Care Home: 17 Jerome Close

What the care home does well The home provides a good range of activities and individualized programmes for service users to pursue. One to one staffing is available through out the day. The assessed needs of service users are recognised and acted upon including the management of challenging behaviour incidents. Safeguarding matters and liaising with other parties is done well. Service users are supported in maintaining contact with their families. The home promptly addressed issues that were raised about health, safety and medication on the day of the inspection. What has improved since the last inspection? At the last inspection of the home on 17th May 2007, no requirements or recommendations were made. The home have made a number of improvements to the environment and this work is on-going. They have applied for extra funding for a service user to access more community activities. The home has concentrated on continuing to draw up person centred care plans. What the care home could do better: 17, Jerome Close continues to provide good outcomes for service users living in the home. Requirements that have been made relate to expanding and developing upon Quality Assurance systems and gaining service users feedback. The home recognises the need to develop more documentation in formats that service users can understand. Attending to health, safety and fire matters as they arise; ensuring the environment is safe, accessible and medication protocols are followed will enhance the safety and protection of service users. Establishing clearly defined managerial arrangements so that a person is appointed by the organisation who has the knowledge, skills, qualifications and experience to achieve registration will benefit service users and staff as currently the Registered Person is not in control of the home on a day to day basis. Key inspection report Care homes for adults (18-65 years) Name: Address: 17 Jerome Close 17 Jerome Close Eastbourne East Sussex BN23 7QY     The quality rating for this care home is:   two star good 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: Jo Mohammed     Date: 2 1 0 5 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 33 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 33 Information about the care home Name of care home: Address: 17 Jerome Close 17 Jerome Close Eastbourne East Sussex BN23 7QY 01323767399 01323740846 lianjemini@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Jemini Response Ltd care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: 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 The home is situated in a residential estate on the outskirts of Eastbourne and is close to local shops, bus routes and community facilities. The detached property has three bedrooms. A lounge/dining/conservatory area, ground floor cloakroom, kitchen and third bedroom on the ground floor. On the first floor is a bathroom with lavatory, two bedrooms, an office and a separate lavatory that is currently being converted from a store cupboard. There is a triangular shaped open front garden where additional parking space has been added. The rear garden is enclosed by perimeter fencing and is grassed with a small paved area near the home and a fenced and gated area that can enclose a paddling pool at the furthest Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 3 Brief description of the care home end of the garden. The home is one of two owned by the Registered Person that are located in the same road; the proximity of another nearby home allows for joint activities to be planned and take place. The home is for young people with disorders within the autistic spectrum and challenging behaviour. Information about the service, including the Statement of Purpose, Service Users Guide, current fees and CQC reports is made available to prospective service users, relatives and interested parties on request from the home. 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: two star good 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 report reflects a key inspection based on the collation of information received since the last inspection on 17th May 2007 and a review of the homes Annual Quality Assurance Assessment [AQAA]. An unannounced site visit was conducted on Thursday 21st May 2009 between 9.15am and 4pm. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term service user to describe those living in care home settings. 17, Jerome Close is an established home that provides residential care to three people with Learning Disabilities with disorders in the Autistic spectrum and challenging behaviour range. There are currently no vacancies. The establishment is one of two homes owned by the same provider Jemini Response Ltd. Care Homes for Adults (18-65 years) Page 6 of 33 The site visit included looking around the premises, an examination of some care, medication, staffing, menus and general records. The visit also included meeting two of the service users, the Registered Person, staff on duty, a team leader from another home and the deputy Manager. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: 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 8 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 9 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 service users and their representatives would be given information about the home in order to make an informed choice about where to live. Ensuring this documentation is accessible and in a format that service users can understand will support this process. Evidence: There have been no new admissions to the home since the last inspection in May 2007 and there are currently no vacancies. Key standard 2 was not assessed on this occasion. An Independent Mental Capacity Advocate [IMCA] has been appointed by the Local Authority to undertake an assessment of one service user living in the home in reviewing their accommodation and other daily living needs. The homes Statement Of Purpose viewed showed this had been updated on the 7th May 2009 and was in narrative format. It identified the address of another home in the same road run by the organisation. The