Care Home: 2 Princess Close

Similar services:

• 2 Perhaver Park
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• 32 Beaumont Way

What the care home does well 2 Princess Close provides individuals with a comfortable and homely environment. It has been home for some of the individuals for a number of years. Individual`s health and personal care needs are responded to well with good liaison with professionals. What has improved since the last inspection? Individuals have benefited from more guidance being included in the care plan in relation to as and when required medication ensuring a consistent approach. Larger medication storage has been provided ensuring all medication is held securely. The record of complaints was accessible and could easily be found by staff. Individuals have benefited from improved access to the front of the building. There is now a ramp. Staff have benefited from a review of the training attended and an action plan being develped to address any shortfalls. All staff have completed training in supporting people who have mental health needs and safeguarding. What the care home could do better: Individuals must be assured that there is a record of all prescribed medication. This must include a record of the dose where this is variable. It is recommended that where a district nurse administers medication that a record is maintained on the medication administration record. Where a member of staff has not attended statutory health and safety training it is strongly recommended that they work alongside competent staff until this has been completed. Key inspection report Care homes for older people Name: Address: 2 Princess Close 2 Princess Close Keynsham Bath & N E Somerset BS31 2NG     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: Paula Cordell     Date: 1 0 0 3 2 0 1 0 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 Older People Page 2 of 29 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 Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: 2 Princess Close 2 Princess Close Keynsham Bath & N E Somerset BS31 2NG 01179077222 01179699000 heather.hinton@brandontrust.org www.brandontrust.org The Brandon Trust Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 5 The registered person may provide the following category of service only: Care home ony - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home 2 Princess Close is a detached house, situated in a quiet cul-de-sac, in a residential area of Keynsham. The house has been extended to provide accommodation for five people with learning disabilities. There is one vacancy. On the ground floor there is a lounge, kitchen and dining room. Also on this floor are two bedrooms, a toilet, utility area, and a walk in shower. There is a stair lift to the first floor where there are three bedrooms, a large fourth room currently used as a staff sleep-in/meeting room and a small office space. There is also a bathroom with specialist bath and separate toilet. At the rear of the property there is a patio and small garden that can be accessed by Care Homes for Older People Page 4 of 29 Over 65 0 5 0 1 0 4 2 0 0 9 Brief description of the care home means of a ramp. The home is within easy access of local amenities that include a leisure centre, shops and a park. There are accessible transport routes to Bath and Bristol by both bus and train, and there are bus routes to other local areas. The Brandon Trust operates the home with the day-to-day management being cascaded to a registered manager. A review of the management of the home has recently been completed and a new manager with additional responsibilities has been appointed. The statement of purpose clearly details the staffing levels as two staff working during the day with one member of staff providing sleep in cover at nights. Charges range from 682.60 to 931.91 pounds per week. Care Homes for Older People Page 5 of 29 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit as part of a key inspection process. The purpose of the visit was to review the requirements and recommendations from the last visit in April 2009. In addition to reviewing the quality of the care provided to the people living at 2 Princess Close. There have no complaints received by the Care Quality Commission in the last twelve months. There have been no additional visits since April 2009. The visit was planned using the information received prior to this and the last visit. This included regulation 37 notifications of incidents that effect the well being of the individuals, the annual quality assurance assessment completed by the provider and correspondence. During the visit an opportunity was taken to review a number of records that are Care Homes for Older People Page 6 of 29 required in accordance with the Care Home Regulations, including care documentation. A tour of the home was conducted which allowed for discussions with both the staff and the people living in the home. There were three staff on duty during the visit, the senior team leader and the manager The visit was conducted over five hours. Care Homes for Older People Page 7 of 29 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 Older People Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. Potential people moving to the home have adequate information to enable them to make an informed decision. Individuals can be confident that their assessed care needs are kept under review. Evidence: The home has a statement of purpose and a service user guide. These documents were not viewed on this occasion. The manager said she was planning to review the documentation. There have been no new admissions to the home and there is one vacancy. The manager explained that there have been some discussions on the future of the home and the organisation is considering changing the service from residential to a supporting people model. Care Homes for Older People Page 10 of 29 Evidence: The four individuals living in the