Care Home: 33a Forest Road

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What the care home does well The people living at 33a Forest Road have complex care needs including challenging behaviour and due to the high support needs there are good individualised staffing budgets in place. Individuals benefit from flatlets that exceed the National Minimum Standards. There is a good rolling programme of decoration. The flatlets were personalised to the taste of the individuals and homely. What has improved since the last inspection? There have been some improvements to the care planning processes with more information being recorded. Care files have been organised so that they are more accessible to staff. Individuals now have a structured plan of activities but these are not always taken place. Individuals are better protected now there are good systems in place in relation to the management of their medication. Individuals can be assured their health care needs are being met. What the care home could do better: There is a lack of communication and direction for staff which means that the care needs of the individuals is not being met consistently. Individuals must continue to benefit from the improvements that have been made in respect of the care planning processes, the structured activities and a continual review to ensure that staff are following them. A review of the incidents of aggression must be completed including the environment. Staff would benefit from guidance in respect of the record keeping and consideration being given to simplifying the present system. Staff should be encouraged to raise concerns and communicate better with each other. Better support systems must be in place to guide and direct staff. Individuals must be assured that competent staff work in the home in the event of fire with member of staff attending a fire drill once in a six month period. Key inspection report Care homes for adults (18-65 years) Name: Address: 33a Forest Road 33a Forest Road Kingswood South Glos BS15 8EW     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: Paula Cordell     Date: 2 5 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 45 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 45 Information about the care home Name of care home: Address: 33a Forest Road 33a Forest Road Kingswood South Glos BS15 8EW 01179677447 01179677239 forestroad.manager@shaw.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Shaw Healthcare (Specialist Services ) Ltd Name of registered manager (if applicable) Mr Mandla Msibi Type of registration: Number of places registered: care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home 33a Forest Road is a purpose built home providing personal care with nursing for 9 adults with a learning disability. The home is owned and operated by Shaw Healthcare (Specialist Services) Ltd, an organisation that specialises in providing accommodation and support that promotes independence.The accommodation is set over two floors and a lift is available. Individual rooms are spacious with en-suite facilities; some rooms have small private garden areas. Communal space includes lounge, relaxation room, kitchen/diner, therapy room and a large Jacuzzi tub. The home provides individual support to people who use the service using a variety of approaches determined by a detailed assessment of individual need. Individuals are encouraged to be involved in the everyday running of the home, and activities in the local community are organised on a regular basis. The home opened on the 6th January 2003. The fees for the home are in the region of 2512 pounds per week at the time of publishing this Care Homes for Adults (18-65 years) Page 4 of 45 2 4 0 6 2 0 0 9 9 Over 65 0 Brief description of the care home report. Care Homes for Adults (18-65 years) Page 5 of 45 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit as part of a key inspection process. The purpose of the visit was to review the progress to the requirements and recommendations from the visit in June 2009 and monitor the care provided to the individuals living in 33a Forest Road. There have been no additional visits since the visit in June 2009. A joint safeguarding meeting was organised a week before this visit with South Gloucestershire Council, the Care Quality Commission and the provider to discuss the amount of safeguarding referrals that have been made in the last twelve months in relation to altercations between individuals living in the home. The management have agreed to review the incidents and the environment as part of an exercise to reduce the incidents. Two anonymous complaints were received by the Care Quality Commission in relation to the lack of meal choice and male carers supporting a female with personal care. The Care Homes for Adults (18-65 years) Page 6 of 45 provider was requested to investigate the concerns, which the provider had done and these issues are covered in this report. The visit was planned using information that has been received over the last twelve months including regulation 37 notifications that effect the well being of the individuals living in the home, surveys from relatives, staff and people who use the service and visiting professionals. The visit was conducted over three days for a total of 18 hours with structured feedback being given to the manager and the operations manager. A tour of the home was conducted which gave an opportunity to speak with people who use the service and the staff team. Six members of staff requested to see the inspector during the visit. Records were viewed in respect of the running of the care home, including care records, staff recruitment, training and those required in accordance with health and safety. Care Homes for Adults (18-65 years) Page 7 of 45 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. Care Homes for Adults (18-65 years) Page 8 of 45 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 45 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 45 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. Individuals could be confident that a full and comprehensive assessment is completed prior to moving to 33a Forest Road. Good information is available to individuals and stakeholders about the service provided at 33a Forest Road. This would be enhanced if the correct contacts of the Commission were made available. Evidence: There was a statement of purpose and service user guide in place. The manager had recently reviewed and amended the documentation in relation to the change of management. There was only one area that required updating which was to up date the contact details for the Care Quality Commission from the regional office to the National Office in Newcastle. This would ensure stakeholders could contact the Commission. The service user guide was in an accessible format. Some individuals had chosen to keep copies of this in their bedrooms. For some of the individuals living in 33a Forest Road there is little choice on whether they want to move there, as this is a specialist Care Homes for Adults (18-65 years) Page 11 of 45 Evidence: service for individuals that challenge. For some of the individuals it was the only option available to them to enable them to succeed at living in the community. 