Care Home: 20 Boadicea Close.

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What the care home does well People who use the service have care plans in place to ensure their assessed needs are being met. Residents are supported by staff to make decisions about their daily lives. Staff promote contact between residents and their family and friends, and there are no restrictions to visitors. A balanced diet is provided to residents living at the home. Physical and health care is offered in such a way as to ensure residents` needs are met. Residents are protected by the home`s storage and administration of medication procedures. The privacy and dignity of people using the service is promoted by staff at the home. Residents have access to a satisfactory complaints system that enables them and their families to raise concerns. What has improved since the last inspection? Each resident has a list of their weekly activities in their care plans and a copy is kept in their bedrooms, so staff and residents know what activities they are doing each day, and what they need to have ready. The home now has it`s own transport that will allow residents to access external activities outside the care home. Residents had their first annual holiday in May of this year that provided them with the opportunity and experience of being away from the care home. Monthly residents meetings are being recorded to evidence that residents have been part of the decision making in the home. The home has a complaints procedure that is available to anyone who may wish to use it. It is clear about how to make a complaint and what will happen when they have complained. The necessary recruitment documents are kept in the care home that enables the manager to satisfy himself of the fitness of the staff to ensure residents safety. What the care home could do better: The identified risk assessments must be signed and dated and risk assessments must be in place for the use of bed rails. This will ensure the health and safety of residents is maintained. All staff working at the care home must receive up to date training in regard to Safeguarding Adults. This will ensure that residents are protected from abuse, and their rights are protected. The manager must submit an application to attend the local Safeguarding Team training in Safeguarding Adults. This will increase their knowledge and understanding of the procedures to be followed in the event of any abuse occurring at the care home. The badly stained carpets in the care home must either have a deep clean or be replaced. The heavily stained sink in the identified bedroom must be repaired or replaced. The loose air vent cover in the laundry room must be repaired. This will further enhance the general decor of the home for residents. Regulation 37 Notifications must be forwarded to the Care Quality Commission of all events that adversely affect any resident living at the home. Key inspection report Care homes for adults (18-65 years) Name: Address: 20 Boadicea Close 20 Boadicea Close Cippenham Slough Berkshire SL1 5UJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Joseph Croft     Date: 2 0 0 7 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: 20 Boadicea Close 20 Boadicea Close Cippenham Slough Berkshire SL1 5UJ 01753822496 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.pentahact.org.uk PentaHact Limited trading as Adepta Name of registered manager (if applicable) Mr Melvin John Coelho 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 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 20 Boadicea Close is a purpose built home for five female residents with a learning disability, some have associated physical disabilities. The home is located on a residential housing estate in Cippenham, Slough, it provides accommodation and twenty-four hour care. Boadicea Close can be accessed via Moor Furlong. Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 5 Brief description of the care home The home is operated by Adepta and owned by Windsor and Maidenhead Housing Association. It is a single storey building, which provides ground floor accommodation in two dwellings, linked by a central foyer. Two people live in one side and three in the other. The dwellings can operate independently or as one home. A range of specialist adaptations have been made to the home in order to meet the needs of residents with physical disabilities. The home is near to local shops and facilities and a few miles from the Town Centre, has its own transport, and residents are also able to use public transport or taxis to access the community. The fees are 98,725 pounds per annum, with residents contributing £69.90 per week to the costs. 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: The quality rating for this service is one Star. This means the people who use this service experience adequate quality outcomes. The Care Quality Commission (CQC) (us,we) took over the Commission for Social Care Inspection regulatory duties as of the 1st April 2009. This unannounced site visit to the service was undertaken on the 20th July 2009 using the Inspecting for Better Lives (IBL) process. This site visit was undertaken by Regulation Inspector Mr Joe Croft and took seven hours, commencing at 10:30 and concluding at 17:30. The registered manager was not present for the beginning of the site visit due to taking a resident to hospital. However, the manager returned at approximately 12 noon and assisted the Inspector throughout the rest of this site visit. The inspection process included a tour of the premises and the sampling of care plans, risk assessments, health records, menu, duty rota, staff recruitment files and the administration of medication records and storage of medication. The complaints procedure, Statement of Purpose and Safeguarding Policies were also viewed. Care Homes for Adults (18-65 years) Page 6 of 33 Discussions took place with the manager, deputy manager and two members of the care staff team. Due to the complex levels of understanding and the communication difficulties, discussions took place with only one resident. They told us that they like their bedroom because they have their own belongings and they choose what they want to do every day. The manager returned the Annual Quality Assurance Assessment when we asked for it. Information provided in this document has been used as a source of evidence in this report. Surveys were received from four parents, however, two parents had completed the wrong survey, they were provided with surveys for Social and Health Care Professionals to complete, therefore, only some of the information provided in these surveys has been used as a source of evidence in this report. The manager told us that residents contribute 69 pounds per week to the costs of their care. The Inspector would like to thank the manager, staff and residents for their cooperation during this site visit. The last key inspection for this service was undertaken on the 23rd July 2007. 