Care Home: 36 Shooters Avenue

Similar services:

• Ashlong House
• Norbury Crescent (30)
• Edenvale
• Wadham Avenue
• Chatsworth Care - Dawson House
• Cowden Road, 52 - 54
• Chatsworth Care - Tudor Lodge
• Foxley Lane (121a)

What the care home does well The care home has a very welcoming atmosphere. The acting manager is experienced, and competent, and knows the people using the service very well. It is evident that she aims to provide a quality service to all the people using the service. People using the service are supported to have the contact that they wish with relatives and friends. People using the service spoke positively about the staff and of living in the care home. They told us that they are supported to make choices. They informed us that they enjoyed the activities that they participated in. What has improved since the last inspection? Requirements from the previous inspection have been fully or partially met. Care plans and the risk assessment of people using the service have been reviewed and further developed. What the care home could do better: The environment could be improved. The communal areas could be more clean and should be de-cluttered to ensure that the environment is always attractive and safe for people using the service. The garden could be better maintained. There could be better evidence that staff receive on-going up to date training to ensure that their skills are always up to date, and further developed. One to one formal staff supervision needs to take place regularly, and be recorded. Staffing numbers in the home need to be reviewed to ensure that it is evident that the acting manager has support in carrying out the day to day management responsibilities of the service as well as the other duties i.e. cleaning, cooking, and providing support and care for the people using the service. Complaints and `concerns` could be better recorded. The format of some documentation could be improved to ensure that the information is accessible as possible to people using the service who might have difficulty reading, an/or visual sensory needs. The `person centred` documentation of the care plans and each person`s health action plan should be fully completed and it be evident that they are `working` tools, central to and led by each person living in the care home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 36 Shooters Avenue 36 Shooters Avenue Kenton, Harrow Middlesex HA3 9BG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Judith Brindle     Date: 1 8 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 38 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 38 Information about the care home Name of care home: Address: 36 Shooters Avenue 36 Shooters Avenue Kenton, Harrow Middlesex HA3 9BG 02089078270 02084270458 QSCC1@bt.conig.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Quality Family -Based Community Care care home 3 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 3 The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home 36 Shooters Avenue is a care home providing personal care and accommodation for three people who have a learning disability. The home is owned and run by Quality Family-Based Community Care (QFBCC), a local private and independent care service provider. The home has 24-hour staffing, including one staff member sleeping-over at night. It has been operating since 2001. The home is located within a residential area of Kenton, part of the London Borough of Harrow. The home is close to local shops and bus links. Parking restrictions do not apply on the road outside the home. The house is semi detached and is in keeping with other houses in the locality. Two of the bedrooms are on the first floor, with the other is on the ground floor. All are single Care Homes for Adults (18-65 years) Page 4 of 38 Brief description of the care home rooms, fully furnished, with built-in washbasins. The home has one bathroom with an adapted shower facility. There are toilet facilities on each floor. Access to the first floor is by the stairs only. The home has a kitchen, a lounge, and a large rear garden. Information/documentation about the service provided by the care home and the fees is available from the owner of the care home. Care Homes for Adults (18-65 years) Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced inspection of 26 Shooters Avenue took place during six hours throughout a day in June 2009. The last inspection of this service was completed on the 15th July 2008. There were no vacancies at the time of the inspection. We were pleased to meet and talk to all the people living in the home (some communicated with us by using sounds and gestures). The acting manager was present during all of the inspection. The owner/responsible individual was also present for part of the inspection. A number of feedback surveys for people using the service and others, including health professionals were supplied to the care home prior to the inspection. At the time of writing this report the Commission had not had any returned to us. Documentation Care Homes for Adults (18-65 years) Page 6 of 38 inspected included, residents care plans, risk assessments, residents financial records, and some policies and procedures. The inspection included a tour of the premises, and observation was also significant tool used in the inspection process. Assessment as to whether the requirements and the recommendations from the previous key inspection (15th July 2008) had been met, also took place during the key unannounced inspection. 28 National Minimum Standards for Adults, including Key Standards, were inspected during this inspection. Prior to this unannounced key inspection the registered manager supplied the Commission with a completed Annual Quality Assurance Assessment (AQAA) document. This record includes required information from the registered manager about the quality of the care home, and the planned improvements for the service. This document gave us some information about the service but could have been completed in more detail, and be better linked to the key standards within each section of the document. Reference to some aspects of this AQAA record is documented in this report. The inspector thanks the people living in the care home, and staff for their assistance in the inspection process. 