a good range of activities available to residents. They go to the pub, swimming, bowling, a Mencap nightclub, the park, day centres, shopping (for the food they will cook and eat) and local eateries. Staff showed how they help residents to try new things and take account of peoples nervousness of new activities and frame of mind. They may need several goes at an activity before they can tell if they like it. They also use public transport as well as their minibus. Residents are supported to maintain important relationships with friends and families. Care plans contain details of important contacts with addresses and telephone numbers. During discussions the manager and staff told us that there are no restrictions on visitors to the home, and residents can go to their parents homes if they wished to. Daily routines are flexible with bedtimes and mealtimes arranged to meet individual needs. Residents are encouraged and supported by staff to undertake daily household tasks. One resident told us that they help with the shopping and cooking meals. The same resident was observed doing their ironing under the guidance of staff. The Expert by Experience informs that it was good to see the lengths that staff go to so as to offer choices to the residents. Where there is limited communication, they encourage the use of objects of reference and use their knowledge of the residents likes, dislikes and behaviour. This is obtained from residents experiences, family carers, previous records and care managers. It was good to hear that they try to look at what is visually obvious to them. Residents choose what time they go to bed and this is flexible, and they are able to stay up very late if they want. Staff helped the Expert by Experience to ask questions of the residents, who have little verbal communication. The Expert by Experience reports that it was good to observe how staff had involved residents in how the home is run, and that the Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: routines are built around residents needs and preferences. They told the Expert by Experience that they have house meetings where they try to include everyone. This came across as very genuine in that staff had changed one residents personal care routine from 2:1 to 1:1, in order to take account of his preferences. Staff were passionate about running the home in a person centred way. The menus were viewed during the site visit. They included fresh meat, pasta, fresh and frozen vegetables, desserts and fresh fruit. A roast dinner is provided each week. The manager told us that they have taken advice from a Physiotherapist in regard to monitoring one residents weight. The manager was advised to seek advice from a dietitian in regard to menus and menu planning. During discussions staff and one resident told us that they plan the menu together every week, and then go to the local supermarket to buy the food. Staff use photographs of meals and foods that help residents to choose the meals they would like. The Expert by Experience reports that staff talked about offering a healthy diet in the home and this seemed to be the case. They saw them eating a lunch of wraps with lettuce, mayonnaise and meat. They looked like they were enjoying it and had a hand in preparing it. They did, however have the chance to eat their favourite foods of chips, sausage and beans. The training matrix and the viewing of certificates provided evidence that staff had received training in regard to food hygiene and handling. Records confirmed that fridge and freezer temperature checks are undertaken and food is temperature probed regularly before serving. The AQAA informs that the service promotes lifestyle that provides wide and varied opportunities, and to support residents to learn as many independent skills as possible. Residents are involved in choosing a balanced and healthy diet. Care Homes for Adults (18-65 years) Page 18 of 36 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. Personal support provided to residents meets their preferences, and their physical and emotional needs are met. People who use the service are protected by the homes storage and administration of medication procedures. The principles of respect, dignity and privacy are put into practice. Evidence: The two care plans viewed provided information in regard to the level of support each resident required with their personal care needs. It was evident through discussions that staff were knowledgeable of the personal care needs of residents. Staff told us that they attend to the personal care in the privacy of bedrooms and bathrooms. We observed staff always knocking on bedroom doors before entering, and calling each resident by their preferred names. From discussions with the manager and staff, and the viewing of care plans for two residents, it was clear that residents have access to all health care professionals as required. We were shown a Health Action Folder that the manager is developing for each Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: resident. This includes information in regard to all health care needs, and for recording and monitoring the health of residents. During discussions we advised the manager to have separate sheets for recording each health care appointment. The manager told us that they have submitted permission forms to the GPs to sign giving permission for staff to administer PRN medication as required. The home has a Medication Policy and Procedure that was dated June 2009. This provided information for staff in regard to medication. The home uses printed Medication Administration Record sheets (MARs) from the local pharmacy. The Medication Administration Records for the residents were viewed. The MARs sheets included the quantity of medication received, however, there were two omissions for one residents medication. This was discussed with the manager who told us that this would be followed up immediately. Medication was appropriately stored in a locked metal cabinet.The manager told us that they have ordered a larger medical cabinet, as the one they have could be too small to accommodate the medication when the home has all residents admitted. Each resident had a medical profile with their MAR chart that also provided information as to what each medication is for, and the known side effects for staff to be aware of. The home has a returns book for recording of medication that has been returned to the pharmacy. The manager told us that they are able to telephone the local Pharmacist