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. People who use the service are provided with information that will enable them to make a choice about living at the home. The needs of prospective residents would be fully assessed before they are offered a placement at the home. Evidence: The home has a Statement of Purpose that includes information in regard to the purpose of the home, aims, objectives, service user group catered for, a summary of the complaints procedure and a statement that several of the staff team have NVQ level 2 in support. This document did not include the qualifications of the registered provider or the relevant up to date qualifications or experience of the registered manager or staff. One parent survey informed that Our daughter is looked after well by her carers, but we have no idea of their qualifications. The Statement of Purpose should include the relevant experience and qualifications of the registered provider, the full up to date qualifications and experience of the manager, and further information in regard to the experience and training of staff employed at the care home. Care Homes for Adults (18-65 years) Page 10 of 33 Evidence: There has been a change of manager since the last key inspection of July 2007. The new manager told us that he registered with the Commission in May 2009. A requirement was made at that time that a Service User Guide must be produced for the home. However, evidence was seen that the manager is currently producing the Service User Guide. The manager reassured us that this would be completed by the end of the week of this site visit and a copy would be forwarded to us. We have since received confirmation during a telephone conversation with the manager that this document has now been completed. We were told that a copy of this document is to be forwarded to us. The manager told us that there have not been any new admissions to the home since 2003. The manager stated that the home would follow the organisations Admissions Policy that was last reviewed in November 2007. An assessment of need would be obtained from the placing authority and the manager would visit the prospective resident at their current placement to undertake an assessment to ensure the home could meet their needs. This would include assessing the personal, medical and health care needs, mobility, the environment and choices. Prospective residents and their relatives would be encouraged to visit the home to meet the other residents and staff, and to have a meal. The manager told us that they would only admit residents whose assessed needs could be met at the home. The Annual Quality Assurance Assessment (AQAA) informs that the home provides a service based on individual assessments, these are carried out by a multi-disciplinary team. The assessment process takes into consideration the total needs of the person, ie; social, emotional, physical, mental, financial and psychological needs. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have care plans and risk assessments in place that ensure their assessed needs are being met, however, further information is required to ensure risks to the health and safety of residents is appropriately maintained. Evidence: Two care plans were viewed during the site visit. Neither of these care plans included a personal information sheet for each resident, and these were not in the care file maintained in the office. However, the manager did locate these. They had been placed in the health care record file by mistake. This has been further covered under the Conduct and Management part of this report. Both care plans included information in regard to the personal and health care needs, medication, social skills, behaviour, communication, finance, and cultural and spiritual needs. One care plan had been signed and dated as the 15/06/09, and an annual review had been held on the 2/06/09. The other care plan did not have a date on it, but this was rectified during the site visit. Evidence was seen that this care plan had Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: also had a recent annual review undertaken. Both care plans included information in regard to the way residents prefer to be supported when staff are attending to their individual assessed needs. Each bedroom visited had a Person Centred Plan that provided information in regard to residents communication needs, and specified their likes and dislikes. Care plans also included a list of the weekly activities. The manager told us that they have recently commenced using this care plan format at the home, and that they are to be reviewed on a monthly basis. Daily notes were being maintained, including night time records. These records related to the assessed needs as recorded in the care plans. During discussions, staff told us that residents make choices each day. They told us that residents have communication difficulties, but they can communicate with them through their body language, facial expressions and moods. Staff always offer alternatives to residents such as clothing, meals and activities. One resident told us that she makes choices every day. She chooses what activities she wants to join in with, and which ones she does not want to partake in. Recently she decided to spend time with her mother as opposed to going on holiday with the other residents and staff. Surveys received from parents informed that the care service usually support residents to live the life they choose. Each of the two care files viewed had risk assessments that included risks in regard to house hold activities, going into the community, moving and handling, use of a wheelchair and other identified risks pertaining to the individual. The risk assessments had been recently reviewed, however, one identified residents risk assessments in regard to medication, use of wheelchair, and eating and drinking, had not been signed or dated by the assessor. It was noted that bed rails are used, however, there were no risk assessments in place for these. Risk assessments for the use of bedrails must be produced to ensure the health and safety is maintained at all times for residents who use these. A requirement has been made in regard to these. The AQAA informs that all residents are involved in the reviewing of their care plans. Annual reviews are undertaken with involvement of key people. They assess individual needs daily as health issues may arise at any time. Residents are not restricted on choice and appropriate risk assessments are in place to meet their needs. 