33a Forest Road is made up of nine individual flatlets where individuals can chose to live separate from the others, or when stable can interact with the other people in the home. There are intense staffing packages, which enables individuals to have their own allocated staff member during a shift. For two of the individuals two members of staff support them in the home. A number of individuals have additional staff to support them when out in the community. This varies from one to two or one to three staff. Admission to the home is through the care management approach and each admission is usually planned. The home has one vacancy. One person has moved to supported living since the last visit. There were clear procedures for staff to follow in respect of filling a vacancy. These were included in the statement of purpose. It was evident that a comprehensive assessment of need prior to an admission would be completed. This was clear from documentation seen at the last visit. Individuals were encouraged to visit the home. The visits would be tailored to the person and would vary in length and could include an overnight stay. Individuals were offered a three month trial. This is then formally reviewed with the individual, the placing authority, relatives and other professionals where appropriate to ensure that all parties are happy with the care provision. Comments from relatives at care reviews were generally positive. Copies of placing authorities assessments and care plans were seen on file for the individuals. It was evident that these inform the assessment and care planning processes completed by the staff in the home. It was noted during the last visit that one person although placed by the Community Learning Disability Team was found to not to have a diagnosis of a Learning Disability but an acquired brain injury. This has since been clarified and the area manager wrote to the Commission. The home is registered to support individuals with a Learning Disability. However, from talking with the manager, the staff and the operations manager it was evident the home was meeting the needs of the individual. This must be kept under review by the manager. Letters from relatives forwarded to the Commission prior to the visit further evidenced the person had settled in well and their needs were being met in relation to the behaviours that challenge and health care. However, there were concerns about the social aspects of the care package and accessing the community that were still being agreed, although the person had lived Care Homes for Adults (18-65 years) Page 12 of 45 Evidence: in the home for eleven months. The manager had liaised with the placing authority to secure some additional funding to provide one to two staffing for 10 hours per week when out in the community. There were also issues of accessing external support due to the person not having a diagnosis of a learning disability. The manager said that services are accessed via the GP and not the local Community Learning Disability Team. Care Homes for Adults (18-65 years) Page 13 of 45 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. Whilst there have been improvements in the care documentation there are gaps in the daily recording which could put individuals of risk. Staff are not consistently recording how plans are being implemented. At the time of the visit the service was in transition from a medical model of care planning to a more person centred approach. This is good practice but there is still work to be done on goal setting and from having their long term aspirations being met. Confidentiality of the information in care files was being compromised. Evidence: Three peoples care was looked at as a means of determining the processes the home goes through to support the individuals living at 33a Forest Road. Comprehensive assessments were available that informed the plan of care. The home uses the model of activities of daily living to document the needs of the individuals. Concerns were raised at the last visit that some of the documentation lends itself to a Care Homes for Adults (18-65 years) Page 14 of 45 Evidence: medical model rather than that of social care. Previously staff stated that this format has to be used as it is the way Shaw Healthcare like this to be done to ensure consistency. At the time of the visit the service was in transition from a medical model of care planning to a more person centred model of planning care. However, as recommended previously care planning documentation should be available in a format accessible for the individuals living in the home. The home should explore whether other care planning approaches would be more suitable for the people accommodated at 33a Forest Road. It was noted that much of the care planning was about the here and now and not about goal planning and looking to the future. There was little about encouraging individuals to be independent. Three staff gave examples when in the past individuals were supported to make there own drinks and snacks or go to college but they said this no longer happens as staff do much of this for the individuals. Some improvements have been made including a section called all about me which provides an insight that enables staff to support each person in a person centred way and enables staff to get to know the individual. Care planning documentation was being reviewed on a monthly basis. A new format has been introduced to review progress and the well being of individuals on a monthly basis. This had only been introduced in the last two months but the documentation was comprehensive and should assist in staff measuring the effectiveness of the care delivery. During the last visit it was noted that one person had been assessed by the GP as having weight management issues, and there was no care plan to guide staff. A requirement was made for this to be addressed. Since the last visit a further person was reviewed by a Dietician in February 2010 but the advice was not incorporated into the plan of care. This was discussed in depth during the visit and by day three of the inspection the care plan had been updated. Compliance with the requirement has been achieved. Since the last visit the information held in care files has been reviewed. Each person had two care files, one containing day to day care planning information, behaviour management plans, daily records, activity plans and the other contained clinical information the assessments, letters from health appointments. Files were better organised than on the last visit and it was evident that a lot of work had gone into making these more accessible for staff. As noted at the last visit daily records were often incomplete in relation to menu planning and activity charts. It was noted that staff have to record information in a Care Homes for Adults (18-65 years) Page 15 of 45 Evidence: number of places. Consideration should be taken to simplify the recording and staff to have training on the legal aspects of writing reports and the expectations of the organisation. There were a few daily records that were not signed by the support worker or the registered nurse. A member of the care staff said that the registered nurse was expected to sign each entry, but there were examples where this had not occurred. A regular bank support worker had highlighted in the communication book that some of the daily recording including bowel charts, activity plans and menu records were not being completed and gave an example where this was detrimental to the individual. It was disappointing that this was not picked up by the registered nurses working in the home who have responsibility for ensuring the care documentation was up to date. It was evident that there were other concerns about the lack of consistency in the approach of staff with examples given. Care planning information included the triggers for the behaviour and how staff should support the person. Much work has been completed in this area with plans being expanded and demonstrating a person centred approach in managing behaviours that challenge. This was commendable. Staff receive specific training whilst working in the home, which includes using