Care Home: 136 Grovelands Road

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What the care home does well Prospective residents/their representatives have the information they need to decide if the home can meet their needs. Assessment information is gathered before admission, about the needs and wishes of the prospective resident, and this information is used to develop the individual care plan. The care plans identify the needs of each resident together with their wishes and any preferences about how they are supported. Their physical and emotional healthcare needs are also met. Residents are encouraged and supported to make decisions and choices in their day-to-day lives, and to take appropriate risks in the pursuit of a fulfilling lifestyle. The home has an appropriate system to manage their medication on residents` behalf. Complaints by residents and others are listened to and appropriately acted upon. The home has systems in place to safeguard residents from abuse. The home provides residents with a homely and comfortable environment which meets their current needs. The home`s recruitment systems provide safeguards to residents. What has improved since the last inspection? An appropriately experienced permanent manager has now been appointed to manage the home and provide the necessary stability and continuity. Two of the requirements made at the last inspection have been addressed and two are still in the process of being addressed. What the care home could do better: The complaints recording systems and formats could be improved Although standards of hygiene were generally good, it is recommended that the torn flooring in the bathroom be replaced, as this is a potential infection-control issue. The impact of the current staffing levels on residents` independence and choice needs to be explored further. A full overview of the current training position needs to be established by the manager to ensure that all mandatory training and updates are provided. More staff need to undertake an NVQ. The provider has not yet done a survey to obtain the views of residents, staff and others on the care provided and also needs to seek their views regularly during monthly monitoring visits. The degree to which the home promotes and protects the health and safety of residents and staff is potentially compromised by several issues identified in this report which need to be addressed. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 136 Grovelands Road 136 Grovelands Road Reading Berkshire RG1 7LP     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: Stephen Webb     Date: 2 3 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 33 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 33 Information about the care home Name of care home: Address: 136 Grovelands Road 136 Grovelands Road Reading Berkshire RG1 7LP 01189393628 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) : Prospects For People With Learning Disabilities care home 3 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 3 The maximum number of service users to be accommodated is 3. The registered person may provide the following category/ies 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). Date of last inspection Brief description of the care home 136, Grovelands Road is a small care home that offers a service for three adults, who have varying degrees of learning disabilities. It is a domestic semi-detached house in a residential area of Reading, approximately ten minutes from Reading town centre. The home has an enclosed landscaped back garden accessible from patio doors in the lounge. On the ground floor there is a small lounge, a kitchen-diner, a toilet and one bedroom. On the first floor there are two further bedrooms, an office/sleep-in room for staff, and a bathroom with a toilet. The home is on a public transport route and there are local amenities within a short Care Homes for Adults (18-65 years) Page 4 of 33 Brief description of the care home walk of the home. At the time of inspection the care managment fees ranged between five hundred and eight, and six hundred and sixty-nine pounds per week. Care Homes for Adults (18-65 years) Page 5 of 33 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 included an unannounced site visit from 9.30am until 17.15pm on the 23rd of June 2009. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with the manager. Residents also provided some verbal feedback and the inspector also observed the interactions between residents and staff at various points during the inspection. An inspection survey was completed by each of the residents, supported by staff, and by two relatives and two staff members. Their feedback about the service was positive, though few additional comments were recorded. Verbal feedback from the residents Care Homes for Adults (18-65 years) Page 6 of 33 during the inspection was also positive. The inspector also examined the premises. What the care home does well: What has improved since the last inspection? What they could do better: The complaints recording systems and formats could be improved Although standards of hygiene were generally good, it is recommended that the torn flooring in the bathroom be replaced, as this is a potential infection-control issue. The impact of the current staffing levels on residents independence and choice needs to be explored further. A full overview of the current training position needs to be established by the manager to ensure that all mandatory training and updates are provided. More staff need to undertake an NVQ. The provider has not yet done a survey to obtain the views of residents, staff and others on the care provided and also needs to seek their views regularly during monthly monitoring visits. The degree to which the home promotes and protects the health and safety of residents and staff is potentially compromised by several issues identified in this report which need to be addressed. Care Homes for Adults (18-65 years) Page 8 of 33 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 33 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 33 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. Prospective residents/their representatives have the information they need to decide if the home can meet their needs. Assessment information is gathered prior to admission, about the needs and wishes of the prospective resident, and this information is used to develop the individual care plan. Evidence: The home has an appropriate Statement of Purpose and Service User Guide, both recently reviewed. The