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. People who use the service are able to make choices about their lifestyle with staff support. Staff promote contact with family and friends and there are no restrictions to visitors. A balanced diet is provided to residents living at the home. Evidence: All but one resident attend day centres throughout the week. One resident had chosen not to attend activities at the day centre. This same resident told us that she chooses what she wants to do during the week, and this often includes going shopping, looking at her many books and going on her swing in the garden. As stated earlier in this report, each resident has a list of their weekly activities in their care plans and their bedrooms. This has been produced since the last key inspection. Activities undertaken include listening to music, shopping, going out into the community, walks and meals out. During discussions staff told us that other Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: activities provided include ice skating, swimming and picnics. At weekends residents go to watch local football matches, and visit theatres and pubs. We were told that four residents had their first annual holiday earlier this year. They went to a holiday town in Dorset with staff. This was confirmed during discussions with one resident who told us they chose not go on this holiday. The manager told us that they will be arranging other holidays for residents. Staff told us that the home has its own transport that is used for external activities. During observations residents were being supported by staff to engage in an activity of their choosing. One was in the lounge watching television, one had her hair done with a member of staff. Two residents were in the kitchen listening to music whilst one member of staff was preparing the evening meal and talking to them. During discussions the manager and staff told us that there are no restrictions to visitors at the home. Family and friends are always welcome, and residents can see their visitors in the privacy of their bedrooms. Residents are encouraged to maintain contact with their families. One resident has an advocate who visits them on a regular basis. Surveys received from parents inform that the service helps their relative to keep in touch with them. Some residents are able to help with some chores at the care home. Residents had a list of their weekly routines in their bedrooms for bathing, linen change and other chores that are undertaken by staff. The routines of the house continue to follow the needs of the residents, are as flexible as possible and take into account residents choices. Monthly residents meetings are now being recorded to evidence that residents have been part of the decision making in the home. We were told that residents are able to go to church services when they request. One resident is able to attend the Temple and has religious artifacts in her bedroom. Surveys received from parents inform that staff usually respond to the different needs of individual residents. We were told that residents are able to receive telephone calls with staff support, and regular telephone contact is maintained with families. All mail is opened in front of residents and the contents are read with them. Meals are cooked by staff at the home. The menu was viewed during this site visit and included fresh meat, fish, vegetables and fruit. The manager was advised to specify the type of vegetables on the menu as opposed to putting fresh greens, and also to Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: include the type of desserts provided. Fresh fruit and fresh vegetables were observed in the kitchen during the site visit. During discussions staff told us that special dietary needs are catered for. Evidence was seen that staff had received training in regard to food handling and hygiene, and dates for refresher training have been booked for the 28th July 2009. One resident told us that they always like the meals provided at the home. The manager and staff told us that the menu is viewed by the dietitian who is very pleased with the food they provide to the residents, however, there was no evidence to support this. The manager should maintain written records to evidence that the menus have been viewed by the Dietitian. The AQAA informs that that they promote community involvement through visits to various locations, residents currently attend day service, restaurants, pubs, ice skating, leisure centres, shopping and aromatherapy sessions. Care Homes for Adults (18-65 years) Page 16 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. Physical and health care is offered in such a way as to ensure residents needs are met. People who use the service are protected by the homes storage and administration of medication procedures. The privacy and dignity of people using the service is promoted by staff. Evidence: The two care plans viewed provided information in regard to the level of support each resident required with their personal care needs. During discussions staff told us that the privacy and dignity of residents is promoted at all times. Staff always knock on bedroom doors before entering, call residents by their preferred names and attend to their personal care needs in the privacy of bathrooms and bedrooms. Staff also told us that they talk to the residents when they are attending to their personal care, and ensure that residents dignity is maintained at all times. We were told that residents choose the members of staff they prefer to help them with their personal care needs. Three parental surveys informed that the service usually responds to the diverse needs of residents, one infomed that