positive measures to reduce the behaviour and trying to avoid the triggers. Staff spoke positively about the individuals and not focusing on the negative reputations of the person. It was evident they had a good understanding of the day to day needs of the individuals and how they liked to be supported. Risk assessments were in place and described how staff minimise risks ensuring the safety of the person. These had been kept under review. Care files were left in communal areas unattended. Whilst it was positive that one of the individuals was looking at their own care file others were left laying on tables and in an unlocked office. Care Homes for Adults (18-65 years) Page 16 of 45 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst there has been some improvements in the area of activities with individual plans being drawn up, the lack of communication, transport drivers and the organisation of staff often means this does not happen. Contact is maintained with relatives. Deficiencies in recording means it not possible to evaluate whether individuals are being offered a choice of menu and receiving a healthy balanced diet. Evidence: Care documentation included information abut the interests and hobbies of each individual. Staff spoken with said that the activities are very much led by the individual. Since the last visit activity plans have been introduced for each person detailing what the person should be doing. There was a balance of activities both in the home and the local community. However from reading the daily records there was still little information about activities that were being completed. Care Homes for Adults (18-65 years) Page 17 of 45 Evidence: Some individuals were observed going out in the community with staff and others were seen relaxing in the home. In the three days there was no structured group activities although a few of the individuals were sat in the lounge area together. One person was supported to make a cake, whilst others were seen relaxing in their bedrooms watching television or listening to music. Staff said that it was always the same individuals that go out. This was confirmed in the activities record by the front door. Some of the individuals required increased staffing when out in the community. Whilst it was evident that this was happening for one of the individuals, it was not so for others. According to two members of staff, one individual has only left the home socially once since moving to the home eleven months ago. When this was discussed with staff and the manager it was explained that there has been some health issues however after liaising with the placing authority additional funding has been approved to assist with this. However staff were concerned about the lack of opportunities for this person to go out. One response from management was that the person should be supported to either go out for a curry or have a take away every Saturday night. Staff said this did not always happened because there was not alway the money available and staff do not follow the plan on the shift planning board. The management highlighted issues with the lack of staff who are able to drive the homes mini bus as a reason that activities did not always happen. A driver was employed to assist with this and support one specific person who requires three staff to go out in the community. The manager said a new vehicle has been purchased and it was hoped that more staff would be able to drive this vehicle enabling people to go out on a regular basis. A relative raised the concern of the lack of vehicle in a completed survey stating they could provide more transport and out of house activities. In home home activities are very few and not structured or regular and this has been an ongoing complaint for over a year. Another relative stated arrangements for home visits are invariably cancelled due to lack of staff or transport and there are issues around the lack of holidays and lack of activities in the home. One person living in the home said they go out regularly to the local shops. However, they also said they wanted to go to other places. When reading the records for this person it was evident that they went to the same place. One member of staff said they were keen to take this person to the Zoo, but obstacles had been put in their way due to accessibility arrangements with no solutions offered. From talking with home Care Homes for Adults (18-65 years) Page 18 of 45 Evidence: support workers it was evident that they were enthusiastic and had lots of suggestions but these were not always followed through by the senior staff in the home. It was noted that one person enjoyed swimming and this had been identified as an area to pursue but again staff said nothing had been done about it and a similar concern was raised about a person who wanted to go to college. The lack of coordination was evident. Staff said that due to the lack of key group meetings the planning of the activities has been reduced with no direction given to them. There was evidence that individuals were encouraged to maintain contact with relatives. The record of visits indicated that some of the individuals have regular contact with family in the home. One relative is collected by the staff to visit the home on a twice weekly basis. Another relative is able to use the homes vehicle to enable them to take their son out. Menus were viewed during the tour of the home. Feedback from people who live in the home and staff about the food was good. However, prior to the visit an anonymous complaint was raised stating there was little choice of food and if individuals did not like what was offered there was no alternative. When staff were asked about this all said individuals were offered a choice on a daily basis, and there was always alternatives to the planned menu. One person was observed having lunch in their flatlet. The member of staff was mopping the bathroom floor with very little interaction with the person, it was evident the person did not like what they were eating and needed it cut up for them, but this had not been done. The individual was not offered an alternative. When staff were asked whether the person liked the food normally, there was no conclusive answer. Records in care files relating to food were often incomplete. One person was being encouraged to eat a healthy diet however, it was noted that they had not eaten a meal on one occasion but 8 chocolate snack bars. A member of staff raised a concern about another person who had been on a healthy diet plan prior to moving to the home and had lost a lot of weight. However since they had been at 33a Forest Road they had gained a considerable amount of weight according to the member of staff. Despite a care plan being in place the individual was eating a lot of high carbohydrates on a daily basis. The manager was able to demonstrate that the person was loosing weight but there was no initial weight assessment to determine how much had been gained since the person had moved to the home. Care Homes for Adults (18-65 years) Page 19 of 45 Evidence: Daily records relating to food did not capture what fruit and vegetables individuals were eating to determine if they were receiving/being offered at least five portions per day. The cook was asked during a visit to the kitchen whether all the individuals liked the meals that were being served. All the meals were the same, there was no evidence of any choice and the response was yes all the individuals liked the meal prepared. However, two of the individuals were reported/observed not to like what was offered to them and one person was given brown bread when they were intolerant of this. Another person shortly after the lunch was eating a