Service User Guide was undated, Care Homes for Adults (18-65 years) Page 10 of 33 Evidence: without text, containing symbols and drawings. Both these documents are held in the office. The home need to ensure these documents contain all the information they should, are accurate, dated, available and accessible to service users in a format they can understand. Care Homes for Adults (18-65 years) Page 11 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. Care planning processes are individualised and reflect changing needs. The system in place supports service users and staff. Evidence: The home has introduced new person centred planning documentation for service users to assist in identifying, monitoring and evaluating their daily living needs. One of these plans was examined in full and another service users partially. The structure and format was clear and easy to read in tracking the care identified. The file was divided into four sections. Some areas were blank or incomplete and some information required updating in certain sections such as risk assessments. It was identified to date and sign these plans to show when they had been compiled and record a review date. The named key-worker identified in a service users care records required changing as they had left the organisation. It is acknowledged that work is currently underway to fully complete these records. Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: The home maintains daily report sheets for each service users that were clear and easy to read. Personalised Flow Charts are also in place that provide staff with details of actions to be taken to meet service users care and support needs during the day. Information contained within the homes Annual Quality Assurance Assessment [AQAA] indicates care plans are developed with service users. All service users are described as non-verbal. The home recognises the need to provide information using different communication methods for example Widget signs as well as enhancing the understanding of service users communication and explore alternatives ways of giving out information. Care Homes for Adults (18-65 years) Page 13 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. Service users are supported to make good use of the community for activities and lead active lifestyles. Exploring ways to involve service users more in menu planning would assist in enhancing their choice, decision making and in the running of the home. Evidence: On the day of the inspection, two service users were initially at home. One service user had gone to their respective day centre. The plan for the other two service users involved a trip to the General Practitioners, a Picnic lunch and one-one activities. Activities and lifestyles were discussed with the Deputy Manager and 1-1 timetables viewed. Service users have individualised programmes and 1-1 staffing. They access a range and variety of different activities in the community on a regular basis. One person goes two mornings a week to Mencap. Two other service users attend different day centres between three and four times a week. Massage and Reflexology sessions Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: are arranged for all service users. Extra staff funding for one service user to support them in accessing more community activities has been applied for via the Local Authority and the home await a response in respect of this. The methods of communication used within the home is Makaton for one service user and Picture Enhanced Communication System [PECS] for two others. These methods were observed being used during the course of the inspection. The home supports service users in maintaining contact with their families. The meals served during the course of a week are recorded on the daily planner sheets that showed variety and a range of different meals. There is no overall menu in place, however it was said that two alternatives are offered at most meal times. It was reported that two service users would not say anything regarding their meals so menu planning would be difficult but staff know what food they like. One service user is more involved in the cooking and shopping. The main house shopping is done on-line via Tescos and delivered weekly. This was delivered on the day of the inspection and it was observed how a service user participated in putting the shopping away. Service users also go out to buy fresh food. Further consideration should be given to finding ways of involving service users in meal choices and in the planning and compilation of the menu. Care Homes for Adults (18-65 years) Page 15 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. Service users health and personal care is assessed and recognised. Medication procedures and practices require review and action so that service users are fully protected. Evidence: Each service user has a health action plan contained within their person centred file. Personal and health care needs are identified, known and good links maintained with other health and social care professionals in meeting service users needs. There was evidence that service users receive specialist advice and support as necessary in order to meet their individual and complex needs. The management of service users challenging behaviour is through Non Violent Crisis Prevention and Intervention techniques[CPI]. In the homes Annual Quality Assurance Assessment [AQAA] this indicates they work with service users to re-direct any negative behaviour before it escalates and that restraint is only used as a last resort in line with challenging behaviour guidelines. Further reference to Non Violent Crisis Prevention and Intervention techniques [CPI] is covered in the next section of this report. