Care Home: 24 Tower Road West

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What the care home does well The service provides a good standard of accommodation to the residents. They receive an excellent service tailored to their specific needs and responsive to their wishes and preferences. There has been improvements in the communication between staff and also between staff and residents although it is recognised that work on communication with residents can be developed further. The home takes a responsible attitude to risk that ensures the residents are not prevented from exercising their rights to experience new things. In survey feedback asked what the home does well staff commented: "being person centred, home is individualised and meets the needs of the residents and is organised" "provides individual support that residents require". "supports residents to their individual needs" In Survey feedback a health and social care professional commented that: "already been a lot of improvements around communication...... still room for further work in this area" "They are looking at introducing guidelines to ensure all staff are aware of individuals changing mental health needs and how to support them" "They have been very pro-active in approaching me for support in this area" What has improved since the last inspection? Since the last inspection the service has addressed all outstanding requirements and implemented most of the recommendations. One residents mobility has greatly improved and they no longer need to use a zimmer frame when mobilising. The installation of a ramp to the front door of the property has greatly improved accessibility for residents with mobility issues. Two staff are now on duty in the afternoons between 3PM and 9 PM when all of the residents are at home. The residents have been more actively involved in the recruitment of new staff. There has been investment in the upgrading of the property, and this has provided residents with a new kitchen, the home has been rewired, and a new boiler installed. Separate laundry facilities have been created. Three residents went on holiday to Spain this year and a fourth holidayed at Butlins Infection control training has been added to the staff training programme. The management structure has been improved to include a deputy position and this provides opportunities for career progression for staff in the home. All support plans have been developed in the new format What the care home could do better: In general the inspection highlighted that the service is working to a good standard in most areas but has provided exceptional support to service users in regard to their personal and health care needs and this is reflected in the overall rating awarded. When we surveyed staff and asked them how the service could improve they commented : "lack of training for non verbal communication for one resident, as only receives limited communication" A health and social care professional observed: "some staff could be more person centred and take more time to listen and respond to service users" We note minor improvements are needed in some areas and have commented on these within the report. No new requirements have been issued but we have issued several good practise recommendations where we consider the home could improve further the current arrangements or need to progress plans to review them. These are: The review of company policy in regard to the frequency of reviewing risk. Minor improvements to medication arrangements. Improved facilities to foster good hand cleansing practises, and improvement to the staff recruitment files maintained in the home to make their content fully compliant with legislation. Key inspection report Care homes for adults (18-65 years) Name: Address: 24 Tower Road West 24 Tower Road West St Leonards-on-sea East Sussex TN38 0RG     The quality rating for this care home is:   three star excellent 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: Michele Etherton     Date: 0 1 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 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 32 Information about the care home Name of care home: Address: 24 Tower Road West 24 Tower Road West St Leonards-on-sea East Sussex TN38 0RG 01424427607 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.eastviewhousing.co.uk East View Housing Management Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 4. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disabilities (LD). Date of last inspection Brief description of the care home 24 Tower Road West is a large Victorian house, rented for its services users by East View Housing Management Limited (EVH). The house has a wide hallway and there are two communal rooms on the ground floor. These include a large lounge area and a small dining room next to the kitchen. There is also an office and a downstairs toilet. There is one ensuite bedroom on the ground floor and there are three bedrooms, one bathroom and a toilet on the first floor. The third floor is office space for the Health Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 4 1 9 0 3 2 0 0 9 Brief description of the care home and Safety Officer of EVH; the Commission has been assured the office is always locked when not in use. The back garden is large and has an uneven terrain. However a newly installed decked area has been added which makes the garden area accessible to all residents. The house is in walking distance to the local shops, and is near the main bus route to Hastings and St Leonards on Sea town centres. The house is registered for four younger adults with learning disabilities. The home makes inspection reports available to prospective residents and their relatives/representatives upon request. The gross weekly fee inclusive of income support is variable dependent on need but ranges between £948 to £1,242 as at April 2008. Residents pay for their own toiletries, hairdressing and magazines. Care Homes for Adults (18-65 years) Page 5 of 32 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: three star excellent 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: A routine key inspection of this service has been undertaken. This has taken account of information received from and about the service since the last inspection. This information includes the receipt of an Annual quality assurance assessment(AQAA) completed in part by the new manager and the local area manager, this was returned to us on time. We found the AQAA has been completed to a reasonable standard in parts and would benefit from additional detail to illustrate fully the daily routines of the service, achievements in the last 12 months and future plans for service development. We have discussed the shortfalls with the new manager who understands the level of detail required and will undertake to ensure this is provided in future versions. Our inspection of this service has also included a site visit to the premises on 1st December 2009. When we met with two residents, a staff member and the new Care Homes for Adults (18-65 years) Page 6 of 32 manager. We have also surveyed the resident, staff and other stakeholders to obtain their views about the service. We have not received a response to the surveys from residents, or health and social care professionals but a good return has been received from staff. Analysis of surveys received indicates that overall the service is viewed positively by staff, and those professionals who responded. Feedback from surveys has been influential in planning and reporting on the inspection, and individual comments made have been incorporated into the report. At our site visit we met and spoke with one of the two residents present, who gave us permission to enter their bedroom and examine medication storage and records located there. We also examined a range of documentation held in the main office including staff recruitment, training and supervision records, support plans, risk information, staff and resident meetings to inform our judgement. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? Since the last inspection the service has addressed all outstanding requirements and implemented most of the recommendations. One residents mobility has greatly improved and they no longer need to use a zimmer frame when mobilising. The installation of a ramp to the front door of the property has greatly improved accessibility for residents with mobility issues. Two staff are now on duty in the afternoons between 3PM and 9 PM when all of the residents are at home. The residents have been more actively involved in the recruitment of new staff. There has been investment in the upgrading of the property, and this has provided Care Homes for Adults (18-65 years) Page 8 of 32 residents with a new kitchen, the home has been rewired, and a new boiler installed. Separate laundry facilities have been created. Three residents went on holiday to Spain this year and a fourth holidayed at Butlins Infection control training has been added to the staff training programme. The management structure has been improved to include a deputy position and this provides opportunities for career progression for staff in the home. All support plans have been developed in the new format 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 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 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. From information provided to them by the service prospective residents may not know that this can be provided in alternative formats and the admission process also needs revising to reflect this. In the event of a vacancy occurring robust systems are in place for the assessment of prospective residents and opportunities provided for them to visit. The service demonstrates its ability to respond flexibly to the changing needs of residents. Evidence: Statement of purpose and user guide information is made available to prospective residents and the service has also developed this information in an audio format, the availability of this information in other formats is not made clear within either the Statement of Purpose and user guide or in the organisations admission procedure. We have discussed these omissions and the need for greater clarity with the manager and local area manager who have agreed to address this. There are no plans for new residents but systems are in place to undertake a robust assessment of need should a vacancy arise, the admissions process also ensures that Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: opportunities for introductory visits are offered and compatibility issues are taken account of. The service has experienced changing needs within the resident group particularly in regard to health care, they have demonstrated their ability to respond flexibly and appropriately to support these needs Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Support plans contain an excellent standard of information about residents to inform staff practise but this could be enhanced by suggested improvements in recording. Staff practise demonstrates a good understanding of maintaining the confidentiality privacy and dignity of residents in their care. Risk is managed positively and this is regularly reviewed, clarity is needed within organisational policy about the frequency of this to better inform staff. Evidence: We examined three support plans out of four, information has now been transferred over into the new my life plan formats, these contain an excellent level of detail to inform staff about the individual needs preferences, routines and specific guidance needed in working with individuals in regard to communication and behaviour. When we spoke with the manager and staff it is clear that residents are central to the updating of the plan and there is evidence of updating of some sections. Because residents are actively involved in discussing each area of their support plan this is not Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: updated in one go but piecemeal over a period of time, this would seem to be an ongoing process without obvious start or end. There is a need to ensure that updating of plans is maintained within a timescale of a minimum of six monthly intervals and we have discussed these improvements with the manager and local area manager. Goals are established for residents and we noted two out of three files we viewed had these recorded. We also noted achievements have been made for one resident but this has not been recorded within the support plan. We discussed with the manager some of these omissions and the need for improved recording to evidence the work that is clearly happening within the service. In survey feedback asked what the home does well staff commented: being person centred, home is individualised and meets the needs of the residents and is organised provides individual support that residents require. supports residents to their individual needs Asked what could improve staff commented: lack of training for non verbal communication for one resident, as only receives limited communication In Survey feedback a health and social care professional commented that: already been a lot of improvements around communication...... still room for further work in this area some staff could be more person centred and take more time to listen and respond to service users From observations made during our visit to the service and from discussions with individual staff, we found staff to demonstrate a respect for the privacy and dignity of residents in their everyday practise and are protective of residents confidentiality. There is a responsible attitude towards risk taking that does not seek to hinder residents experience of new situations or activities. Examination of resident files indicates all those viewed to have a comprehensive range of risk information in Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: place.Whilst there is clear evidence of risks being updated at least annually, the organisation has identified the need to review its own policy regarding the frequency of reviewing to make this more achievable, and we would support the need to do so to ensure consistency. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are helped and enabled to live an ordinary life, and to pursue activities and interests meaningful to themselves, they are helped to integrate into the community and their rights as citizens upheld by home staff. They are supported to maintain important relationships. They enjoy a nutritious and varied diet. Evidence: Each resident has a weekly programme of structured activities, this has been developed with them and incorporates their personal preferences and interests, and provides opportunities for stimulation and exercise. Where possible attendance at college is pursued if residents express an interest and a relevant course is available. Two residents at the home enjoy independent travel around the local area. All the residents have an active role in the upkeep of the home and undertake domestic tasks to support this. The residents either independently or Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: with staff support make use of some local leisure and community facilities, although this could be improved upon. In survey feedback staff commenting on what the service does well reported that: Involvement of residents with decisions in the house for decision making around shopping,decor, employment of new staff, meetings, changes to any routines. commenting on what they could do better, staff reported: more one to one opportunities through external funding options encourage residents to participate in community activities i.e. Gateway club on a Thursday, going out at weekends Support residents to maintain friendships with others from the Company. There is evidence that the home staff have been proactive in helping one resident reengage with family members and regular contact is now maintained,where family relationships are well established the home staff encourage and support these contacts facilitating trips home where possible. Staff are protective of residents privacy and dignity and respectful of their human rights. Residents are involved in the development of a weekly menu which covers the main meal of the day, the majority of residents are out during the weekdays, but if at home are consulted about what they might wish to eat for lunch on an individual basis, with various options offered. When we examined records of foods eaten we are satisfied that they are enjoying a varied and nutritious diet, staff and the manager are encouraging of residents maintaining a healthy lifestyle and this extends to ensuring a healthy diet is provided.Mealtimes are flexible and relaxed. Care Homes for Adults (18-65 years) Page 17 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal, physical and mental health of residents is well supported Evidence: Support plans provide staff with an excellent range of information about personal preferences in daily routines, plans clearly record peoples personal and health care needs and record how these are to be delivered. The make up of the staff team ensures residents receive support from staff of their own gender. Staff respond appropriately and sensitively to situations involving personal care and are protective of the privacy and dignity of residents when conducting personal care. Each resident has a health action plan that details changing needs and support in regard to health issues. The health care needs of residents are well supported. Staff ensure that residents have access to routine health care checks and take action promptly where issues are highlighted. Some more able residents are encouraged to take an active role in making their own appointments. Residents are supported by staff if they need to be when attending doctor or specialist health care appointments. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: Home staff are proactive in seeking referral to specialists in response to either mental or physical health care needs, the new manager has initiated well women clinic appointments for all the residents and this has picked up the onset of a serious health concern for one resident requiring urgent interventions, a plan of treatment is now underway as a result of this. In survey feedback a health professional comments that: They are looking at introducing guidelines to ensure all staff are aware of individuals changing mental health needs and how to support them They have been very pro-active in approaching me for support in this area During a short term health crisis for one resident the home has been able to demonstrate that it has provided the necessary equipment to support their care needs during this time, adaptations to the property to enable the resident to continue to live in the home in spite of reduced mobility are to be commended. Examination of individual records indicates that residents weights are recorded regularly although the frequency of this varies, some thought needs to be given to standardising this. The home has previously been compliant with medication arrangements, medication records we examined indicated medication is being appropriately received, administered and recorded. Staff have the required training to administer medication and systems are in place to ensure their competency to do so is routinely re-assessed. Handwritten changes on medication records are being signed for appropriately but would benefit from the addition of dates for the purpose of auditing.Recent issues of stock control have been resolved with the local pharmacy, with many excess medications already returned. Some extra topical medications have been retained however, owing to the frequency of their use. Each resident has been provided with their own medication cabinet and therefore have some involvement in their medication regime even if they are not self medicating. Some residents undertake self medication under staff supervision, although they do not retain the key to their medication cabinets at this time. Risk assessments, consents to medication and capacity judgements are in place in regard to medication arrangements for individual residents. We sampled the content of one cabinet with the residents permission, we found the Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: cabinet to be clean and generally well organised, with separate storage compartments for different types of medication, this is not always adhered to and we found a tube of cream located with oral medications, we have reminded the home staff of the need to ensure creams are not stored on the same shelf as oral medications because of possible cross contamination. The storage of resident medication records within individual cabinets is under review, and we would support the need for this arrangement to be revised. We noted that PRN medication guidelines have been developed but these are overdue review, the manager indicated an awareness of this and an intention to update them in the near future. We have recommended that the home implements some of the good practise improvements we have discussed. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with opportunities to express their views, but the complaints process would benefit from review to make this more accessible. Systems are generally in place that protect residents from harm, suggested improvements in recording will enhance these. Evidence: The AQAA informs us that no complaints have been received since the last inspection. We have commented elsewhere about the content of information in the AQAA with regard to this outcome area. The complaints procedure is not currently displayed in the home, new display boards are on order that will incorporate a more accessible version of the procedure and other important information and are to be standardised across the organisation. Residents are provided with opportunities to be listened to through one to one meetings,house meetings, regulation 26 visits, and annual surveys, in addition to any informal interactions they have with staff each day. Although the home has a complaints record in an accessible place within the home, this is not used by residents, and as a consequence there were plans to implement individual moans and groans books , a term coined by the organisation, however after further deliberation it has been decided that this term provides a somewhat Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: negative view of any concerns residents may have and devalues their importance. Consequently each resident will now receive a daily diary in which they can discuss with staff things that have happened, and can refer to minor concerns if they wish. There is a need for staff to be proactive in implementing the complaints process on residents behalf, where they consider that an expressed concern would have precipitated a similar response in the general population. The organisation has demonstrated an understanding of adult safeguarding processes and acts appropriately to refer incidents or seek advice from adult safeguarding staff, newer staff are still to receive adult safeguarding training and are booked to attend a course in January 2010. one adult safeguarding alert has been appropriately raised by the service in relation to an incident between two clients and is currently under investigation. The use of physical intervention is rare although some staff are trained to use minimal interventions. With recent staff turnover newer staff have not received this training, and company policy dictates they should not attempt to use any form of restraint until trained to do so. Behaviour support guidelines have been developed for one resident which make clear the level of physical intervention that can be used, such guidance should be extended to any other residents who may be viewed as needing this type of intervention. The home uses the system of ABC reports to record behaviour incidents but this process needs rationalisation. Currently all incidents are reported through the ABC reports process to the local area manager who analyses incidents and implements behaviour support changes accordingly. Specific behaviours are not targeted and monitored over a time limited period which would better inform support plans and help reduce some behaviours. We discussed this with the new manager who agrees these are not being used effectively and will discuss their use with the local area manager to bring about change. We are aware that in regard to one resident, the withdrawal of privileges in response to negative behaviour incidents has been agreed previously within a multi disciplinary setting, however this is not made clear within the behaviour support plan or a time given for reviewing the effectiveness of such a strategy. We have discussed the need for this to happen with the manager. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: Systems used for the management of residents monies have been strengthened and the policy relating to this updated, the new manager is working to the new system and copies of records maintained by the home are forwarded to the head office for scrutiny as part of an organisational improvement around resident finances. We checked the records of monies held for two residents against the cash balances and found these to be accurate. Care Homes for Adults (18-65 years) Page 23 of 32 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. Residents live in a pleasant, clean environment that will benefit from planned upgrading and suggested infection control improvements Evidence: The home offers a pleasant, safe environment to residents. They enjoy single occupancy of their bedrooms and have been able to personalise these to their own taste. A communal lounge is spacious and decoration is to a good standard but would benefit from some added colour, the new manager reports this is to be redecorated in colours of red and cream chosen by the residents, with colourful accessories. The issue of storage for some of the activity items is also to be addressed. A settee previously identified as broken and needing replacements is still in use in the home although we are advised there are plans to replace this in the near future once items suited to meet the needs of all the residents can be identified, we would urge that this is progressed. In general we found the home cold on the day of our visit despite the heating being on full all day, residents and staff have also commented intermittently about being cold, and a previous plan to install secondary glazing has not been pursued. The new Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: manager was unaware of any proposed plans to provide secondary glazing at this time, we would urge some reconsideration of this, in view of the high cost of heating the home and the need to be energy efficient. When we visited previously we identified that an upstairs toilet lacked the facility to enable residents or staff to wash or cleanse their hands after using the toilet, this remains unchanged although hand sanitiser gels have been installed elsewhere around the home. An upstairs bathroom is scheduled for upgrading, with the bath being replaced with a shower,when we visited this contained neither liquid soap or the means to dry wet hands. A downstairs toilet used by residents and staff had a cloth towel which was somewhat ragged in place. We do not consider that the present arrangements promote good hand washing and action should be taken to provide either paper towels or a hand dryer to maintain better infection control. Care Homes for Adults (18-65 years) Page 25 of 32 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. Staffing is responsive to the changing needs of residents. The recruitment process for new staff has been strengthened. A training programme is in place to provide staff with the necessary training, knowledge and skills they need. Systems