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 set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 38 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 38 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 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service have the information needed to choose a home that will meet their needs. There have been no residents admitted to the home since the previous inspection so a judgement could not be made with regard to whether prospective residents have their needs assessed, with their full participation, prior to moving into the care home. Evidence: The home has an accessible up to date (reviewed 20/04/2009) written service user guide and statement of purpose which include information about the service provided by the care home. The format of the up to date service user guide should be developed (audio, picture and Braille) to improve its accessibility to people using the service who might have difficulty in reading and or have sensory needs. This was a previous recommendation. We were shown an up to date statement of purpose. A copy of a previous statement of purpose was found in a care plan, and this referred to a property next door to the care home that was once a registered care home owned by the provider. This person using the service (and other residents) should be supplied Care Homes for Adults (18-65 years) Page 11 of 38 Evidence: with an up to date copy of the service user guide, which is in an accessible format. The home has a referral and admission policy. AQAA (Annual Quality Assurance Assessment) information told us that this had been reviewed in April 2009. There have been no residents admitted to the home since the previous key inspection, and there are no vacancies. We were told by the acting manager that a comprehensive initial assessment of a prospective resident would be carried out by a senior suitably qualified member of staff member, with full participation from the prospective resident. This had not been evident during the previous key inspection, but looking at the care plan of the most recently admitted resident it indicated to us that this person had had their needs assessed, and that these needs had been recently reviewed. We were told that the referral and transition process, of a person moving into the home, is flexible in accordance to the needs of the prospective resident, and that the number and kind of visits to the care home are discussed and agreed with the person (and family members if agreed by that person). Care Homes for Adults (18-65 years) Page 12 of 38 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. People using the service have an individual plan of their needs, which includes details of the care and support that they require from staff. Care plans could be more person centred. People using the service are supported, and encouraged to make decisions and choices about their lives, and are supported to take risks as part of an independent lifestyle. Evidence: Each person using the service has a plan of care. We looked at all three care plans. These care plans are based upon assessment of the persons needs. This assessment includes persons health, medication, behaviour, personal care skills, cultural/religious needs, community presence, personal relationships, and finance needs. There was some written guidance to ensure that these recorded needs of each resident are met through staff support. We were told by the owner that the care plans are in the process of being further developed to include more comprehensive person centred (where the plan is central to the person using the service and led by them) information Care Homes for Adults (18-65 years) Page 13 of 38 Evidence: about the person using the service. We saw some documents which included My Life Plan and a person centred profile. These included information/sections in picture format and they covered a number of areas that could be important to each person using the service, but they had not been finished, and some of these documents had not been filled in with information about the person at all. We were told that there were plans to ensure that each of these records was to be completed with each person using the service over a period of time. If these are completed (with the person using the service), they could be working tools and useful and important records about each persons wishes and needs, and of how these needs could be met by the service. These records should be completed. It was evident that the support plans (care plans) and the persons goals had been recently reviewed (with the person using the service and family members), and are reviewed approximately every six months, and that some care plan review meetings included the funding Authority Care Manager. The support plans included a number of risk assessments with staff guidance, which were linked with the persons needs, such as mobility needs, independence , personal care, road safety, and out in the community needs. We were told that there was guidance to minimise these risks to support the person using the service to enable them to lead a quality life as independently as the are able to. It was evident that these risk assessments had been improved since the previous inspection. People using the service spoke positively about the staff. They confirmed that staff actively provide them with one to one support, and assisted them with meeting their needs, including personal care needs, as well as shopping for personal items. A resident told us about the shops where he goes with staff to buy clothes and toiletries. He confirmed that he can choose what to buy and where to purchase the items. We were told by a resident of the other choices that he made. Examples of these included deciding when to go to bed and when to get up in the morning, a person using the service commented that he had a lie in at weekends. Other decisions that residents spoke of (or indicated that they made) included; choosing their own clothes, meals, and bedroom furnishings. Staff were seen to offer residents a number of choices during the inspection, and to respect the decisions that the residents made. AQAA told us that the home has a management of service users money, valuables and financial affairs policy/procedure