Service user Guide is available in a picture-supported format to support its explanation to residents, where necessary. Copies of original assessments were not on the current files, having been archived, but the resulting care plans were detailed and positively focused on the identified needs, wishes and preferences of the residents which had been identified during the original assessment and reviewed thereafter. Care Homes for Adults (18-65 years) Page 11 of 33 Care Homes for Adults (18-65 years) Page 12 of 33 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 needs of residents are identified within their care plans together with their wishes and preferences about how they are supported. They are encouraged and supported to make decisions and choices in their day-to-day lives, and to take appropriate risks in the pursuit of a fulfilling lifestyle. Evidence: A sample of the care files for two residents were examined for this inspection. The files included information on the identified physical, social, healthcare and spiritual needs of residents. The service has a Christian ethos and actively supports residents to pursue their spiritual wishes and needs. Care plans identify the plans for worship and any related activities for each individual. The All About Me and Essential Lifestyle Plan formats, and others, provide detailed information on the individuals needs as well as their wishes about how they are supported, and the things that are important to them as regards family and other contacts and leisure interests. Records of social activities are also maintained. The care plans include prompts and individual guidelines for staff Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: on how to offer any necessary support, to encourage self-care and independence where possible. Individual personal care monitoring sheets are also completed to enable the care provided to be monitored. The files also contain information about the residents income and the fees for their support. The plans include aims and action plans, though some of these documents would benefit from dating to enable their review Copies of recent reviews and day-services reviews were on file indicating that a regular cycle of review was in place. None of the residents is currently able to manage their own funds. Each residents funds are managed separately and records maintained in individual cash books showing a running balance. Individual funds are held in separate tins. The records indicate appropriate expenditure on behalf of residents including weekly contributions to the day-care service. Receipts are retained for any expenditure. Residents have bank cards but are supported by staff when they go to withdraw their weekly money. Residents are encouraged to make choices and decisions in their daily lives and this was observed on occasions during the inspection. Examples of some of the choices made by residents would include them choosing the colour for their bedroom when it is decorated, choosing where they want to go on holiday and whether or not to attend outside events, clubs and activities. Individual risk assessments are used positively to support residents to enjoy a fulfilling lifestyle, and include guidance to staff on how to enable and support the relevant activity. Each resident has a set of individual risk assessments relating to routine events and regular activities. These were in the process of review, with some having already been updated. Care Homes for Adults (18-65 years) Page 14 of 33 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. Residents have access to a range of appropriate activities and events in the community, though the homes solo-staffing most of the time, could limit the development of their life experiences and opportunities for participation in new activities. Residents contact with family is supported and they have opportunities to develop friendships through their community and church links. They are encouraged to take part in the daily living tasks in the home and to make decisions and choices about aspects of their lives. Residents are provided with a varied diet, in consultation with dietitians and are encouraged to have involvement in menus, though involvement in shopping can be limited by their support needs as against the levels of available staff. Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: Residents all attend day services daily, Monday to Friday, which provides a range of opportunities, activities and community access. This is popular with the residents and two confirmed this to the inspector during the inspection. Activities include numeracy and literacy sessions, trampolining, library access, bowling, trips out, parties and public events as well as spiritual activities and gender-based activities. Two of the residents have family who will also take them out. However, the solo-staffing usually in place, together with the support needs of residents within the community, can limit access to activities and outings to times when all three residents wish to take part in the same event. Whilst the residents interests are the same at times, such as attending some clubs; on other occasions additional staffing has to be planned in advance to facilitate individuals to pursue their preferences. The manager stated that this had been raised in recent reviews but as yet no additional resources had been provided by funding authorities to enable additional staffing on a more regular basis. This could limit the further development of individuals community involvement and the opportunities for broadening their life experiences at times and the benefits provided by additional staffing should remain under review. (Requirement made under section 7, Staffing, later in this report). Two of the residents are going on a holiday together but this is with residents from another of the providers homes, which enables staffing levels on the holiday to be met between the two services. The other resident will go on holiday separately with a befriender. The home is operated by the provider within a Christian ethos and all staff have to be practicing Christians. Residents all attend ther same church as well as other spiritual events, supported by staff from the home. Residents may also pray within the home. Individual records of activities and community participation are maintained within files. Levels of family contact vary between residents, with two having very frequent contact including home visits and accompanied holidays. The home supports contact with familly. Residents attend a range of clubs