sandwich. The home employs a full time cook and a part time assistant cook. During the last visit the cook said that they were planning to make the menu more accessible and provide two choices for every meal. This had not been implemented at the time of the visit. By day three of the inspection the photographs of meal choices had been developed enabling individuals to make their choices known. All meals seen during the three days looked wholesome and well presented. The cook highlighted a concern in relation to preparing two different meals enabling the individuals to have more choice in respect of waste, storage and that the cooker had only 4 burners making it difficult to prepare more than one meal choice. The senior management must review this to ensure that this moves forward. Staff said the lunchtime and the tea time meal is cooked by the cook, however breakfast and snacks are prepared by the care staff. There was an extensive choice for breakfast including cereals, toast, full English Breakfast and crumpets to name a few. Care Homes for Adults (18-65 years) Page 20 of 45 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst it is evident that the personal and health care needs were being met. This could be enhanced with clearer communication being given to staff on their roles and the expectations of the service and the needs of the individual which could lead to a more consistent approach. Improvements in the medication system affords individuals with better protection. Evidence: Individual care records included information that demonstrated that the people living in the home had access to a GP, dentist, optician and other health professionals. The home liaises with other relevant professionals in the planning of care that is provided ensuring the individuals care needs are met. This included the local Community Learning Disability Team, Consultant Psychiatrists, Physiotherapists, Dieticians and Occupational Therapists. Care plans included daily routines regarding their personal care needs and the way they preferred to be supported. From talking with staff it was evident that where individuals expressed a wish for a specific gender of staff to support them this was accommodated. A recent complaint was anonymously forwarded to the Commission Care Homes for Adults (18-65 years) Page 21 of 45 Evidence: stating a female does not want to be supported by male staff. However from talking with staff and the manager this persons preferences changes on a regular basis, and some of the male staff feel uncomfortable supporting the person. This should be kept under review ensuring the risks to the individual and the staff are minimised offering a consistent approach and respecting the dignity and privacy of the individual. Each person has an allocated group of staff to support them called a key work group, consisting of a registered nurse, a senior carer and four to five home support workers. This could assist with providing a consistent service and ensure good communication between staff. However three members of staff said that there has not been any key worker group meetings for a long time. This was confirmed in care files. Staff said that when the key work group meetings were held, decisions were made about roles and support, for example who would buy toiletries, liaise with relatives or what activities would take place. Staff said this was no longer clear and it was effecting the care of the individuals due to the lack of clarity of roles and communication. Staff have training in first aid and health and safety as evidenced in conversations with staff and the manager and records seen. The home continues to use assessments that are designed for supporting an older person including nutritional screening and pressure sore assessments. The manager stated that these are now only used as a baseline on admission. Because it is acknowledged 33a Forest Road is a care home that provides nursing, generally the people living in Forest Road do no have a medical condition but behaviours that challenge, mental health and a learning disability. Consideration should be taken to ensure the care documentation is fit for purpose and the needs of the individuals the home is supporting. Howevever, there have been some improvements in relation to the reduction of records including fluid balance charts where there was no indication of dehydration. Each individual has a medication profile, identifying health needs and medication including a current photograph. Since the last visit the medication system has been reviewed and systems improved. Regular audits were being completed on the stock held in the home. New Cabinets have been purchased ensuring there is suitable storage. Registered Nurses have the responsibility to administer the medication. They have attended training on the medication systems in place. Care Homes for Adults (18-65 years) Page 22 of 45 Evidence: Medication Administration records had improved in content and detail and included a signature of the nurse administrating the medication. Staff were completing all sections of the record including the carers comments on the reverse of the chart. There were clear records of medication entering the home, administration and disposal. Requirements made at the last visit in relation to recording and ensuring prescribed medication were in stock have been met. Policies and procedures in relation to the safe administration of medication were in place as seen at the last visit. There have been two regulation 37 notifications relating to health. One was a medication error and it was evident that a full investigation was completed and actions taken to address the issue with the staff involved. The other related to a delay in a person getting medical attention for three days due to the individual refusing personal care support. Again this was investigated. Care Homes for Adults (18-65 years) Page 23 of 45 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. Whilst there is some evidence that concerns are being listened to, there is a reoccurring theme from relatives and staff in relation to the lack of activities and communication in the home. Policies and procedures were in place to protect individuals from abuse with staff showing a good awareness. Whilst there are measures in place to protect the finances of the individuals it would be beneficial to review the system that is presently in place. Evidence: Policies and procedures relating to complaints and safeguarding were in place. These met with the National Minimum Standards. A record of complaints and compliments was being maintained. The Annual Quality Assurance Assessment stated there have been 5 complaints in the last twelve months and 39 referrals to the local Safeguarding team in South Gloucestershire Council. Of the five complaints two were upheld. There was documentation in place to demonstrate that complaints were investigated and action taken to address the concerns. One relative has raised a continuous concern about the lack of activities in the community. This remains ongoing as this was mentioned in the completed survey received last year and again this year. A further relative raised this as a concern stating that due to lack of staffing home visits are often cancelled. This was also raised by staff as an area of concern. Care Homes for Adults (18-65 years) Page 24 of 45 Evidence: Of the 39 referrals to the local safeguarding team most relate to incidents of aggression from one individual to another. Two were allegations made about staff. A recent meeting was had with the local Council, the Care Quality Commission and representatives from Shaw Healthcare to discuss some of the incidents the allegations made. An action plan was developed to