which was reviewed in April 2009. We were told by the owner that all the people using the service have support with the management of their finances. One resident has their finances managed by a solicitor. Another manages his/her own money with minimal support from staff. Another resident is presently having their finances managed by the owner/responsible individual, but we were told by the owners that this is under review with the funding Local Authority, with the aim that the Local Authority manages the persons finances in the future. This is positive, because the owner/responsible individual should only become agent with Care Homes for Adults (18-65 years) Page 14 of 38 Evidence: regard to a residents finances where there is no other person outside the service available. So minimise the risk of financial safeguarding issues. We viewed residents financial records. These were up to date and included records of expenditure. The acting manager told us that she carries out ongoing monitoring of each persons finances, and that there are also monthly checks of these records. Care Homes for Adults (18-65 years) Page 15 of 38 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle, and are supported to develop their life skills. The people living in the care home have their rights respected, and their responsibilities are recognised in their daily lives. Meals are varied, and wholesome, and chosen by people using the service. Evidence: A person using the service told us of the activities that they participated in and enjoyed. These activities included taking part in a variety of leisure pursuits at resource centres, and a club (that met this persons cultural needs). Residents spoke (and/or indicated via gestures and some words) of enjoying meeting friends and others at the resource centre that they attend several days per week. We were told that a resident is presently completing a cooking course at a local college. Other Care Homes for Adults (18-65 years) Page 16 of 38 Evidence: activities included shopping for clothes, and food items, going to the local hairdresser, buying their toiletries, making snacks, watching soaps on television, participating in some household chores, and listening to music. The acting manager told us that activities, and leisure pursuits are flexible, and chosen by the people using the service, and that residents participate in the community, by accessing amenities, and facilities. AQAA told us that the home includes service users in discussions concerning preferences for meals, holidays, and what they would like to do on days off from clubs, activities and work at the weekends. It was evident from talking with the acting manager that she had knowledge and understanding of each persons activity preferences including a resident who sometimes lacked confidence going out into the community. We were told (and saw during the inspection) that residents use dial a ride community transport to access some community facilities. Residents told us that they enjoy festivals and celebrations including Christmas (and other religious days), New Years eve, and birthdays. AQAA told us that we support service users to attend respective churches. Staff told us that a resident carries out a volunteer job regularly at a local church. A letter was seen from the church which told us about the positive role that this resident carried out at the church. We were told by a staff member that a resident enjoys using (with staff support) a lap top computer. A resident was seen to take part in daily living activities including some domestic tasks such as tidying up and cleaning some communal areas of the home. He indicated to us that he tidies his own bedroom. The visitors book confirmed that there are visitors to the care home. It was evident from talking with staff and a person using the service that the home supports residents to develop and actively maintain relationships (if they wish) with family and friends. A resident told us about a relative visiting, and of regular phone calls with that person. AQAA told us that the home does not have a pre planned menu as this reduces choice. We were told by the acting manager that residents choose what to eat each day. Meals recorded indicated that the residents receive a varied wholesome menu. A resident spoke of enjoying the meals. Two residents indicated that they had chosen their breakfast during the inspection. Another resident was seen to eat a variety of fresh fruit for breakfast. Staff told us of the support that a resident needs with their meals, due to his/her changing needs. The kitchen included storage of some fresh, frozen, dried and canned food items. The acting manager showed us a shopping list, and told us that food shopping was planned to be carried out (with residents) later that day. A person using the service told us that residents had a choice of snacks when they wished. The acting manager told us of how staff get to know what a resident (who has communication/speech/visual needs) likes to eat. A resident who stayed at home during the inspection was seen to be offered drinks and meals throughout the inspection. Care Homes for Adults (18-65 years) Page 17 of 38 Care Homes for Adults (18-65 years) Page 18 of 38 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs, and the principles of respect, dignity, and privacy are put into practice. The recording of residents contact/appointments with health care professionals could be better. Systems are in place to ensure that medication is stored, and administered safely to people using the service. Evidence: It was evident from talking with staff, residents, and from general observation and looking at records that staff have knowledge, and understanding of the importance of ensuring that the residents have their personal care needs assessed and met. Records and residents told us that they receive varied support from staff with their personal care needs. A resident told us that he/she was happy with the way that staff deliver care, and confirmed that he/she was respected by staff. AQAA told us that the home has a values of privacy, dignity, choice fulfillment, rights and independence policy/procedure. The care plans that were looked at, included some evidence of Health Action Plans of each person, but these were not fully completed. Each