and other services which provide opportunities for the development of friendships with others. Residents are supported to make decisions and choices in their day-to-day lives, They can decline to attend day-services if they wish, but in reality this only happens if an individual is unwell. They choose the contents of their packed lunch daily, and are encouraged to take part in the household chores, such as setting and clearing tables, loading the dishwasher etc. As part of developing individual social and self-care skills residents also clean their bedrooms and do their laundry with any necessary support. All can have access to their own front door and bedroom keys but only one of the current residents actually uses them. Residents also choose the colour of their bedroom, where they like to go on holiday and which clubs to attend. Menus are discussed in residents meetings and recipe books are used to help Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: residents to select menu items which they would like to cook for the group, with staff support. Staff maintain an overview of healthy eating issues and a dietician has previously been consulted for two of the residents. A poster on foods containing saturated fats was present in the kitchen and a full fruit bowl was also readily available. The impact of Autism may mean that individuals tend to prefer a familiar diet, and one residents individual menu consiststs of a limited number of items which he will eat, thought he, like the others will make specific meals for others in turn, based on a rota. Others will eat a wider range of meals. Steps have been taken to provide supplements for missing elements of his diet. The views of a dietician were to be sought the following day as part of the annual healthcheck for the remaining resident, and residents needs have been discussed within reviews. Residents generally take little part in the shopping, owing to the limitations of staffing and the needs of individuals, so the manager undertakes a lot of the shopping. This is another area where the limitations of the solo-staffing, in place much of the time, may be felt. Care Homes for Adults (18-65 years) Page 17 of 33 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. Residents receive support according to their needs, with due regard to their wishes and preferences. Their physical and emotional healthcare needs are met. Though none of the residents is able to manage their own medication, the home has an appropriate system to manage this on their behalf. Evidence: As noted the care plans include reference to the wishes and preferences of the individual resident. The focus of care plans is on supporting the resident to maintain and develop their independence, and as noted the plans include aims and action plans, though these need to be regularly reviewed to monitor developments and achievements. Support is provided within the context of risk assessments and, where necessary, individual guidelines for managing specific behaviours, both of which provide staff with appropriate guidance on how to respond and support individuals. Healthcare records provide details of appointments with relevant external healthcare professionals, enabling tracking of how individuals healthcare needs are being met. Examination of a sample of these records indicates appointments at appropriate Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: intervals. One file included details of an Occupational Therapist assessment, which had been reviewed recently. One resident explained to the inspector how she liked her new walking frame. The home has an appropriate system in place to manage the medication on behalf of residents, as none is currently able to manage their medication themselves. The records include individual medication profles and homely remedies consents from the GP which had been reviewed in response to a previous inspection requirement. The medication records provide an audit trail for the medication as they include details of the quantities of medication coming in, when it is administered and of any returns. Two gaps were noted in the recent administration records for the application of creams. Care Homes for Adults (18-65 years) Page 19 of 33 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. Although complaints recording systems and formats would benefit from some improvements, the views of residents and others are listened to and appropriately acted upon. The home has systems in place to safeguard residents from abuse. Evidence: The home has an appropriate complaints procedure in place, though the format is potentially confusing in terms of its layout. The home also has a version available in symbol format, which needs updating with the current managers details and the contact information for the Commission. The complaints log indicates one recorded complaint in the previous twelve months. The manager had identified two complaints in the completed AQAA, one of which was still in process at the point of inspection. The manager agreed to record the summary details of the current complaint within the log. The complaint which had been logged actually related to a residents experience at another service and was appropriately reported to that service for investigation. The current complaints log is held in a spiral-bound book without numbered pages, and has related papers stapled within the pages making it less secure and liable to the potential loss of records. The home has an appropriate safeguarding procedure for vulnerable adults and also had a copy of the local multi-agency safeguarding protocol, though this was the 2006 Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: version and the current version should be obtained. The manager also had a copy of the National Safeguarding Adults Framework of Standards. As noted earlier, the home has appropriate systems in place to safeguard residents funds, and maintains appropriate records of this. Staff have received safeguarding training and the manager was due to attend an update of this training in the near future. One safeguarding issue had arisen since the last inspection, which was appropriately investigated leading to an action plan which was in the process of being implemented. Care Homes for Adults (18-65 years) Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides residents with a homely and comfortable environment which meets their current needs, though future adaptations are likely to be needed as residents age. Laundry facilities are appropriate for the homes small size and standards of hygiene were generally good, but could be compromised within the bathroom, owing to the torn flooring. Evidence: The home is decorated in a homely and domestic style and at present there are no adaptations made for physical disabilities. One resident recently obtained equipment, mainly to support their mobility outside the home. Since the last inspection the carpet in the hall, stairs and landing and the kitchen flooring had been replaced, which had improved the environment. The ceiling of the ground floor toilet was in need of redecoration and the upstairs bathroom flooring was split meaning that satisfactory hygiene standards could not be maintained and there was a potential trip hazard. This needs to be addressed. The surface of the bath had also become worn and rough and the bath either needed re-enamelling or replacement. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: The manager had obtained quotes for the planned replacement of some wardrobes, where doors had been damaged. The home provides one ground floor and two first floor bedrooms, which were each individualised to reflect the interests of their occupant, and the manager stated that two of the bedrooms were due to be redecorated, and one resident had already chosen the colour scheme. Residents are supported to do their own laundry and the washing machine is located in the kitchen as is often the case in such small homes. The tumble drier is located in the small lobby opposite the ground floor toilet. The home has a secluded garden though the manager had plans for improving its accessibility and appearance. Care Homes for Adults (18-65 years) Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff are competent and caring but NVQ attainment across the team remains low. The impact of current staffing levels on residents independence and choice should be explored further, to ensure that their skills development and life-experiences are not being unreasonably curtailed. The homes recruitment systems provide safeguards to residents. A full overview of the current training position needs to be established by the manager to ensure that all mandatory training and updates are provided in timely fashion and that staff receive training on any relevant new legislation. Evidence: NVQ attainment levels are below the national target with only one of the three support workers having an NVQ (level 3). One other support worker is undertaking a Diploma in Community Care but the manager was unsure whether this was equivalent to an NVQ award. The home has had a 25 hour support worker vacancy since April, which has been advertised internally without success and is now to go to an external advert. The home operates within a Christian ethos and for most posts, the staff member has to be a practicing Christian. Solo staffing is the norm in the home, which at times limits access Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: to opportunities within the community, since none of the residents is able to access the community unsupported. Examples could include individual shopping trips, and where residents may wish to go to different activities at the same time. At times a second staff member is rotad to enable more flexibility for planned events (on Saturdays and Mondays), and attendance at the same day-care service by all residents from Monday to Friday makes things easier, but only where all three residents agree and wish to attend the same day service provider. At times two of the residents also benefit from having relatives who will take them out for outings and home visits. Residents choice of holiday destination had been influenced, at least in part by the opportunity for two female residents to go on a holiday with residents from another service, enabling additional staffing cover to be available. The original assessments do not appear to have allowed for sufficient staffing to enable the maximisation of residents independence outside the home, and the issue of increasing funding to facilitate greater individualisation of community access has been raised with funding authorities in successive reviews without success to date. However, it remains the providers responsibility to ensure that sufficient staff are provided at appropriate times to meet the full range of needs of residents, including enabling them real choice about individual activities and other community access options. Specific examples of where the current situation is limiting residents choices, should perhaps be recorded to assist with making this case, as it appears that residents potential for skills development and rights to free choice may not be being maximised at present. No new support workers had been appointed since the last inspection so no staff recruitment records were inspected on this occasion. This Standard was met at the last inspection in July 2008. Residents had not taken part in the recruitment of the current manager, but the manager had worked with all three residents previously within another Prospects service. Examination of the training records provided indicated that not everyone had attended all of the mandatory training within a satisfactory timescale. It was also noted that no staff training had yet been provided on the Mental Capacity Act, which is now essential training for all staff. The manager had established a training overview format which was still being completed with all of the relevant information, and this should be prioritised to clearly identify any remaining shortfalls so they can be addressed promptly. It is the providers responsibility to ensure that all staff are appropriately trained for their role. Care Homes for Adults (18-65 years) Page 25 of 33 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 residents benefit from an appropriately experienced permanent manager having now been appointed to manage the home and provide the necessary continuity. The provider has yet to take the necessary steps to take proper account of the opinions of residents and others on the operation of the service, through an appropriate quality assurance process or when undertaking monthly monitoring visits. The degree to which the home promotes and protects the health and safety of residents and staff is potentially compromised by a number of ongoing health and safety issues which need to be addressed. Evidence: The recently appointed manager is appropriately experienced for the role and is undertaking her NVQ level 4. She has fourteen years relevant experience and had been acting manager since February 2009. The manager has continued to update her