assist in reducing the incidents, including clearer reporting from the home and a review of the environment. The management have kept us informed of any investigations that have taken place and the outcome. Where one person has made allegations in the past there is a clear plan to support the person which clearly states that all allegations will be taken seriously. There was evidence that this was being discussed with the placing authority so that this can be shared and agreed within a multi-disciplinary team. Staff spoken with during the visit highlighted a number of concerns in relation to the lack of activities, staffing, communication and support. Whilst the manager was aware of some of the issues, staff still felt little had been done to alleviate the concerns. Staff have raised two concerns directly to the Care Quality Commission relating to gender of staff providing personal care and the lack of choice at meal times. The provider was requested to investigate these concerns. These were clearly recorded in the homes complaint book. It was clear when speaking with staff they could raise concerns to the manager and the deputy. It was clear however, in some of the situations the outcome was not always fed back to the staff. Staff confirmed they had attended training in safeguarding and the management of behaviours that challenge. As part of the safeguarding meeting it was recommended that the staff in addition to attending training with Shaw Healthcare Trust, staff also attend the local councils training. Policies and procedures were in place relating to restraint and the management of aggression as seen on previous visits. Where restraint had been used there were clear records in place detailing the time, the reason, the well being of the person and a review of the incident to ensure that the restraint was used appropriately. The service was in the process of ensuring that where restraint is being used this is agreed with the placing authority. This is good practice and commendable in relation to ensuring an open and transparent service is provided. Each person had a plan of care describing how the individual should be supported with Care Homes for Adults (18-65 years) Page 25 of 45 Evidence: their challenging behaviour including the triggers. A considerable amount of work has been undertaken in this area since the last visit. Plans contained much more information to enable staff to support the individual in a person centred way. Care plans included physical interventions that could be used. From talking with the management it was evident they were still trying to involve other professionals in the decision process on the use of restraint but there has been a reluctance. Staff said restraint was only used as a last resort. It was evident that the high staffing levels and the individualised care plans were having a significant impact on the reduction of challenging incidents. Body charts were maintained of any injury either caused by self injurious behaviour or that from an incident involving another person receiving a care service. These linked with other care documentation including accident records enabling the staff to fully review accidents and injuries. Individual finances were not checked on this visit, however these were discussed and records examined. The manager, the administrator and the deputy have access to the individual persons finances. The manager was observed checking these during the visit. A concern has been raised by a local placing authority on the safeguards to protect individuals finances ensuring that the people retain responsibility for this where possible. Some of the individuals access their money using cash cards with support from deputy, the administrator and the manager. There are risks involved, however measures had been taken to reduce the risks by ensuring cards and pin numbers are kept separately. The manager also demonstrated there were stringent checks in respect of withdrawals by cross referencing all the records available to them including bank statements. The manager had also introduced a new record that details when cards were taken from the home, by whom and the length of time. From the conversations with the operations manager and the manager they were exploring alternative financial arrangements and were liaising with the local placing authority and Shaw Healthcare Finance Department. Records seen relating to finances were well maintained with two staff signatures and receipts obtained for expenditure. Staff have access to petty cash for the use of individuals. Then the administrator on behalf of the individual reimburses petty cash. Staff said that at times there has been insufficient funds to enable individuals to go out as money had been used from petty cash for transport. The manager said that this is kept under review and has recently been increased. Care Homes for Adults (18-65 years) Page 26 of 45 Evidence: It was noted that inventories only detailed clothing, but from observations and conversations it was evident that individuals owned music centres, equipment and furniture. This must be recorded on their inventory of belongings. Care Homes for Adults (18-65 years) Page 27 of 45 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 33a Forest Road provides a clean and safe place to live however it lacks a homely feel in communal areas. It would be beneficial to review the areas in the home where there are high incidents of challenging behaviour taking positive steps to address any issues identified. Evidence: 33a Forest Road is a purpose built building. Each person has a large bedroom, which exceeds the National Minimum Standards. These were furnished to suit the individual and had an area for sleeping and relaxing. All bedrooms have ensuites. Flatlets on the lower floor had access to a private garden. There is one communal lounge which is used by the people living in the home. There are concerns raised in that much of the behaviours that challenge and the incidents that are forwarded to the Commission occur in this area. The room lacks a homely feel, there are no curtains on the windows and minimal furniture. Consideration should be taken to review not only the use of the room but the lay out of the furniture. From talking with the manager it was evident that due to the behaviours that are exhibited it is more difficult to make the environment homely whilst ensuring the safety of the individuals and the staff and there was recognition that this must be done within a risk assessment framework. Care Homes for Adults (18-65 years) Page 28 of 45 Evidence: From the incident reports and discussions with the manager and staff it would appear that the sofas pose a risk and can restrict access when individuals were being challenging. Whilst it was clear from conversations staff now try and seat themselves between the individuals, there was still concerns being raised that the staff could not move around one of the sofas to intervene if individuals were challenging. Staff raised a concern that the smaller lounge area was now an office which has meant that if the lounge was particular noisy, individuals had no other place to go, other than their flatlets. Staff said that this has affected two of the individuals in particular. A foyer area has been made into a quiet seating area, but this was directly above the hot tub and staff were concerned about the odour from the chemicals used. The management stated that the home needed further office space and that previously this area was used only by the staff and rarely by the individuals. Staff highlighted issues about access to the foyer area especially for those who use a wheelchair to move around the home, in addition to the to the hot tub being