home have lived there for many years. There is one vacancy. As the individuals have lived in the home for many years the initial assessment information had been archived. Care files contained a copy of the placing authoritys assessment and care plan and it was evident that this had informed the care planning processes within the home. Information about the assessment process was clearly described in the statement of purpose as seen at the last visit. It was evident from previous visits that individuals would be offered a trail period prior to making a decision to move to the home. From reading care records it was evident that the needs of the individuals were being continually reviewed. Where needs had changed considerably in respect of the care of one individual, the manager and the staff were liaising with the continuing health care team and the individuals social worker to ensure the home continues to be suitable. As part of the discussions the manager was requesting additional funding and equipment so that the persons needs could continue to be met at 2 Princess Close. Care Homes for Older People Page 11 of 29 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Individuals health and personal care needs were being met. Good systems were in place to ensure individuals are protected in relation to the administration of medication. Evidence: Two care plans were looked at during the visit to determine the processes the home goes through to support the people living at 2 Princess Close. Care files seen contained valuable information about the person to enable the staff team to support them. Documentation was being reviewed on a six monthly basis or as and when needs change. Monthly key worker reports are completed detailing any health appointments, any changes to the persons well being and social activities they had completed. The manager was in the process of reviewing and improving the care planning format. This had been completed for two of the individuals. Support plans had been developed for all activities of daily living including support with money and relationships. The Care Homes for Older People Page 12 of 29 Evidence: information was person centred and clearly described how the staff were to support the individuals. Care plans were in place to describe how to support the individuals when angry or upset. There was clear protocols for the use of as and when required medication and it was evident that this had been discussed with the prescribing doctor. Compliance had been demonstrated to a previous requirement. Good records were maintained in respect of health care. All individuals were registered with a local GP surgery. In addition individuals are supported to attend regular check ups with an optician, dentist and a chiropodist. Records were maintained of the visits. Individuals are referred as required to the Community Learning Disability Team. Professionals involved in the care of the individuals include Speech and Language Therapists, Consultant Psychiatrist, Psychologists, Occupational Therapists and Physiotherapists. One individual was being reassessed in relation to their changing health care needs and it was evident that the manager was ensuring appropriate equipment was in situ and seeking guidance and support from the palliative care team. Risk assessments were in place covering a wide range of activities in the home and the local community, including falls. These had been kept under review and updated where needs had changed. Individuals have a Passport to Hospital a record that can be extracted from the care file to give to staff in the hospital giving them clear information on how the person likes to be supported, medical history and contact details. This is good practice and assists a smooth transition from one care setting to another. The staff in the home were keeping the Care Quality Commission informed of incidents that affect the well being of the individuals. Records were maintained of accidents. The medication system was reviewed during this visit. There were records of medication entering, the administration and the disposal. Generally the records were clear including how the person likes to be supported and confirmation what over the counter remedies could be offered. It was noted that one persons pain relief was conflicting in respect of the Medication and Administration Record and the details on the box. Whilst there was a stock record it was not clear from the Medication Administration Record how may tablets were given. Whilst the person was not at significant risk clearer records must be maintained. Care Homes for Older People Page 13 of 29 Evidence: It was noted that one person was receiving an injection from an external health professional. There was no record on the Medication Administration Record detailing the medication. The manager said that the professional maintains their own record of administration however it would be good practice for them to sign the Medication Administration Record. There was a record of when the district nurse visited and what treatment was given in the health records of the person. Since the last visit a new medication cupboard has been purchased demonstrating compliance to a previous requirement. Staff competence and training was reviewed at the last visit on the administration of medication. This was not followed up during this visit. Staff interactions were observed during the visit. It was evident that good relationships had been fostered with the people living at 2 Princess Close. Staff were knowledgeable about the care needs of the individuals and spoke in a positive and professional manner about life at 2 Princess Close. Care Homes for Older People Page 14 of 29 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. Whilst there has been some improvement in activities this continues to be ongoing. Individuals are encouraged to maintain contact with friends and family. Individuals have a healthy diet available to