training since her appointment, attending courses on first aid and safeguarding. The Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: manager plans to apply for registration once she has been in post for three months. In the course of the changeover from the previous temporary manager to the new manager, the proposed quality assurance survey system, having been devised, (following a previous inspection requirement), was reportedly not undertaken. This is an essential part of the cycle of ongoing management planning and review and demonstrates that the service welcomes the feedback of others. The provider must ensure that a quality assurance process is undertaken as part of its ongoing management monitoring of this service. Internal managements audits were undertaken in October 2008 and June 2009, though the latter document was undated. The manager indicated that she planned to produce an annual development plan by the end of August 2009, so it would be appropriate for a quality assurance survey to be undertaken ahead of this to enable the outcomes and any emerging issues to be addressed within the development plan. Examination of the reports of the required monthly monitoring visits to the service by or on behalf of the provider indicates that these had taken place monthly as required over the past year. However, the recorded level of consultation with residents and others, and observation of staff interactions with them was poor, with significant records of this having occured, only appearing in four of the reports over the past twelve months. Given that this is a required element of these visits and essential to enable a balanced picture of the homes operation to be obtained, the provider is urged to include this element routinely as part of every monitoring visit. It is noted that the new regulation 26 visit format includes specific sections for recording these matters. In order for this to happen it will be necessary for visits to take place when residents are present in the building, which has often not been the case previously. Examination of a sample of routine service certification indicated that most systems were regularly serviced. However, the gas certificate identified an issue with earthbonding which remains outstanding and needs to be addressed in a timely fashion. There was also no certificate available for the fire extinguisher service but the manager later confirmed that this had been located. The periodic testing of the electrical installation was also overdue and needed to be undertaken again. As noted earlier a selection of relevant risk assessments for individual residents are in place which provide guidance to staff on how to address the identified hazard to enable the activity. In addition there is a range of generic risk assessments for the home. The risk assessments had been reviewed in May. However, there was no lone-working risk assessment in place, though there were some guidelines on file for staff. An environmental health officer inspection had taken place in May with a Satisfactory outcome, but the report noted some action points which were being addressed. Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: A fire officer inspection also took place in May which resulted in a deficiency notice. At the time of writing, most of the issues identified had been addressed or where in process, but one issue remained to be resolved. The provider is strongly advised to discuss this issue further with the fire officer to agree what action will be necessary. At present the provider is not complying with the Health and Safety at Work regulations and appropriate action must be taken to address these issues. There had been two fire drills undertaken so far in 2009, which were recorded appropriately. The homes fire risk assessment notes that staff had received fire safety training in January 2009. The document had been amended and appended with various handwritten notes and it is advised that a new copy be printed, incorporating the relevant changes, when it is again reviewed in July. Accident records were made using an appropriate tear-off pad and completed forms were filed in the relevant residents file, though no collective record of accidents was being maintained for monitoring purposes. Care Homes for Adults (18-65 years) Page 28 of 33 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 29 of 33 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 23 The manager must ensure that the identified issues relating to decor and hygiene are addressed. In order to maintain the quality of the environment and the health and safety of residents and staff 09/10/2009 2 33 12 The manager must review the current staffing levels to establish whether they are unduly restrictive of residents independence development and choice In order to ensure that residents opportunities for an independent lifestyle and choice of activities are maximised. 09/09/2009 3 35 18 The manager must establish 09/10/2009 an overview of the current staff training position and ensure that all staff have up-to-date statutory training and that they also receive Care Homes for Adults (18-65 years) Page 30 of 33 training on relevant new legislation. In order to ensure that staff have received all of the training required to meet the needs of residents 4 39 26 The provider must undertake the monthly monitoring visits in accordance with Regulation. In order to obtain the views of residents and others, and observe care practice, to be able to form an opinion about the quality of the care provided. 5 39 24 The provider must ensure that a quality assurance process is undertaken as part of its ongoing management monitoring of this service In order to obtain the views of residents, relatives and others about the conduct of the service. 6 42 13 The provider must address the health and safety issues identified in this report. In order to ensure compliance with health and safety regulations; and to promote and protect the health, safety and welfare of residents and staff. 09/08/2009 08/09/2009 08/08/2009 Recommendations These recommendations are taken from the best practice described in the National Care Homes for Adults (18-65 years) Page 31 of 33 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 23 The manager should address the potential infection control issue presented by the damaged bathroom flooring. Care Homes for Adults (18-65 years) Page 32 of 33 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. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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