are now in place to ensure staff practise is supervised and monitored and that they have opportunities to meet with the manager and their colleagues Evidence: There are enough staff on duty to meet the present needs of the residents, deterioration in the health needs of some residents may need this to be revised, and this should be kept under review. The organisation has responded flexibly to the recent need to increase staffing levels between PM and PM each weekday and two staff on duty during day time shifts at weekends. Whilst the main recruitment files for all staff are maintained at head office, copies of these are retained in each home where the staff member works. when we examined files of new staff appointed we found these are better organised and information is easily accessible, however there remain minor omissions in the information that should be contained within the file under current legislation. whilst this information may well be kept within the master file at head office, those in the home lack current photographs and evidence of identity. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: We are satisfied that the organisation has strengthened recruitment to provide evidence of interviews and that gaps in employment are being pursued at interview, and all necessary checks and vetting are conducted. However all the files viewed lacked evidence of the actual start date of employment, and personal details relating to the member of staff are missing, requiring the home manager to ring head office for details, which in an emergency may not be feasible if it occurs out of hours. We have discussed these shortfalls with the manager, and recommend that the identified shortfalls are addressed. A rolling programme of training is organised for all staff, from the files we examined of newer staff we are satisfied that all have completed mandatory training or there is evidence of course bookings to fill gaps in training that remain for individuals. We have discussed the benefit to the manager in developing a training matrix for the home, and to revise the present training profiles and make these more usable. With the recent turnover of staff the home has just under 50 of its staff trained to NVQ2 although two newer staff who have completed LDAF have just registered for NVQ training. When we spoke with staff they reported that they find the new manager supportive and receive regular supervision since she started work at the home. We noted evidence of supervision records that have been undertaken with staff since the new manager commenced working at the home, a schedule of planned supervisions is in place. Since July 2009 team meetings are generally held monthly Care Homes for Adults (18-65 years) Page 27 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has experienced an unsettled period with changes in management and staffing, it is generally well managed in the best interests of residents and will benefit from suggested improvements. Evidence: The new manager commenced working at the home in august 2009, she reports that application for registration is underway. We found the AQAA submitted by the home has been completed to a reasonable standard but would benefit from improved detail in some areas to illustrate better the day to day routines of the household , improvements and achievements to address previous shortfalls and plans for future development. Whilst responsible for completion of only some of the AQAA we have discussed with the new manager the shortfalls in the information provided, and our expectations for the completion of the AQAA,and she has agreed to ensure future versions are completed to this standard. General risk assessments have been updated but not 3 monthly as per company policy, we found one risk assessment that has been updated but is no longer relevant relating to the locking of the office and kitchen doors, and we have discussed the need for this to be either discontinued or revised to Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: reflect present arrangements. Accidents are being recorded and sent to the organisations health and safety officer to assess causes, risks etc. A copy of these has not been retained in the home and we were unable to therefore assess the nature and frequency of accidents occurring since the last inspection, as stubs within the accident book are not routinely filled in. We have discussed the need for accident report information to be retained in the home although we welcome the fact that the organisation is taking its responsibilities for the health and safety of residents seriously. The new manager has stated that she has already agreed with the Health and Safety officer that copies of accidents will be retained in the home in future and we would urge that this be implemented, these new arrangements have also been confirmed by the local area manager for the service. We are informed that the quality of the service is assessed through a number of ways. Residents are provided with opportunities to express their views through one to one sessions with their key workers, and house meetings. The organisation surveys them annually and evaluates their feedback, a periodic review of the service is undertaken every quarter and this informs an annual report of the service quality, a version of this is made available to residents, we did not view this information on this occasion. The AQAA informs us that all health and safety servicing and checks have been completed, some omissions in information have been confirmed by sampling specific records during our visit and we are satisfied that all checks have been completed. A current certificate of insurance is displayed. Care Homes for Adults (18-65 years) Page 29 of 32 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 30 of 32 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 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 There is a need to establish clear timescales for the reviewing of risk that is achievable in practise. Risks should be updated in keeping with reviewing of support plans or when changes occur as a minimum. The home manager should ensure that prescribed creams are stored separately to oral medications to avoid cross contamination. PRN guidance for individual residents should be updated a minimum of annually. 2 20 3 30 Steps should be taken to provide the necessary facilities to residents and staff that promote good hand washing habits and improve infection control The registered provider should ensure that staff files maintained in the home contain all the information required by legislation, this includes a current photograph of the staff member and evidence of identity. A start date of commencing employment and personal details providing information of next of kin and contact details would be considered good practise 4 34 Care Homes for Adults (18-65 years) Page 31 of 32 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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