them. Evidence: There has been some improvement in the area of activities provided for individuals, although this remains ongoing. From talking with staff and reading records it was evident that more activities were being organised including trips to the cinema, theatre and out for meals, a fortnightly relaxation and massage session and monthly entertainment being brought into the home. The staff said that it has been difficult to organise some activities due to the changing health needs of the people living in the home and sometimes the individuals reluctance to want to go out either due to the weather or their preference to stay at home. Whilst there was some evidence in daily records that individuals had refused to participate in activities, staff agreed that this did not capture all the times individuals were being offered to go out and their reluctance. The manager said she was in the process of organising a person to come to the home on a weekly basis to provide arts and crafts for the individuals living in the home and Care Homes for Older People Page 15 of 29 Evidence: was pursuing additional funding for one person to enable more one to one support due to their changing health care needs. Staff described a change of emphasis on the general running of the home giving them more autonomy to plan and make decisions on how time was spent with the individuals including accessing the community. Previously staff said the culture was about household chores being completed and less on getting people out and about. During the visit three of the individuals were at home and one was out with a day care worker. Two of the individuals were sat in the lounge area with staff and one was resting in their bedroom. Individuals were being offered a choice of what to do which consisted of either listening to music or watching television. Staff said that individuals are actively being encouraged to participate in life at 2 Princess Close including assisting with making of drinks and household chores where they are able and shopping. However, a member of staff on the day of the visit completed a household shop without the presence of the individuals living in the home. Staff said that some of the individuals are reluctant to assist with the weekly shop. Three of the individuals use non-verbal communication to vocalise so it was difficult to determine their opinions on what it was like to live at 2 Princess Close. However, staff were observed communicating with individuals and offering them choices in respect of what they wanted to do and drinks. One of the individuals was more expressive than has been noted on previous visits and another appeared more relaxed. Staff said that they organise game evenings. Consideration could be taken to organised more activities in house including arts and crafts and music evenings if this is what the individuals enjoy. Individuals were supported to maintain contact with friends and family as evidenced in care records. Menu planning was not viewed on this occasion but was assessed as meeting the National Minimum Standards and the needs of the individuals at the last visit. Care Homes for Older People Page 16 of 29 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. Good systems are in place to protect individuals and for concerns to be raised. Staff have a good knowledge of the individuals and can recognise when they are unhappy and would take appropriate steps to alleviate the concerns. Evidence: There is an organisational complaints policy that indicates the timescales to respond to a complaint. This was available in an accessible format. The individuals have varying abilities to communicate. It was difficult to determine whether the individuals knew how to complain. However staff gave reassurances that where an individual uses non-verbal communication this is monitored and staff would act appropriately if individuals were distressed or unhappy. The home or the Care Quality Commission has not received any complaints since the last visit. Policies relating to safeguarding and reporting allegations of abuse were in place. Staff had received training in safeguarding. Staff at the last visit were able to demonstrate how they raise concerns both with the manager and the policies that are in place to guide them in relation to safeguarding and whistle blowing. Care Homes for Older People Page 17 of 29 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, 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. 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. 2 Princess Close provides a safe, clean and homely place for the people to live. Evidence: The home is in keeping with the local neighbourhood and is near to local shops and amenities. There are bus routes available to neighbouring Bath and Bristol. The home provides a suitably furnished environment that meets the needs of the individuals however this will need to be kept under review, as the individuals get older. Great attention has been taken to personalise the home. All areas of the home were clean, hygienic and odour free. However, there was staining on the carpets of three of the bedrooms. Discussion with staff indicated that the carpets are routinely cleaned but the stains were difficult to remove. The manager stated that there are plans to replace the carpet in one of the bedrooms. It was agreed that the three carpets would be replaced within three months, with the first carpet being replaced within four weeks. Suitable aids and adaptations were available to assist the individuals with their personal care including a walk in shower (wet room), a high low bath with a built in hoist and a stair lift. Evidence was provided that the equipment was routinely checked Care Homes for Older People Page 18 of 29 Evidence: and maintained. Occupational therapists had been involved in the assessment of equipment as evidenced in care records. The home has responded to a requirement to risk assess the access arrangements