for advice, and when the home is full, she would ask the Pharmacist to visit the home to undertake an audit of the medication and medication practices. The manager told us that no resident is taking a controlled drug or self-medicating. The staff training matrix provided to us on the day of the site visit, and the sampling of training certificates provided evidence that staff had received training in regard to medication. Further training dates had been booked for January 2010. The manager told us that ageing and death is being addressed with residents parents, one of whom are taking full responsibility in this area. The AQAA informs that residents are able to choose how their individual care is carried out, and all health care appointments are facilitated. There is a Medication policy and all staff have attended certified medication training. Care Homes for Adults (18-65 years) Page 20 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to a satisfactory complaints system that enables residents and their families to raise concerns. Residents are not being fully protected from abuse through the homes policy and procedures. Evidence: The Care Quality Commission has not received any concerns, complaints or allegations in regard to the home. The home has a Complaints Policy that was dated June 2009. The complaints policy included the timescales for responding to complainants, and included the correct contact details for the Care Quality Commission. A summary of this document is included in the Statement of Purpose and Service User Guide. A user friendly copy of this document was displayed at the home. The manager told us that they have not received any complaints since the service commenced operating. During discussions staff told us that they are able to tell by residents body language, facial expressions and moods if they are unhappy. All staff surveys informed that they know what to do if someone has concerns about the home. Staff told us that they would inform the manager. The home has a copy of the recent local Safeguarding Procedures, and staff follow the Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: organisations abuse Policy that was dated June 2009. However, this document needs to be reviewed to ensure it is in line with the local Safeguarding Policy and Procedure. It states that when instances of abuse involve members of staff that the service would conduct their own investigation. This has to be amended to inform that all suspicions of abuse, including those involving members of staff, would be referred to the local Safeguarding Team who would take the lead in any investigations. A requirement has been made in regard to this. The viewing of the staff training matrix and sampling of training certificates provided evidence that staff had received training in regard to safeguarding Adults in 2009. Different scenarios in regard to abuse were discussed with the manager and staff. They were knowledgeable about the procedures to be followed and were aware that the safeguarding issues must be reported to the local Safeguarding Team. The manager and registered provider have booked themselves on a Safeguarding for Managers training course in January 2010. The Annual Quality Assurance Assessment informs that the home has not made any Safeguarding referrals and no Safeguarding investigations have taken place since opening. However, a review of documents held at the home revealed that the registered person had dealt with one Safeguarding issue internally, that should have been referred to the local Safeguarding Team. Discussions took place with the registered manager and registered provider in regard to understanding and implementing the local Safeguarding Procedures. A Regulation 37 Notification should also have been sent to the Care Quality Commission notifying us of this event. This has been further reported on under the Conduct and Management of the home section of this report. A requirement has been made that the local Safeguarding procedures must be followed for all instances and suspicions of abuse. The manager told us that parents have power of attorney for residents finances. The home holds a small amount of money for residents that is kept secure in a locked cabinet. Staff check residents money every week. Staff signed all transactions and receipts of purchases are maintained. Records of one residents money was viewed during this site visit. The money held matched with records maintained. The AQAA informs that the Complaints procedure is displayed in the communal areas of the home. All staff are subject to the recruitment checks. Staff attend mandatory training in regard to Safeguarding Adults. Care Homes for Adults (18-65 years) Page 22 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service live in a safe, well maintained, comfortable and homely environment. Evidence: 13 Manor Crescent is a detached bungalow that has been adapted and furnished to accommodate up to four people who have a Learning Disability, and may also have a Physical Disability. The accommodation consists of four single bedrooms with en-suite facilities, communal lounge/dining room and an open plan kitchen. There is a laundry room that has a washing machine, tumble drier and ironing facilities. The floor was fully sealed and the walls are washable. The Control of Substances Hazardous to Health (COSHH) were kept safe in a locked cupboard, and the home has the safety data for all substances used at the home. There is a garden and patio area to the rear of the property, and a small garden to the front. There are car parking facilities to the front of the home for four cars. A tour of the premises was undertaken and bedrooms were viewed. Two bedrooms that are currently occupied included the furnishings as required, and residents had Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: brought some of their personal possessions. One resident told us that they liked their bedroom and they had chose the decor for it. It was noted that there were no lockable facilities for residents to keep personal possessions secure. The manager told us that these have been ordered and they are waiting for the delivery. The manager and staff told us that residents are offered keys to their bedrooms. On the day of the site visit we observed staff knocking on bedroom doors and waiting to be invited into the residents rooms. The communal bathrooms and toilets were very clean and included adaptations as required by residents. Each had liquid soap dispensers and paper towels. The