resident Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: should have a comprehensive up to date health action plan. AQAA told us that the home aims to build on the maintenance of health care plans. This should take place. We were told that advice was sought as and when required from health care professionals, and that referrals were made in accordance to residents needs, and their changing needs. Treatment and care for residents from some health care professionals including the GP, chiropodist, and optician, were recorded. Though we were told by the acting manager that residents receive care and treatment from a number of other health care professionals and we were given an example of a resident recently seeing the dentist. It was not easy to access recorded evidence of when these appointments/contact take place. The recording of residents health care appointments could be better, and be accessible in their plan of care. A resident told us that he had remained well for a lengthy period of time and had not needed to see a GP. AQAA told us that the home has an up to date medication policy. We were told that all the people using the service require support with taking their prescribed medication. Medication is stored securely. The medication storage, and administration systems were inspected. Medication administration records looked at were up to date. The acting manager told us that all staff administering medication to people using the service have received medication training from a pharmacist, and have receive an in house medication assessment to ensure that they are competent to administer medication to people using the service. There have been no new staff employed in the home since the previous key inspection. Care Homes for Adults (18-65 years) Page 20 of 38 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service, have access to an effective, robust complaints procedure, and are protected from abuse, and have their rights protected. It could be more evident that residents are fully supported to express any concerns that they may have, which are then listened to, and acted upon. The recording of complaints could be better. Evidence: The care home has an up to date complaints procedure (which was supplied to us following the key unannounced inspection), in written format, a summary of which is recorded in the service user guide. The complaints procedure includes timescales with regard to responding to a complaint. During a previous key inspection we noted that the care home has a copy of the complaints procedure in Braille, which a resident could access. It should also be in an accessible format (i.e. audio, picture format) to other residents that might have difficulty in reading. This is a previous recommendation. AQAA told us that the home responds very well to suggestions and concerns raised by our service users, and that the home has regular resident meetings where suggestions or concerns are raised and responded to, and are minuted. AQAA told us that the home tries to anticipate concerns or complaints before they happen, and that there had been one complaint within the last twelve months and that it had been resolved within 28 days. The record of this complaint (despite the acting manager looking for it) was not accessible at the time of the Care Homes for Adults (18-65 years) Page 21 of 38 Evidence: inspection. All complaints need to be recorded (and available to for inspection) to ensure that it is evident that people making a complaint are listened to and that the complaints procedure is being followed, and that appropriate action is taken. A resident told us that he would speak to his relative or staff if he had a concern or complaint. The home should look at developing systems to ensure that any residents concerns are recorded and acted upon as required. This was a previous recommendation. AQAA told us that the home has policies and procedures with regard to the protection of people using the service. We were shown this policy during the inspection. The acting manager told us that staff had received safeguarding adults training, so that they knew what action that they need to take if there is an allegation or suspicion of abuse. AQAA also told us that the home has policies with regard to counter bullying, dealing with violence and aggression, equal opportunities, diversity, anti-oppressive practice and whistle blowing. There are procedures in place for ensuring that accidents/incidents are recorded and reported appropriately. Care Homes for Adults (18-65 years) Page 22 of 38 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. The layout of the home is suitable with regard to meeting the needs of people using the service, but the environment could be cleaner and better maintained to ensure that it is a comfortable and attractive for people using the service. Residents bedrooms, meet their individual needs, and are individually personalised. Evidence: The house is in-keeping with other houses in the location, and it is situated close to local bus transport facilities and amenities. The inspection included a tour of the premises. At the start of the inspection we observed that the front of the premises was not attractive, the flower bed on the forecourt was weedy. Also the front door is in need of re-varnishing, and the window ledges, were observed to have chipped paintwork, which should be cleaned and re-painted to make the entrance to the home more welcoming and attractive. During the inspection the acting manager removed the weeds from the flower bed, which made it look better. The home could look into purchasing (with residents) some bedding plants for this area of the home. The back garden raised flower beds also had a significant number of weeds. The garden should be a more attractive environment for people using the service. Care Homes for Adults (18-65 years) Page 23 of 38 Evidence: The living environment at the start of the inspection was seen to be cluttered, untidy and not clean in some areas, including the sitting room coffee table (which had marks over it), radiator cover ledges and some floors including in the dining room. It was evident that some items in the sitting room/lounge area did not belong to residents. These included some reels of tape, and a babys toy. Cushions on the sofa looked