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: It was reported that no service users self administer and no controlled drugs are currently used. The home use a monitored dosage system that was introduced about four months ago. It was said that two staff are involved in medication whereby one person signs to confirm they have administered medication which is witnessed by another member of staff. A number of issues arose when the storage of medication was examined. This included finding a tube of cream in an unlabelled box. Found stored in two different unnamed envelopes were Tablets; one identified a tablet that had been spat out dated 16th April 2003. In the other unnamed envelope was a tablet that had been dropped on the floor dated 13th May 2009 as night medication. The Medication records were tracked to establish who this related to and it was found this person had instead been given a tablet from the same weeks supply that had been missed medication on 11th May 2009. This previous supply had not been returned to the Pharmacist. Found wrapped in aluminum foil was a tablet for a service user saying Thursday week 1. Large bottles of prescribed liquid medication were found stored laying down, the labels of some were torn and faded and evidence that liquid medication had dribbled down the side of these bottles onto the name labels. It was apparent that the medication storage space was insufficient as there was not enough room in the medication cabinet for larger items. Medication is located a busy and narrow kitchen; consideration should be given to re-locating this to ensure medication can managed in a controlled and quieter setting. The home does not maintain their own record of medication returned to the Pharmacy. The deputy Manager acknowledged medication was not up to scratch. By the end of the inspection, the home had taken action to address medication issues that had arisen. A requirement will be made for the home to make arrangements and take action to ensure the recording, handling, safekeeping, administration and disposal of medicines into the home is maintained and followed through. Updating staffs training in medicine management should be considered. Also considered important is to have a system in place to monitor medication practices. Care Homes for Adults (18-65 years) Page 17 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. There are good systems in place to protect service users from harm and abuse. Evidence: In the homes Annual Quality Assurance Assessment [AQAA] it identifies that service users cannot verbally complain but they have key-workers who act on their behalf, have regular reviews and social workers, family and day services are encouraged to highlight any issues. The AQAA identifies that no complaints have been received over the last twelve months and records examined at the inspection showed there has been none since 2006. The home indicates that they could do better by providing service users with the complaint form in Widget symbols. A recent safe guarding investigation has been concluded and the home follow appropriate reporting protocols. There are no current safeguarding matters. The home is good at reporting issues that may fall under Safeguarding to the Local Authority and the Commission. It was reported that all staff are trained in Safeguarding Vulnerable Adults with yearly refreshers provided. The deputy Manager of the home is the Safeguarding lead and trainer within the organisation and oversees all reporting. Policies and procedures are in place for Safeguarding, complaints and whistle-blowing. The management of service users monies was not examined on this occasion. In relation to the management of service users challenging behaviours, the home Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: follows Non Violent Crisis Prevention and Intervention techniques [CPI]. The organisation has its own CPI instructor. The home reports all Crisis Prevention Interventions [CPI] to the Local Authority in the event that they may fall under safeguarding. They record all instances of CPI in a central restraint book; the necessary pages are photocopied and sent to the Local Authority as and when interventions happen. Examination of this book showed the record primarily related to incidents involving the same service user. It was recommended the time and duration of all Crisis Prevention Interventions [CPI] be recorded and to consider confidentiality as the record kept contains sensitive information about each service user. The number of interventions in respect of a service user had reduced as a new way of managing this persons challenging behaviour has been introduced. Care Homes for Adults (18-65 years) Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the home are taking place and these are ongoing to enable service users to live in a comfortable and well maintained home. Regular monitoring of health and safety practices and procedures will assist in minimising risks to service users. Reviewing and agreeing the practices of locked doors within a multi-disciplinary framework will benefit service users in enhancing their dignity and rights. Evidence: A tour of the home and grounds took place to see the composition of the premises and the improvements that had taken place. It was identified in the homes Annual Quality Assurance Assessment [AQAA] that maintenance works can be difficult to achieve and there can be delays due to the challenging behaviours of service users; thus they wait for appropriate times to do. The home is investing in tough furniture. The home was free from odours and the level of cleanliness satisfactory. All staff have received training in infection control. New carpets in the two bedrooms upstairs, the stairway and new laminated flooring in the lounge, dining, conservatory area has been fitted. The office is located upstairs and this has been rearranged to allow more work space. An old store cupboard next to one of the upstairs bedrooms is being converted into a single toilet, it was unfinished Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: and not yet in use. The upstairs bathroom/toilet had been modernised. There was no inner lock on this door or toilet paper. It was explained that all service users have one to one staffing and there are issues with objects being thrown. This bathroom is kept locked from the outside when not in use. The two service user bedrooms upstairs were satisfactory in appearance and personalised. There is one ground floor bedroom. This has laminated flooring and new tough wearing