they sometimes respond. The AQAA informs that the service has a diverse staff team who promote equality and Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: choice. Staff follow the organisations Equal Opportunities Policy , and they ensure that residents are not discriminated against. From discussions with the manager, staff, one resident, and the viewing of health care records, it was clear that residents have access to all health care professionals as required. Each of the two health care records viewed contained information of all health care appointments that included the GP, dentist, Psychiatrist, opticians, Speech Therapy and other specialist health care professionals. However, there was a lack of information in regard to follow up treatment for two residents who had dental extractions under anaesthetic, one on the 6th June 2008 and the other on the 21st November 2008. Neither the manager or staff could substantiate if follow up appointments were required, or if either resident had attended another appointment since. The manager did make further dental appointments on the day of the site visit. Although evidence of medical appointments are being maintained, some medical information had been filed in the wrong sections of the medical appointments maintained by the home. Further comments in regard to the maintenance of records are made under the Conduct and Management section of this report. Evidence was viewed in the two care plans viewed that residents had a recent review of their medication undertaken. Weights and bowel movements are also monitored and recorded. Staff at the home follow the organisations Medication Policy that was last reviewed in November 2007. During discussions staff and the manager told us that staff had received training in regard to medication. Evidence was viewed that all but one member of staff had received this training on the training matrix maintained at the care home. Staff had also received training in regard to Epilepsy. The home obtains medication from the local pharmacy in blister packs, and uses printed Medication Administration Record sheets (MARs) that record the quantity of medication received. The MARs sheets viewed on the day of the site visit were accurately maintained with no omissions in the recordings. The home maintains samples of staff signatures. Medication is kept secure in an appropriate locked metal medicine cabinet. Records of medication returned to the pharmacy were maintained. It was noted the pharmacist has not visited the care home since the new manager has been in post. The manager told us that he would request a visit from the pharmacist. It was noted that photographs of residents were not included in the MAR sheet folder. This was discussed with the manager and a recommendation has been made that photographic identification of each resident should be kept on the front of each MAR Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: chart that would help to ensure that medication is administered to the right resident. This would also be beneficial to new staff and agency staff working at the care home. We asked the manager if he undertakes regular audits of records that include the medication records. He told us that he did, however, there was no was nothing to evidence that this takes place. We were told that no current residents are self medicating or taking a controlled drug. The AQAA informs that the health care needs are well assessed and monitored in line with the homes policies and procedures. Medication reviews are assisted by the manager and staff. Personal support is undertaken in private. Residents have access to all NHS services. All staff are competent to administer medication following training. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to a satisfactory complaints system that enables residents and their families to raise concerns. Staff and the manager require the appropriate training to ensure people who the service are protected from harm. Evidence: The AQAA informs that the service has dealt with two complaints since the last key inspection. The home has dealt with four complaints. A record of these are kept in the homes Complaints book. The complaints were discussed with the registered manager during a telephone conversation on the 21st July 2009. One complaint that the home had dealt with should have been referred to the local Safeguarding Team, and is further commented on below. The home follows the organisations Complaints Policy and Procedure that was last reviewed in November 2007. A copy of this procedure has been produced using key words, pictures and symbols for the people who live at the care home, and each resident had a copy of this document in their bedrooms. The Complaints Procedure includes the timescale for responding to complainants and the contact details for the Care Quality Commission. One parent survey informed that they know how to make a complaint, one stated they did not. However, we noticed that a copy of the complaints procedure was displayed throughout the home on the day of the site visit, including on the noticeboard in the Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: entrance to the home. This was in compliance with a requirement that was made at the last key inspection. During discussions staff told us that they would inform the manager if they received a concern or complaint about the care home. The Care Quality Commission has not received any Safeguarding allegations in regard to the care home. The AQAA informs that no Safeguarding issues have been dealt with during the last twelve months. However, as stated earlier in this section, one complaint was investigated in April 2009 and concluded by the service. We asked the manager if this was referred under the local Safeguarding Team Procedures, we were told that it was not. A Regulation 37 Notification that should have been sent to the Care Quality Commission was not sent. A requirement has been made in regard to this under the Conduct and Management section of this report. The home has a copy of the recent local Safeguarding procedures of 2008 that is available for staff at the home to read. Staff follow the organisations Safeguarding Policy and Procedures that were last reviewed in November 2007. The viewing of the staff training matrix maintained by the manager evidenced that there is a short fall in regard to training for staff in this important area. The