worn, curtains in the dining room area were stained in some areas, and the dining chairs (which we were told had been purchased since the last key inspection) had some finger marks on them, and some furnishings were dusty, and the stair carpet was dusty and stained. There were also some vases with dead flowers in them, located in the communal areas. This environment was commented on by us during the inspection and a significant amount of cleaning and de;cluttering was carried out by staff (mainly the acting manager) during the inspection, which resulted in the environment being much cleaner and more de-cluttered. The small office/sleep in room was also untidy and cluttered. The acting manager told us that she had planned to carry out a spring clean of the home. The light switch cord in a bathroom should be cleaned or replaced, and the paintwork above the bathroom tiles is flaking. Following the inspection the acting manager told us that she had been out shopping with all the residents and had purchased new cushions, and pictures for the home,which she told us had been chosen by people using the service. She also told us that she had carried out further cleaning of the home and washed the dining room curtains which she told us were now looking very nice. The acting manager said that she was going (on the day that she telephoned) out with residents to purchase new stair carpet, and she confirmed that the cleaning of the communal areas in the home would continue to improve and that the environment would always be clean. The acting manager also told us that paint had been purchased for the redecoration of the care home. This should take place. The home could develop a household task check list to ensure that cleaning duties are all carried out. It seems to be evident from talking to the acting manager that she carries out the majority of cleaning duties in the home. There needs to be a review of staffing numbers to ensure that there are sufficient staff at all times to carry out the cleaning duties in the home, and if necessary a staff member be employed to carry out domestic/household duties in the home. There is a large garden (shared by the next door care home that is owned by the provider) with raised vegetable beds. The garden was very weedy, and should be better maintained. This was a previous recommendation. There was garden furniture located in the home. AQAA told us that the home intends to focus on the garden and wood bark over areas that are prone to weeds, and plan and encourage service users Care Homes for Adults (18-65 years) Page 24 of 38 Evidence: to plant flowers in pots, and to improve the appearance of the garden. The home has one bedroom on the ground floor and two located upstairs. A resident kindly showed us his/her bedroom. It was individually personalised. He/she indicated that he was happy with his bedroom, and cleaned and tidied it himself. Other bedrooms looked similarly furnished, and included a variety of personal possessions. There was several items of equipment (including two computers) on the landing of the stairs, which looked unsightly and could be a hazard (trip hazard) or risk of knocking themselves on it) to people using the service and others. The issue of removing items that were not in use was discussed with the acting manager. She told us that she would look into this. This was a previous recommendation. There needs to be a risk assessment with regard to these items being located on the small landing, and if these items are not in use they should be removed. The laundering facilities are located away from the food preparation area in the home. Suitable hand washing facilities, and paper towels, are located throughout the home. AQAA told us that the home has a policy for preventing infection and managing infection control, and that one staff member had received training on the prevention of infection and management of infection control. All staff need to receive this training and possibly (depending when this training took place) refresher infection control training be provided to the staff member who has completed the course. Care Homes for Adults (18-65 years) Page 25 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home receive some training, and support, but this could be better. A review of staffing is needed to ensure that it is evident that there are sufficient numbers of staff to support the people using the service. Evidence: We were told by the acting manager that there were sufficient staff on duty at all times to ensure that the varied needs of people using the service are met. We were shown a record of the shifts worked by staff. We were told that there were three staff who are presently working in the home (due to other staff being on various kinds of leave). The three staff include the acting manager, and the owner/responsible individual. We were told by the acting manager that that there is usually one staff member on duty. The acting manager and records told us that she generally works six days a week, another staff member generally carries out sleep in duties. There needs to be a staffing review (see environment section of this report), and systems in place to ensure that it is evident that there are sufficient staff on duty at all times to meet the needs of the people using the service, carry out domestic and numerous management duties, and be able to support each resident with their choice of activities including one Care Homes for Adults (18-65 years) Page 26 of 38 Evidence: to one activities, and meet the Working Time Regulations 1998 (and Amendments) Legislation with regard to the number of hours each staff member works. It was evident that the staff know the residents very well, particularly with regard to each persons individual and varied needs. Residents were positive about the staff, and it was noted during the inspection that staff interaction with people using the service was sensitive and respectful. AQAA told us that 75 of the staff team have completed or are in the process of achieving National Vocational Qualification (NVQ) level 2 or above in health and care, and that there is a staff development programme and staff induction training that meets the National Minimum Standards for the service. The acting manager was unable to locate staff training records