situated below. One person was observed accessing the foyer area. There was provision in this area for individuals to listen to music or watch television if they wanted. Consideration must be taken to make this area either more appealing or provide additional areas for lounge facilities to be enjoyed when the other lounge is noisy. It was noted during the last visit some attention has been given to make the environment more homely and less institutionalised with pictures being put up in hallways and communal areas. From talking with staff it was evident that this has not caused new risks or objections from any of the individuals. This work must continue to ensure that 33a Forest Road is a comfortable place to live without putting individuals at risk. Call bells were fitted throughout the building so that staff could respond in the event of an emergency. Particular areas which have been identified as hazardous due the lack of visibility have mirrors installed for example in a corridor leading to the office and on a stair well. Furniture was suitable for the individuals and bolted to the floor where there was a risk it could cause injury. Areas of the home were secure with the training kitchen, office, activity room and the main kitchen being locked when not occupied to ensure the safety of the individuals. People in the home were seen accessing their flatlets, the communal areas and the training kitchen. Care Homes for Adults (18-65 years) Page 29 of 45 Evidence: The individuals have access to a hydro pool/hot tub. The manager stated that this was going to be redecorated to make it more relaxing and comfortable for individuals and was proposing a beach scene. One member of staff was painting one of the bedrooms with an underwater/beach scene. The member of staff said that this was to make the bedroom more pleasing for the individual as they do not tolerate pictures or ornaments. This was good practice and demonstrated creativity in supporting the individual. All areas of the home were clean and free from odour. The home was generally in a good state of repair with a rolling programme of decoration. From reading the communication book there has been an ongoing issue with drainage, which has meant that some flooding has occurred in two of the bedrooms. From reading the information and discussions with the manager this has been an ongoing issue from when the home was first built. Shaw Healthcare must investigate and take appropriate action. A member of staff was mopping a flooded bathroom during the busy lunch time period and consequently the person they were supporting was not supported during with their meal. The service employs a domestic to assist with the cleaning of the home. It is evident that the safety of the staff is paramount. Domestic staff attend training in managing challenging behaviour, safe working practices are in place for both the domestic staff and the people living in 33a Forest Road. It was evident from reading care documentation and speaking with staff that the individuals have some responsibility for cleaning of their bedrooms as part of their daily routines. The home employs a maintenance person and records were maintained of repairs. It was evident that there was a good rolling programme of maintenance work including decoration. It was evident that due to some of the behaviours that challenge the environment at times can be subject to wear and tear. There is a communal bathroom which has an assisted bath to aid individuals with a physical disability. There is a lift to access the first floor and handrails are situated throughout the home. In addition the home has obtained a hoist to assist with personal care for one of the individuals. It was evident that advice had been sought from appropriate professionals in respect of specialist equipment. This is ongoing for one individual. The kitchen was found to be clean and well organised. Deep cleaning schedules were in place and records demonstrating good food hygiene practices were being adopted. The home was inspected by an Environmental Health Office in December 2009 and the Care Homes for Adults (18-65 years) Page 30 of 45 Evidence: home was awarded a five star rating. The food was clearly labelled in the fridge except one item and this was immediately rectified. Care Homes for Adults (18-65 years) Page 31 of 45 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing in the home is adequate to meet the needs of the individuals. However concerns are raised in the turnover of staff, the lack of communication and support which is having an effect of the delivery of care and morale of the staff team. Individuals could be at risk due to the poor recruitment information held in the home. Evidence: The care needs of the individuals living at 33a Forest Road are complex so therefore high staffing levels were found to be in place. Each person had a clear plan in relation to the staffing levels that must be in place, as assessed by their placing authority. The staffing levels were a minimum of one to one support with two individuals requiring two whilst in the home, and one person requiring three staff when out in the community and another person requiring two staff when out in the community. 33a Forest Road is a registered care home to provide both personal and nursing care. There is a registered nurse working in the home 24 hours a day. The nurses have either a background in supporting individuals with a learning disability, general nursing or mental health. Four staff spoken with during the visit stated that there had been a recent recruitment drive and many of the staff were new. The Annual Quality Assurance Assessment Care Homes for Adults (18-65 years) Page 32 of 45 Evidence: stated that 23 staff have left in the last twelve months. However when this was discussed with the operations manager and the manager it became apparent that a large proportion of the leavers were bank staff some of these had never worked in the home. A further print out was given which detailed the following over the last twelve months; three team leaders had left, an administrator, a handyman and nine home support workers. The manager said that of the nine home support workers, three had been non starters. This still remains a high staff turnover. There has been a history where the retention of staff has been particularly difficult as noted at previous visits and low morale as a consequence. The manager stated that there has been a recruitment drive not only to fill the vacant posts, but also due to two new individuals moving in to the home. This has meant that the staffing levels have had to be increased to meet the needs of the new individuals. The operations manager stated that there has been a considerable drop in agency use over the last twelve months due to the recruitment initiative. Two members of staff stated the home is a stressful environment, where there was a lack of support, communication and clear direction. They felt the new staff have little empathy and some of the staff have poor communication skills. Three staff said that there were cultural issues within the team with a lot of the staff being from overseas. The latter was confirmed in the Annual Quality Assurance Assessment completed by the provider. Two members of staff were concerned that in the past some staff have spoken in their own language which has meant the individuals living in the home were not able to participate in the conversations. Evidence was seen that the management team were addressing this issue. From talking with a cross section of staff it was evident that there were divisions among the staff not conductive to team working and effective communication. Observations were made on three occasions where some staff