furniture such as a wardrobe and chest of drawers that is kept locked. It was seen at one point in the inspection how the service user in this room returned to their room after obtaining the keys from a staff member in order to unlock this furniture. In this room is a door leading out into the garden that is kept locked, it was said the keys are held on staff at all times, it was reported as being a fire exit although there are other exits close by due to its location on the ground floor. A window handle was seen to be broken off and both small windows were locked but it was said they could be opened a little bit. There was no door handle on this persons main bedroom door and it was said this would be replaced during the week. A replacement kitchen is to be fitted. It was discussed that as there is no risk assessment in place for when these works commence the home consult with allied agencies before works start to ensure that hazards and risks to service users are kept to a minimum. The door to the kitchen is kept locked when not in use and when open, a strap is tied to the stair banisters. The lounge door was also seen to be wedged open and had a key lock that it was said was rarely used. The risks in the event of fire were raised about these practices. Following a discussion about fire risks, it was recommended that self closing doors may be a better alternative and it is understood this will be pursued for internal doors around the home. The single toilet on the ground floor is also kept locked. It was identified for the home to consider under the principles of the Mental Capacity Act 2005 and the Deprivation Of Liberty Safeguarding [DOLS] the current practices of locking doors around the home and possible implications within a multidisciplinary framework that included care Managers. It was explained how these measures were in place because of service users challenging behaviours and health/safety risks. This is acknowledged, however as there is one to one staffing the risk of harm should be reviewed and action taken to ensure service users privacy, dignity, independence, equality and health and welfare is not compromised. A discussion was also had about arranging training for staff in the Deprivation Of Liberty Safeguarding [DOLS]. Stepping out of the kitchen is a side access that leads into the garden. Many hazards Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: were seen including COSHH stored in an unsecured shed, an extension reel and wires exposed to the elements. Surrounding this area were several objects, large planks of wood that prevented a sliding gate from shutting in cornering off access into the main garden. In the main garden was a disused washing machine, planks of wood, paint and wheelbarrows. Near a paddling pool was an old trailing plug and lead. Outside a service users ground floor bedroom door was a reel of wire. These practices and hazards were raised with senior staff whilst the tour of the premises took place in order for the home to take immediate action in removing the hazards. During the course of the inspection, the home took action and work was underway in removing the hazards from the grounds. Care Homes for Adults (18-65 years) Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from having sufficient staff who receive regular training and are protected by the homes recruitment policies and practices. Evidence: Recruitment records viewed in relation to two staff were satisfactory. There was evidence of application forms, references, full Criminal Record Bureau [CRB] checks and information relating to the Common Induction standards. Staffing levels comprise of one to one staffing for each service user throughout the day and one waking night staff. Extra funding has been applied for one service user to enable two to one staffing so this person can access more community activities. It was reported that staff supervision sessions take place monthly unless there are new staff and this would be fortnightly. It was said that all staff are currently doing their National Vocational Qualification [NVQ] in care at level 3. The staff training matrix was discussed with the Deputy Manager. It was confirmed that all staff are up to date with mandatory training and new training records have been introduced. Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: An office person has been employed to assist the homes within the organisation with their administration duties to enable closer monitoring of staffs training details, filing and other administrative work. In respect of staff meetings, one for the night staff was held on 4th March 2009, and one for the day staff on 20th January 2009. Prior to this a meeting was held on 26th November 2008. The management of the home should monitor and review these practices to ensure they are taking place regularly. Care Homes for Adults (18-65 years) Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recent changes and movement between senior staff should stabilize so that service users derive benefit from having a permanent management team; once clear lines of management accountability are established. Expanding upon Quality Assurance will help protect service users and assist the organisation in the development and monitoring of its service. Evidence: On arrival at the home, the management of the home was initially unclear. A Team leader arrived from another home within the organisation to assist with the inspection. It transpired the deputy who had filled out the Annual Quality Assurance Assessment [AQAA] had transferred to be the deputy Manager of a different home within the organisation. Both this person and the Registered Manager of the other home were on leave. After a short while, a deputy Manager who was initially reported as being the deputy of a home in the same road arrived and confirmed he was now the deputy for 17, Jerome Close. He explained how he had swapped with the other deputy in the last 3 Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: weeks. He foresaw being the deputy at this home for the long term. It is considered important to maintain continuity and stability in the day to day running and