during the inspection, but we were supplied with some information with regard to staff training following the inspection. From this information it was evident that one staff member (the registered Responsible Individual for the organisation) had completed a number of relevant and appropriate training courses to ensure that they have the skills and knowledge to carry out their roles and responsibilities. Training that other staff had received included refresher health and safety training, first aid and training in safe food handling. We were told following the inspection that there was further training planned for staff which included understanding Principles of Care, understanding the organisation and the role of the worker, communicating effectively, and recognising and responding to abuse and neglect. There were no dates given of this planned training, nor of the training that two staff had received. It should be more evident that staff (including the acting manager) are receiving up to date and on going training to ensure that staff maintain and develop the skills that they need to meet the needs of people using the service. The acting manager told us that the responsible individual was doing a training course with regard to the Mental Capacity Act 2005/Deprivation of Liberty Safeguards, and of its relevance to people using the service and staff. All staff should receive Mental Capacity Act 2005/Deprivation of Liberty Safeguards training, so that they gain understanding of its significance with regard to people using the service. AQAA told us that the care home has an up to date recruitment and employment policy/procedure. We were told that there have been no staff recruited since the previous key unannounced inspection, and as the staff personnel files were assessed at that time, the files were not looked at during this inspection. The acting manager told us that she does receive regular informal staff supervision from her line manager (the owner/responsible individual). Records of one to one formal one to one staff supervision were looked at, and the most recent record seen Care Homes for Adults (18-65 years) Page 27 of 38 Evidence: was for January 2009. It needs to be evident that each member of staff receives regular one to one staff supervision, (which is recorded) to ensure that they have the support that they need to carry out their jobs, and that these should take place at least six times a year to meet the National Minimum Standards for the service Care Homes for Adults (18-65 years) Page 28 of 38 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 management, and administration of the home is based on openness, and respect. Some quality assurance systems could be better developed to ensure that a quality service is provided to people using the service at all times. The health, safety and welfare of people using the service is reasonably promoted and protected, but there are aspects of the service that could be better. Evidence: The home does not have a registered manager. When we last inspected we were told by the acting manager that she had considered applying for manager registration with us, but due to the probability of imminent changes to the service, and the care homes planned de-registration, she had decided that she would not go ahead with the process. As the home is at present still registered with us, the owner/responsible individual should look into putting in an application for a manager to register with us. It was evident that the acting manager has the necessary experience to run the home, and that she knows the residents very well, and that she works hard to provide them Care Homes for Adults (18-65 years) Page 29 of 38 Evidence: with the care and support that they need. But it is also evident from talking with her and from records that she is carrying out a number of duties that include, cleaning the home, cooking meals for residents, carrying out activities with residents, shopping, up dating records, caring and supporting people who use the service as well as carrying out management duties. There needs to be a review of the staffing in the home (see the staffing section of this report, National Minimum Standard 33) so that it is evident that the home has an effective staff team, with sufficient numbers to ensure that the needs of people using the service are met, and that management duties are carried out. The acting manager is aware that there are a number of areas where the home needs to improve, particularly with regard to recording, staff training, staff supervision, maintaining the cleanliness of the home and improving the attractiveness of the interior and exterior of the care home. We were told that the home has a quality assurance procedure/policy, and that a business plan was to be completed. The responsible individual told us that the AQAA would be used as a tool for monitoring the quality of the service provided to people using the service. AQAA told us that the home will introduce questionnaires for service users. Ensuring that they are clear and available in different formats. This should be put in place so that the home has a formal forum for residents to communicate their views of the service. We were told that people using the service have the opportunity to participate in resident meetings. AQAA told us that the home has required health and safety policies and procedures which are up to date. We saw that the home has some health and safety risk assessments, which include recorded control measures. Records told us that monthly health and safety checks of the service are carried out. During the inspection a large cooling fan was seen to be located in the sitting room. The home should be aware of the possible health and safety issues of the positioning of cooling fans in the home, ie trailing wiring, knocking into it, leaving it on. If needed in the home there needs to be a risk assessment with guidance to minimise the risk of residents and others being harmed by it. This was discussed with a staff member who chose to remove the fan from the home. AQAA told us that told us that equipment in the home is regularly serviced/checked by appropriate persons. Fridge/freezer temperatures are monitored. Hot water temperatures are also monitored. Fire drills were recorded. The service needs to