manager last attended this training on the 20th July 2006, two staff on the 9th June 2005 and one staff in May 2004. One waking night staff had received this on the 25th February 2009, the other had received this in August 2004. There was no evidence that four members of staff had attended any training in regard to Safeguarding Adults. The manager has since told us that he has arranged Safeguarding training for all staff in September 2009. A requirement has been made that all staff must receive up to date training in regard to Safeguarding Adults, and the manager must apply for a place to attend the local Safeguarding Team training. Two scenarios were discussed with the manager and two members of staff in regard to allegations of abuse. Staff stated that they would not hesitate to report bad practice to the manager. Staff at the home follow the organisations Whistle Blowing Policy that was last reviewed in November 2007. The manager told us that he and another home manager of the organisation have power of attorney for residents finances. Residents have their own building society account books. Some money is held at the home, and receipts are maintained for all purchases. Two members of staff sign all transactions. Two residents records were Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: checked during this site visit. Records balanced with the money held in the building society accounts. We asked the manager if he undertakes regular audits of the financial transactions, he told us that he did. However, there was no evidence to support this. The AQAA informs that the home takes complaints seriously. They ensure appropriate measures are put in place to protect residents from abuse. The complaints procedure is available in an accessible format. Care Homes for Adults (18-65 years) Page 22 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. People who use the service live in an approrpaitely maintained, clean and comfortable environment. Evidence: A tour of the premises was undertaken. The accommodation is a single storey home, that is divided into two living areas, one of two bedrooms and the other of three. There are two lounges, two kitchen/dining rooms, two bathrooms, four toilets, and a laundry room. The bedrooms continue to be highly personalised with all the necessary equipment to meet residents diverse physical needs. The decor of the bedrooms was bright and fresh. It was also noted that one resident had religious artifacts in their bedroom, and another resident ,who really enjoys looking at books, had bookcases in her bedroom that were full of books. This resident told us that she likes to look at the pictures in the books, and is pleased that she can have them in her bedroom. One identified bedroom had a badly stained sink that requires attention, and another bedroom had a heavily stained carpet. Requirements in regard to these have been made. Bathrooms had the appropriate aids required, including specialist baths. The toilets and bathrooms had liquid soap dispensers and paper towels. Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: The carpets in the communal areas, hallway and care office were badly stained and in need of either a deep clean or to be replaced. A requirement has been made in regard to this. The kitchens were appropriately decorated, clean and food kept in the fridges were dated and labelled. Records are maintained of all cooking temperatures. The laundry room has two washing machines and a tumble drier. Control of Substances Hazardous to Health (COSHH) were kept secure in locked cupboards in the laundry room. Staff told us that heavily soiled garments are collected in red dissolvable bags that are put into the washing machine with a sluice facility. On the day of the site visit the air vent in the laundry was very loose and requires repair. There is a garden to the rear of the property that is appropriately maintained. There is a patio area for residents to enjoy, and staff at the home use the barbecue during the finer weather. Residents were observed to have access to all communal parts of the care home and the garden. On the day of the site visit, with the exception of the carpets, the home was clean, tidy and free from malodours. The AQAA informs that the home is well maintained, secure and a safe environment is provided for the people they support. The home is well adapted to meet the individual and collective needs of residents. Care Homes for Adults (18-65 years) Page 24 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. The arrangements for staffing are satisfactory, ensuring that there is an appropriate skill mix of staff to meet the needs of people using the service. Recruitment procedures and practices ensure people who use the service are protected. Evidence: There are five residents currently living at the home. The manager told us that the current staffing compliment for the care home consists of the manager, deputy manager, six senior care staff, four care staff and two waking night staff. Of these staff, over fifty percent have achieved the minimum of an NVQ level two and above. We were told by the manager that the deputy manager is currently undertaking the NVQ level 4 in Management and Leadership. The viewing of the duty rota provided evidence that there are always four members of staff on duty for each early each shift, three for the late shift, with another member of staff working from 16:00 until 21:30. There is one waking night staff and one sleeping in person covering the night duties. During discussions with staff we were told that there is not always a fourth member of staff on duty during the late shift. This was discussed with the manager who told us there is always a fourth person on duty, and that he has instructed staff to always ensure this is the case. The viewing of the duty rota did provide evidence of a fourth person, however, the manager was advised to Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: monitor this. The recruitment files are now being kept at the care home, which is in compliance with the a requirement that was made at the last key inspection. The recruitment files of the two most recently recruited staff were viewed. These included an application form, two written references, a full employment history and proof of identification. Each member of staff had a Criminal Record Bureau (CRB) reference number. The home uses agency staff and evidence