lounge/dining room was spacious and had comfortable seating for residents to relax in. There was a television with a DVD player. The kitchen was clean and the food was appropriately labelled and stored. The fridge/freezer temperatures are being recorded each day, and the hot water is tested each week. Residents were observed to have access to all communal parts of the home. All the furniture, carpets and fittings were new, as the home had commenced operating in July 2009. The AQAA informs, and the viewing of the training matrix and training certificates confirmed, that all staff had attended training in regard to Infection Control. On the day of the site visit the home was very clean, tidy and free from offensive odour. The Expert by Experience informs that the home was new, clean, pleasantly decorated and furnished. There was plenty of space for those using wheelchairs and any equipment that people may need. It has a nice homely, comfortable, but modern feel, it felt like their home, not an institution. One resident showed the Expert by Experience their bedroom and pointed out the posters on his walls. One was of Shrek and they had been watching this film on the television in the lounge when we arrived. Their bedroom felt a bit big and empty, but the resident had not been living there for long. The room was painted in a colour that he chose, and the residents can go to their rooms when they want to. We saw a bedroom that was being made ready for a new resident. The manager had put in specialist equipment that this resident would need, including a profiling bed, which was a nice wooden one, not like a hospital type. Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: The kitchen was open plan with the lounge/diner and large enough for residents and staff to cook together. We went into the garden and it was easily accessible by wheelchair and a pleasant place to be. Two problems were identified by the Expert by Experience, one was that the door bell was too high for wheelchair users to reach, and the other was that the wall mounted ashtray in the garden was also too high. These were discussed with the manager who told us that these would be attended to. The AQAA informs that the service provides a clean, safe and friendly environment. Care Homes for Adults (18-65 years) Page 25 of 36 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. The arrangements for staffing are satisfactory, ensuring staff have the qualities and training to meet the needs of the residents. People who use the service are protected by the organisations recruitment policy and procedures. Evidence: All staff employed are provided with a job description that specifies their roles and responsibilities. These were evidenced in the three staff files that were sampled. The manager told us that all staff are provided with a copy of the General Social Care Council Code of Conduct upon commencement of their duties. We were told that for two residents there are three members of staff on duty for each shift, and one waking night staff. However, this was not very clear on the duty rota. We could evidence that there were two staff on duty for each shift from the duty rota. The manager told us that they use staff from their sister home which is next door to provide extra staff, and they also use agency staff to cover staff absences. The manager has obtained written evidence from the supplying agency that all the required recruitment checks have been completed. A good practice recommendation has been made that the duty rota should be clear and record the exact staffing on duty for each shift. Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: The Statement of Purpose informs that the staffing at the home consists of the manager. deputy manager, seven support workers and two waking night staff. However, during discussions the manager told us that the current staff is the manager, one senior, seven care staff and two waking night staff. The manager is sharing the deputy who works at the sister home next door. The manager works as supernumerary to the rota, but does cover staff absences. It is recommended that the manager discusses the role of the deputy manager with the registered provider, and to amend the Statement of Purpose if the home is not being provided with a permanent deputy. The Annual Quality Assurance Assessment informs that there is a team of ten staff, seven hold minimum of NVQ level 2 and above. The manager told us that two staff are currently undertaking the NVQ level 3, and there are two nurses from the Phillipines whose qualifications are recognised as an NVQ level three. All new staff undertake induction that is in line with the Skills for Care Council Common Induction Standards. Staff surveys informed that their induction covered everything they needed to know to do the job when they started. Other training staff had received included Epilepsy, Care Values and Principles and conflict management. The manager told us that all training required would be provided to all staff. Staff surveys informed that they receive all the training they require to fulfill their roles. During discussions staff told us that the training provided is very good. The Expert by Experience reports that staff were pleasant, welcoming and had good, adult relationships with the residents, praising one resident by saying good man. Residents seemed comfortable with staff, and the staff seemed to be well aware of residents needs. Staff were keen to do more training, although they said they had the basics to do their job. They were excited by residents becoming more independent and felt that management listened to what they said and acted upon it. The manager told us that there is a dedicated and committed staff team looking after the residents currently living at the home. It was clear that staff on duty were aware of needs of each resident. Three staff recruitment files were viewed. These included an application form, full employment history, health declaration, proof of identity and a photograph of the members of staff. Protection of Vulnerable Adults (POVA) first and Criminal Record Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: Bureau (CRB) checks reference numbers were recorded in the files. Only two files included two written references. The registered provider told us that a second reference was received for the identified member of staff, and this had been signed off on the check list in the persons recruitment files. A recommendation has been made that the manager should ensure