were either stood or sat on the outer edges of lounge with little interaction with the people living in the home. However, there were a core group of staff that spoke positively about the individuals living in the home and were observed in positive interactions with the individuals. Other observations included one member who was supporting one person where there was no communication to explain to the individual what the staff member was going to do for example massage or to adjust clothing. This was poor practice and although this staff member was an agency carer it would indicate that they were given little direction to the needs of the person or the expectations of the home. Another member of staff was observed mopping a bathroom when they should have been supporting a person with lunch. Another member of staff was happy to let the inspector enter a Care Homes for Adults (18-65 years) Page 33 of 45 Evidence: bedroom whilst a person was having a bath showing no indication that the persons privacy was being compromised. Recruitment information was seen for five members of staff. Copies of the documentation was held in the home with the originals and the criminal record disclosure being held at the main office for Shaw Healthcare. The copies had been poorly copied in three out of the five so it was difficult to clarify the information. The application form lacked information on employment history. It is strongly recommended that the organisation specify a period of time as most of the applicants had only detailed their present employer. The application form requested two references and stated that we may take up the reference from the last employer. The National Minimum Standards clearly state that this must be taken up. Four of the files seen failed to contain written references, one person only had telephone references. One person had no copies of their recruitment information. They had been working in the home since January 2010. Whilst the operations manager and the manager tried to get the information from the main office this should have been in the home. All recruitment information needs to be reviewed and better organised. There was a form in the front of each member of staffs file detailing when information was received by the main office. The manager stated they do not see all the information to enable them to make a decision on whether to employ as this is done by the personnel department. The manager said it was only when staff commence work that copies of the documentation is forwarded to the home. It would appear that the recruitment jigsaw is not complete for the manager. Compliance had been demonstrated to a requirement from the last visit to ensure staff only commence in post once a criminal record disclosure had been received, or with a POVA first working under full supervision until a criminal record bureau had been confirmed as satisfactory. Staff spoken with during the visit confirmed they had completed an induction. Staff said that during the first two weeks of employment, new staff were supernumerary and shadowed more experienced staff. Staff have a probationary period of six months. Written records on induction were seen for four members of staff, the fifth person was still in the process of completing this. The manager stated that all new staff were in the process of completing the Learning Disability Qualification as part of their induction. From discussions with staff, the manager and the operations manager training has been reviewed for all staff with a plan of action in place to address any shortfalls. The deputy manager was in the process of ensuring all staff have attended Positive Care Homes for Adults (18-65 years) Page 34 of 45 Evidence: Behaviour Management Training. Since the last visit the deputy has attended a train the trainer course to enable her to cascade this to the team. The deputy completes this with another member of staff from Shaw Healthcare and is required to attend annual updates. There were gaps in the training of staff but an action plan was being developed to address the shortfalls. It was difficult to navigate the training records as these were held on computer and a traffic light system was used to inform the manager when training was required for each member of staff. The names of the staff on the computerised record included bank staff who no longer work in the home or staff that have left, which made it very difficult to interpret how the home was doing. The manager stated that in addition to the statutory training staff will be expected to attend epilepsy, autism and mental health training. Since the manager has been in post there has been two meetings in six months. Staff described the lack of communication between the different staff, the lack of key worker group meetings, lack of supervision and support and appraisals. One member of staff said they had worked in the home for five years and has only had one annual appraisal and only one supervision in the last six months. The computerised records demonstrated that regular supervisions were not happening for staff, as did information in recruitment and personnel files. Five members of staff highlighted concerns about the recent shift change to long days and that breaks were not being given. Staff said it was difficult to organise breaks whilst ensuring the safety of individuals living in the home. Staff said they were promised a floating member of staff by the organisation but this had not materialised. Staff said the registered nurses allocate time for breaks, but this has to be organised amongst the home support workers with little direction or support from the staff leading the shift. It was evident that this was effecting the morale of staff. A review must be completed and a risk assessment in respect of staff working long shifts in an environment that potentially is volatile Whilst there was evidence of high sickness levels. The operations manager and the manager stated there were policies and procedures to guide both staff and the management of absenteeism. Four members of staff during the course of the visit reported that they were planning to resign from their posts due to the lack of communication, support and the feeling that nothing gets done when raising concerns about practice or making suggestions to improve the lifestyle of the people living at 33a Forest Road. The manager confirmed Care Homes for Adults (18-65 years) Page 35 of 45 Evidence: that they were aware that three members of staff had resigned and were working their notice period. Staff said although they raise concerns nothing happens from an organisational level. However, all staff commended the manager and the deputy for their support. All staff spoken to said that the manager has an open door policy but is often very busy with the paperwork side of the business. The service must review support mechanisms for staff to ensure they are better supported and listened too including the retention of staff. Care Homes for Adults (18-65 years) Page 36 of 45 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 new manager has gained the trust of the staff and is working steadily to move the service forward. However staff morale, the lack of communication and clear roles for staff are having a detrimental effect on the way the home is managed. The safety of the individuals living in the home is given priority, this could be further enhanced with regular and routine involvement of staff participating in fire drills. Evidence: The service has been without a registered manager since December 2007. During this period there has been temporary managers from other homes assisting with the management tasks. A manager was employed in September 2008 but left employment