was viewed that the manager had obtained written confirmation from the supplying agency that the appropriate recruitment checks had been undertaken including the CRB clearances. Each member of staff has an individual training file where evidence of training undertaken is maintained. Training staff had undertaken included Epilepsy, understanding Mental Health, working with the Mental Capacity Act and behaviour interventions. The manager told us that he is currently going through these to ensure all training for staff is up to date. Parental surveys informed that the manager and staff usually have the right skills and experience to support residents social and health care needs. The manager told us that all new staff undertake the Skills For Care Council Induction training. Evidence of this was viewed in the recorded supervision notes of one new member of staff. The AQAA informs that the staff are trained and very competent. Care Homes for Adults (18-65 years) Page 26 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 home has a manager who is currently undertaking the appropriate qualification training. The manager has made improvements since being in post, however, residents health and safety would be further improved once the identified issues raised in this report have been addressed. Evidence: The manager told us that he has five years experience of working with adults who have a learning disability, and has been the manager of Boadicea Close since September 2008. The manager completed his registration with the Care Quality Commission in May 2009. The manager told us that he has the NVQ level 3 and is currently undertaking the NVQ level 4 in Management and Leadership that he hopes to complete by the end of August 2009. We have since been advised by the manager that this will now be completed by the end of December 2009. During discussions staff told us that the manager is approachable, supportive and has an open door style of management. One parent survey informed that the manager is setting new standards of care for the residents, and they are kept informed of changes through the use of E Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: Mail, which did not happen before. Another survey informed that the management is very good at the home. The manager had failed to notify the Care Quality Commission through a Regulation 37 Notification of an incident that adversely affected the well-being and safety of resident that occurred in April 2009. A requirement has been made in regard to this. The manager must address the identified issues raised in this report in regard to risk assessments, Safeguarding, the environment and managerial obligations. It was noted throughout this site visit that not all records were kept in the appropriate places, and the manager is not signing records he has audited. The manager should sign all records he monitors to provide evidence that he is auditing all records and practices in the care home, and should ensure that records are appropriately filed in the correct places. The manager told us that Quality Assurance is monitored through monthly Regulation 26 reports, and copies of these are maintained on the homes computer. These were not viewed during the site visit. Minutes of monthly residents meetings are being maintained and were viewed during this site visit. These evidenced that residents are being included in the decision making at the care home. Annual surveys are undertaken and the manager had the summary and outcome of this survey that was undertaken in March 2009. The manager had included the findings of this survey in the homes business plan for the year 2009 to 2010. The viewing of the staff training matrix provided evidence that staff are receiving the mandatory training as required. Information provided in the AQAA informs that all the Health and Safety maintenance checks of equipment used at the care home have been serviced in accordance with the manufacturers recommendations. The AQAA informs that the management of the home is based on the Aims and Objectives of Adepta and they follow a philosophy that promotes choice, rights, independence, inclusion, respect and dignity. The QA team conduct annual reviews. Resident meetings are carried out. All safety checks are logged with the appropriate certificates. 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 8 13 The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. The identified risk assessments must be signed and dated. Risk assessments for the use of bedrails must be produced to ensure the health and safety is maintained at all times for residents who use these. 20/08/2009 2 23 13 The registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. All staff working at the care 30/09/2009 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 home must receive up to date training in regard to Safeguarding Adults. The manager must submit an application to attend the local Safeguarding Team training in Safeguarding Adults. 3 24 23 The registered person shall 20/10/2009 having regard to the number and needs of the service users ensure that the premises to used as the care home are of sound construction and kept in a good state of repair externally and internally. The badly stained carpets in the care home must either have a deep clean or be replaced. The heavily stained sink in the identified bedroom must be repaired or replaced. The loose air vent cover in the laundry room must be repaired. 4 37 37 The registered person shall 20/08/2009 give notice to the Commission without delay of the occurrence of any event in the care home which 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 adversely affects the well being or safety of any service user. Regulation 37 Notifications must be forwarded to the Care Quality Commission of all events that adversely affect any resident living at the home, including making referrals in respect of any incident of suspected or actual abuse and/or neglect to the local Safeguarding Team. 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 20 Photographic identification of each resident should be kept on the front of each MAR chart that would help to ensure that medication is administered to the right resident. This would also be beneficial to new staff and agency staff working at the care home. 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). 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