recruitment information in regard to staff is maintained at the home. Evidence was viewed in the three staff files sampled that the manager is providing formal one to one recorded supervision to staff employed at the home. Staff surveys inform that the manager provides enough support, and often meets with them to discuss how they are working. The AQAA informs that all new staff are provided with the Skills for Care training. All staff are provided with the GSCC Code of Conduct. All staff are CRB and POVA checked. Care Homes for Adults (18-65 years) Page 28 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for the day to day management of the home ensure that the home is approrpiately managed. There are systems in place for monitoring quality assurance. Robust policies and procedures are in place ensuring the safety of the residents and staff. The health and safety of the residents and the staff are promoted, however, the registered manager must address the issues raised in this report in regard to Safeguarding Adults to ensure they are fully protected from abuse. Evidence: The manager successfully registered with the Care Quality Commission in June 2009, and has nine years experience working with adults who have a Learning Disability. The manager was the deputy in the organisations other care home. The manager holds the NVQ level 3 and the Registered Managers Award (RMA). We were told that she is currently undertaking the NVQ level 4 and hopes to complete this by August 2010. The manager told us that the ethos of the home is to create a happy home for Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: residents, to provide choices and promote Independence. During discussions staff told us the manager is very supportive, has an open door style of management and is approachable. One staff member told us that the manager is firm but very fair. The registered manager must address the issues identified in regard to Safeguarding Adults, and ensure that the homes policy, and the local procedures for the reporting of all abuse, are strictly followed. The manager must also complete and forward Regulation 37 Notifications to the Care Quality Commission of all events that adversely affect the well-being or safety of any resident. A requirement has been made in regard to this. The home has only been in operation for five months, therefore it is not possible to undertake a Quality Assurance survey of residents or other stakeholders in regard to the home. However, the manager has developed a user friendly questionnaire for residents, and parents, staff and other associated professionals to complete when the home meets its first anniversary. The manager told us that staff meetings have commenced. It was not feasible to conduct monthly residents meetings, as one had only been living at the home for one month, however, each resident is constantly asked by staff on a one to one how they are feeling about living at the home. The Annual Quality Assurance Assessment completed by the manager informs that all the policies and procedures as required were implemented in June 2009. Staff told us that they have read and understood the policies and procedures pertaining to the home. The training matrix, and the sampling of training certificates, provided evidence that staff had received the mandatory training as required. Information provided in the AQAA informs that the health and Safety maintenance checks of equipment used at the care home are reviewed in accordance with the manufactures recommendations. We did evidence the Employers Liability Insurance that expires in March 2010, fire risk assessments that were dated June 2009, the electrical installation certificates, the testing of the fire alarm system and the report from the Environmental Health Officers visit to the home. The registered provider has produced a business plan for 2008/2009 for the home. The financial planning and budgeting for the service would have been viewed at the time of the registration of the care home. The AQAA informs that the manager has experience in working with Learning and Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: Physical Disabilities,has achieved the RMA and is currently undertaking the NVQ level 4 in Care. All safety equipment has been serviced within the last twelve months. All policies and procedures were reviewed/implemented in June 2009. Care Homes for Adults (18-65 years) Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 36 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 23 13 The registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The homes Safeguarding Policy and Procedure must be amended to ensure it stated all suspicions of abuse would be referred to the local Safeguarding Team. The registered person and manager must adhere to the local Safeguarding Procedures when Safeguarding issues arise involving residents or members of staff. 16/01/2010 2 37 37 The registered person shall 16/01/2010 give notice to the Commission without delay of Page 33 of 36 Care Homes for Adults (18-65 years) 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 the occurrence of any event in the care home that adversely affects the wellbeing or safety of any resident. Regulation 37 Notifications must be completed and forwarded to the Care Quality Commission of all events that adversely affects the well-being or safety of any resident. 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 1 The out of date contact details for the Care Quality Commission should be deleted from the Statement of Purpose. The date the Statement of Purpose and Service User Guide were reviewed should be included on both these documents. Care plans should be user friendly to enable residents to more easily understand the contents. Personal information pertaining to individual residents should be kept in individual care files. The registered manager should discusses the role of the deputy manager with the registered provider, and amend the Statement of Purpose if the home is not being provided with a permanent deputy. The manager should ensure that all the required recruitment documentation is maintained in the care home. The duty rota should accurately reflect the numbers of staff on duty each shift. The duty rota should be clear and record the exact Page 34 of 36 2 3 4 6 10 31 5 6 7 33 33 33 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 numbers of staff on duty for each shift. Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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