have evidence that there is an emergency plan in the home, Care Homes for Adults (18-65 years) Page 30 of 38 Evidence: which includes recorded guidance with regard to the response needed to be taken by staff if there is an emergency/health and safety issue in the home, such as a gas leak, electrical concerns, out break of flu (i.e. swine flu) etc. The home had a food safety inspection carried out by an Environmental Health Officer in 2008. The acting manager told us that the recommendations from this had been met by the home. The home has an up to date employers liability insurance certificate displayed. Care Homes for Adults (18-65 years) Page 31 of 38 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 32 of 38 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 26 18 All staff need to receive 01/09/2009 training on the prevention of infection and the management of infection control, and/or refresher infection control training. To ensure that staff have knowledge and understanding of how to prevent infection and manage infection control, to keep people using the service and others safe. 2 24 13 There needs to be a risk 01/09/2009 assessment with regard to the items located on the small landing, and they need to be removed if assessed as a risk to people using the service and others. To ensure that any risk to the health and safety of people using the service (including people with visual sensory needs) is assessed, and that action is taken by Care Homes for Adults (18-65 years) Page 33 of 38 staff to minimise any risk to people. 3 24 23 The communal areas of the 01/09/2009 care home need to be clean, at all times. To ensure that the home environment is always attractive and safe for people using the service. 4 22 17 All complaints need to be 01/09/2009 recorded and available to for inspection. To ensure that it is evident that people making a complaint are listened to and that the complaints procedure is being followed, and that appropriate action is taken in response to all complaints. 5 33 18 There needs to be a review 01/09/2009 of staffing needs in the home, and systems be in place to ensure that it is evident that there are sufficient staff on duty at all times to meet the needs of the people using the service, carry out domestic duties, and the numerous management duties, and meet the Working Time Regulations 1998 (and Amendments) Legislation with regard to the number of hours each staff member works. To ensure that it is evident that the home has an effective staff team, with Care Homes for Adults (18-65 years) Page 34 of 38 sufficient numbers and skills to meet the needs of the people using the service, and to carry out the general duties of running the service. 6 36 18 It needs to be evident that each member of staff receives regular one to one staff supervision, which is recorded. To ensure that they have the support that they need to carry out their roles and responsibilities, in meeting the needs of people using the service. 7 42 13 The service needs to have 01/09/2009 evidence that there is an emergency plan in the home, which includes recorded guidance with regard to the response needed to be taken by staff if there is an emergency/health and safety issue in the home, such as a gas leak, electrical concerns, out break of flu (ie swine flu) etc. To ensure that it is evident that the health and welfare needs of people using the service and others are met. 01/09/2009 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 Care Homes for Adults (18-65 years) Page 35 of 38 1 1 The format of the up to date service user guide should be developed (audio, picture and Braille) to improve its accessibility to people using the service who might have difficulty in reading and or have visual sensory needs. The care plans should be more evident of being person centred, and the documents with regard to this should be completed with each resident. So that it is evident that each residents needs and wishes are led by them and central to their plan of care. The responsible individual/owner should only be agent with regard to a residents finances where there is no other person outside the service available. So minimise the risk of financial safeguarding issues. There should be better recording of the health care treatment and care received by people using the service, and of the health care appointments appointments attended by them. The health action plans of the people using the service should be up to date and fully completed. The sitting room, upstairs landing, and the office should be de-cluttered and any equipment or items not in use and/or not belonging to people using the service should be removed. The complaints procedure should also be in an accessible format (i.e. audio, picture format) to people using the service who might have difficulty in reading. It is recommended that the registered person develop systems to ensure that any residents concerns are recorded and acted upon as required. 2 6 3 7 4 19 5 24 6 22 7 24 The garden should be better maintained so that it is a more attractive environment for people using the service. Several areas of the home could be redecorated, window frames and some areas in the bathroom where the paint is chipped should be re-painted, a bathroom light switch cord should be cleaned or replaced, and the front door could be re-varnished. 8 35 It should be more evident that staff (including the acting manager) are receiving up to date and on going training to ensure that staff maintain and develop the skills that they need to meet the needs of people using the service. All staff should receive Mental Capacity Act 2005/Deprivation of Liberty Safeguards training. So that they have knowledge and understanding of its significance to people using the service. Page 36 of 38 9 35 Care Homes for Adults (18-65 years) 10 11 37 39 The owner /responsible individual should look into putting in an application for a manager to register with us. Feedback questionnaires in an accessible format should be provided annually to people using the service, so that they can have a formal opportunity to communicate their views of the service provided to them. Care Homes for Adults (18-65 years) Page 37 of 38 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 38 of 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!