management of the home. In respect of the Registered Person; it was reported that he visited the home about once a week, it was evidenced this person is not identified on the staffing rota. During the course of the inspection the Registered Person arrived and explained he had been registered since 2002; how he goes between the homes in the organisation and that he was not in day to day charge of this home. It was identified that there was a general Manager who would oversee both the homes. The Registered Person confirmed this home and another in the same road ran pretty much together and requested whether there could be one Registered Manager for both homes. It was discussed that an application be submitted to the Commission in respect of this proposal so that the case can be considered. During the course of the inspection the depth in which the Annual Quality Assurance Assessment [AQAA] had been completed was discussed with the Deputy Manager as examination of it showed there were gaps in relation to answering against all the key standards. Quality Assurance processes were discussed including examination of some records. It was identified that a monthly audit is done in respect of the premises, household, documents and daily audits undertaken for the kitchen and food safety. The deputy is planning to introduce weekly audits. The monthly Quality Assurance assessment viewed dated 1st May 2009 needed the name of the home changed to show it related to 17, Jerome Close and not the other home in the same road. Also necessary was to record any action taken if matters arising needed addressing as this was not evidenced as being followed through. Yearly Quality Assurance questionnaires were done in March 2009, that were sent to Professionals, day services and parents. There was no evidence to show when returned how they have been evaluated. Obtaining feedback from service users via the same process is not pursued. A requirement to extend upon Quality Assurance systems in obtaining feedback from all parties and evaluating information received will be made. Following examination of what was thought to be a fire risk assessment, it was brought to the Deputys attention that the home did not have a full fire risk assessment for the building in place as information seen related to brief evacuation Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: details for each service user. A requirement to consult with the fire department about this will be made under the environment section of this report. The home have identified in their Annual Quality Assurance Assessment [AQAA] their undertaking of health and safety checks. A record of accidents/incidents is kept and these were found to be in order. Care Homes for Adults (18-65 years) Page 27 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 28 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 1 6 6 [a] The Registered Person must ensure the Statement Of Purpose and Service User Guide is accurate, up to date, containing all the information they should. This documentation should be easily accessible and in a format that service users can understand. Service users need to be fully informed about the services in the home in a style they understand. 17/07/2009 2 20 13 13 [2] The Registered Person must ensure Medicines are handled in accordance with current legislation and consult with the dispensing Pharmacist. They must make arrangements for the recording, handling, safekeeping, safe 17/07/2009 Care Homes for Adults (18-65 years) Page 29 of 33 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 administration and disposals of medicines received into the home. Service users must be protected by the homes medicines policies and procedures. 3 24 16 16 [2] 24/07/2009 The Registered Person must review service users access around the environment and facilities within a multi disciplinary framework and maintain a record of agreed action. That service users dignity, choice and freedom of movement is protected. 4 24 13 13 [4] & 23 [2] [b] [o] 21/07/2009 The Registered person must audit and compile a written action plan to ensure the health, safety and dignity of service users in relation to the environment is maintained at all times including making sure the home is free from hazards and that maintenance issues receive prompt attention. The Registered Person must maintain service users and staffs safety and welfare at all times. Care Homes for Adults (18-65 years) Page 30 of 33 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 5 24 13 13 [4] [c] The Registered 17/07/2009 Person must consult with the Fire department about locked doors and doors that are held open that may be fire doors/exits. The home must consult with the Fire department about a fire risk assessment for the building and carry out any action identified. The Registered Person must ensure service users and staffs health, safety and welfare is protected from fire. 6 37 39 39 [a] 22/06/2009 The Registered Person must make an application to the Commission to appoint a Manager to obtain registration with the knowledge, skills, qualifications and experience to achieve registration. The Registered Person must ensure the home has a registered Manager in day to day charge so that service users and staff have clear lines of management accountability. 7 39 24 24 [1] [5] The Registered Person must 28/08/2009 Care Homes for Adults (18-65 years) Page 31 of 33 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 expand upon Quality Assurance methods by obtaining feedback from service users and evaluate/action as necessary all feedback received. Effective quality assurance monitoring systems will protect service users and support the running of the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 17 23 The Registered Person should explore ways of involving service users more in meal choices and menu planning. The Registered Person should ensure the time and duration of all Crisis Prevention Intervention techniques [CPI] is fully documented. Care Homes for Adults (18-65 years) Page 32 of 33 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 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!