to the front of the building. A ramp has now been installed to assist with access arrangements. However, it was noted from conversations with staff and the monthly visit record completed by the provider that the ramp has a steep incline and further works are required to ensure that it is safe to use. Each person has a single bedroom which has been decorated and furnished to reflect the taste of the individual. There are two ground floor bedrooms. Individuals have access to a communal lounge and dining area. This is open plan. Individuals were observed making full use of the communal areas and the bedrooms. Discussion with staff highlighted that the lounge space can be busy when all the individuals are at home. Staff said this can limit individuals who want a quieter area to sit and relax or listen to music if the others are watching the television. The kitchen was well organised. Policies and procedures were in place to guide staff on food hygiene principles ensuring the safety of the people living in the home. An environmental health officer visited the home in December 2009. There were two recommendations relating to an area behind the fridge requiring cleaning and ensuring there was hot water to the hand basin in the kitchen. Both have been remedied. Individuals have access to a small enclosed garden to the rear of the property, with established planting and a seating area for the individuals. The front of the property provides parking for three cars. Records are maintained of ongoing maintenance and routine cleaning. Records seen demonstrated that repairs were being responded to promptly. The home has a separate laundry facility which was well organised and met the needs of the people living at 2 Princess Close. Care Homes for Older People Page 19 of 29 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient and competent staff are supporting the people living in the home. It is evident that the review on training has improved the quality of the care and this continues to be ongoing. Evidence: 2 Princess Close is staffed with a minimum of two staff during the day and one member of staff providing sleep in cover during the night in the case of an emergency. This was confirmed in conversation with staff and the manager and further evidenced in the staff duty rota. The manager said that additional staff are employed to assist with social activities as and when required. The manager said that they were in the process of requesting some additional staff hours to support a person due to their changing needs and health deterioration. Staff confirmed that the staffing levels were adequate to meet the needs of the individuals. However, from reading care records and talking with staff it was evident that the individuals living at 2 Princess Close require one to one when out in the community due to mobility issues which means that it is rare for everyone to go out together. Staff said that two of the individuals are reluctant to go out and prefer to spend time in the house. Apparently this was more noticeable during the winter. Recruitment information is held at Brandon Trust Human Resource Department and Care Homes for Older People Page 20 of 29 Evidence: will be subject to an inspection to ensure that an appropriate and thorough recruitment process has taken place prior to a new member of staff taking up a position within the home. There have been no newly recruited staff to the home, although two staff have transferred from another Brandon Trust Home which recently closed. The home has an organisational induction, which includes elements of health and safety training, aims and values of the service and safeguarding. Newly appointed staff complete the Learning Disability Qualification as part of their induction. This was not explored on this occasion as there have been no newly appointed staff. Five out of the eight staff have an National Vocational Qualification in care (3 staff have a level 2 and 2 staff at level 3). One member of staff is in the process of completing a NVQ at level 3. The service has exceeded the governments target to ensure that at least 50 of the workforce have a NVQ in care. Since the last visit improvements have been noted in the information relating to the recording and the attendance of training. Staff training has been reviewed to ensure that staff have training in mental health, dementia, safeguarding and supporting individuals that challenge. Certificate were seen confirming attendance. The manager has reviewed all staff training to ensure that all statutory health and safety training has been completed and developed a matrix stating when training was attended and when updates were required. One member of staff had yet to complete first aid, manual handling and food hygiene. It is evident that this has been out of date since 2008. The manager and the senior carer were exploring how this could be rectified and it was evident that this was being discussed during team meetings and staff supervisions. However, it was strongly recommended that the member of staff works alongside trained staff and is not left in charge of the home until the training is complete. The senior carer said they were waiting for the new training prospectus to enable them to enroll staff on further training. However, the organisation has purchased some courses that staff can complete using information technology. This includes food hygiene and mental capacity training. Training was also being given to staff to increase their confidence in the use of the computer. This will be followed up at the next visit as this was in the early stages of implementation. Staff spoken with during this visit described a cohesive team with good communication and support being in place. Staff said that the new manager has empowered them to make more decisions and the atmosphere is more open. One member of staff said I Care Homes for Older People Page 21 of 29 Evidence: feel I can organise an activity without