twelve months later before being registered with the Care Quality Commission as the registered manager. A new manager commenced in post in September 2009. At the time of the visit they were in the process of submitting an application to the Care Quality Commission to become the registered manager. The manager has kept the Care Quality Commission informed of the reasons for the delay in submission of the application. Care Homes for Adults (18-65 years) Page 37 of 45 Evidence: The newly appointed manager has worked for Shaw Healthcare for approximately twelve months. The manager is a registered general and mental health nurse and has worked in senior posts. Staff spoke positively about the approachability of the manager and the deputy manager. The manager was aware of the issues raised by staff during the course of the visit and has taken some action to address some of them. However, there was still much work to be completed to ensure that the quality of the service provision improves and to boost the morale and consistent approach of staff. The manager has developed an action plan to address the issues in the home, however this lacked timescales so it would be difficult to monitor progress. Quality Assurance systems were in place and regular audits were being completed on the environment, finances, medication, care planning, complaints, staff support mechanisms and staff training. Shaw Healthcare have a Quality Board that assist in reviewing the information on a monthly basis and complete audits in the home. In addition the operations manager visits the home on a monthly basis in respect of regulation 26 visits. Records were maintained of the visits. From the visits it was evident that the operations manager was agreeing targets and developing an action plan with the manager. Views of relatives and individuals were sought during care reviews as seen in care documentation and annual questionnaires as seen at the last visit. There were good systems in place to ensure the safety of the people using the service and the staff. Information was accessible to staff, including policies and procedures and risk assessments. Routine checks on the premises were being completed including the testing of the gas appliances and electrical equipment as evidenced in the Annual Quality Assurance Assessment completed by the manager and certificates seen during the visit. Other checks included water temperature checks, daily food and freezer temperatures and checks on the equipment in use in the home including the hoist, the vehicle and the lift. Records were maintained of these. Fire Records were checked. The local fire brigade visited the service in September 2009 and an action plan was requested in relation to the checking of the fire Equipment. From the records it was evident that this was now taking place. However, in the absence of the manager this was not being completed. A requirement from the last visit was to ensure that all staff attend a fire drill once in a six month period. There are 42 members of staff working in 33a Forest Road and it was evident that the manager has commenced the process. However, 9 staff had still Care Homes for Adults (18-65 years) Page 38 of 45 Evidence: not completed a fire drill in the last six months. This must be completed. Staff attend fire training at regular intervals. A newly appointed member of staff said the fire was discussed during their induction. Care Homes for Adults (18-65 years) Page 39 of 45 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 42 23 For all staff to take part in a 16/07/2009 fire drill at least once in a six month period. Ensuring staff have an awareness of the procedure to follow in the event of a fire. Care Homes for Adults (18-65 years) Page 40 of 45 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 6 12 Ensure that care plans include individuals aspirations and long term goals. To offer the individuals fulfillment. 25/06/2010 2 10 17 Ensure that the 25/06/2010 confidentiality is maintained. Ensure that care files are held securely. Respecting the privacy of the individuals. 3 12 13 Ensure adequate staffing is in place including transport drivers to ensure that activities for individuals continue. Enabling individuals to make full use of the community. 28/05/2010 4 17 12 Ensure individuals have a healthy balanced diet. 25/05/2010 Care Homes for Adults (18-65 years) Page 41 of 45 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 Improving the health of the individuals. 5 23 17 For individuals to have an inventory of belongings including furniture and electrical goods. To better protect individuals. 6 24 24 To review the environment 30/04/2010 to make more homely within a risk assessment framework. Looking at potential areas where there are incidents of aggression. Making it more comfortable for the individuals living there. 7 33 18 Risk assess staff working long days to ensure it is suitable for the care environment. Ensuring the health and safety of the individuals and staff is maintained. 8 34 19 Ensure two written references are in place prior to a member of staff commencing in post. One must be the last employer. Ensuring staff are suitable to work with vulnerable adults. 30/04/2010 27/05/2010 28/05/2010 Care Homes for Adults (18-65 years) Page 42 of 45 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 9 34 19 Ensure that recruitment information is held in the home and available to the manager. Better safeguarding the individuals. 30/04/2010 10 36 18 Ensure staff are suitably supervised. Ensuring staff have clear direction and support meaning a consistent approach to the individuals living in the home. 30/04/2010 11 42 24A Ensure staff participate in regular fire drills at least once in a six month period. Ensuring the staff have a good understanding of the procedure to follow and better protecting the individuals in the event of a fire. 22/04/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 6 12 17 Review the care planning format to ensure it is accessible to individuals living in the home Review of the daily recording to see if can be simplified so that staff can record on one central record. For the menu to be more accessible to individuals offering a choice of food on a daily basis. Page 43 of 45 Care Homes for Adults (18-65 years) 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 4 5 22 24 Explore how staff can effectively raise concerns within the home and how feedback can be given where possible. To review the seating arrangements in the large lounge area to minimise the hazards in relation to supporting individuals and ensuring their safety in the event of behaviours that challenge. Risk assess the small area that is used as quiet area for individuals in relation to the stairs leading to the hydro pool including whether there is a hazard with the chemicals and if this area continues to be used make more comfortable and homely. Ensure there are suitable curtains in the lounge area within a risk assessment framework. For the management team to ensure that the equalities and diversity in the team is better managed. To ensure that there are mechanims for staff to feel supported and listened to, this should include regular staff meetings and key worker group meetings. For the organisation to review the application form to make sure it is clear the length of employment history that the applicant should specify. To clearly state that two references are required and one being from they last employer. For staff to have supervisions at least six per year and an annual appraisal. 6 24 7 8 9 24 33 33 10 34 11 36 Care Homes for Adults (18-65 years) Page 44 of 45 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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