having to seek permission and the individuals in the home are doing far more than before. Care Homes for Older People Page 22 of 29 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. Whilst it was evident that the home was being well managed there has been a long delay in an application being submitted for the manager to be registered with the Care Quality Commission. Individuals benefit from 2 Princess Close being a safe place to live. Evidence: The manager has been in post since April 2009. She has many years experience as a manager working in other services managed by Brandon Trust. Brandon Trust reviewed their management structure for all their care services prior to April 2009 at all levels. New posts were developed and these were called locality managers. Locality managers have responsibility for a number of services including care homes registered with the Care Quality Commission and supported living services which do not necessary come in to the remit of the Commission. Originally the manager was responsible for two care homes and two supported living services. One Care Homes for Older People Page 23 of 29 Evidence: of the care homes has since been de-registered due to closure. As yet the Care Quality Commission has not received an application to enable the manager to become the registered manager. A letter was sent to both the unregistered manager and the registered provider in January 2010 as the delay in submitting an application is unacceptable and raises concerns about the fitness of both the provider and the applicant. Staff in the home stated the manager visits at least three times per week with the day to day management of the home being cascaded to a senior carer. It is evident that the senior carer had many years experience supporting individuals with a learning disability and is a registered nurse for people with learning disabilities. She has completed the Registered Managers Award. Staff were aware of the lines of accountability. The manager stated that the organisation continues to complete monthly visits in respect of regulation 26. This was being completed by other managers on a three monthly cycle. Reports were seen of the monthly visits. These clearly measured the quality of the care provided and identified areas for improvement. During the last inspection it was noted that the manager had identified areas for improvement including making information more accessible. This included developing a complaints board and an activity folder. These still remain outstanding although were still being discussed as a team. The manager said it has been a busy year in relation to managing the other services and the focus in the home has been to ensure that the changing needs of the individuals continue to be met. Individual finances were not looked at during this visit. The systems as noted at the last visit were satisfactory to protect the individuals living in the home. The manager stated that any expenditure over £50 has to be agreed. The home had recently been audited by the Brandon Finance department. The manager said there was one recommendation to ensure two staff sign for all expenditure and where possible the individual. Brandon Trust has financial policies in place. Staff said the communication between staff members was good with daily hand overs, monthly staff meetings and supervisions. The senior carer was responsible for completing supervisions for the staff working in the home. She was aware that this had lapsed but had developed a pro-forma for this to be completed at regular intervals. This will be followed up at the next visit. The fire log book provided evidence that individuals were being protected in the case Care Homes for Older People Page 24 of 29 Evidence: of a fire with staff participating in regular training and fire drills with routine checks on the equipment being completed. Risk assessments were viewed in relation to individuals and generic to the home. These were being periodically reviewed and updated. Policies and procedures were in place relating to health and safety. Data sheets in respect of COSSH were being maintained along with a risk assessment. Other areas that demonstrated that the health and safety was paramount was the routine checks on the aids and adaptations, the landlord gas certificate, electrical equipment testing and the routine checks on the environment. Staff complete routine checks on the water and food temperatures. These were satisfactory. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 30 18 Ensure staff attend statutory 01/05/2009 training including first aid, manual handling, food hygiene. Ensuring staff are competent to support the individuals. Care Homes for Older People Page 26 of 29 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 9 13 Ensure that medication 22/03/2010 records correspond with the amount on the box. For staff to clearly record the amount of medication given on the MAR sheet where this is variable. Better protecting the individual. 2 19 24 For the carpets in three of the bedrooms to be cleaned or replaced. Ensuring the home is kept in a state of good order. 10/06/2010 3 30 18 Ensure all staff complete statutory health and safety training including first aid, manual handling, fire and food hygiene. Ensuring individuals are supported by competent staff. 12/05/2010 Care Homes for Older People Page 27 of 29 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 9 Ensure that all medication prescribed is recorded on the Medication Administration Record. Where this is given by a health professional external to the home good practice would be that they would sign the homes record. Where staff do not have training in first aid, food hygiene, manual handling or fire they work alongside a competent member of staff until they have completed it. 2 30 Care Homes for Older People Page 28 of 29 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. 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