Care Home: 3a The Droveway

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What the care home does well The lively and welcoming environment at 3A The Droveway reflects the commitment and motivation of the deputy manager and the dedicated core support staff. The welfare of both service users is clearly of paramount importance and staff have worked hard through difficult times to ensure that their complex care and support needs are met. The well maintained decor and good quality furniture and furnishings continues to provide a comfortable and pleasant environment for service users. Communication and consultation with service users` family members is effective and ongoing. Relatives have the opportunity to partake in individual care planning and reviewing processes. What has improved since the last inspection? Policies and procedures relating to the control of medication have been reviewed and updated. Staff recruitment policies and procedures have also been reviewed and improved. The introduction of online training (E Learning) for all support staff has proved to be both successful and popular. Specific training relating to Safeguarding Vulnerable Adults has been provided for alll support staff, as required, since the previous inspection. A `Communication Passport` has also been developed which is a useful and practical guide to help support workers, health care professionals and others in the community to communicate with and better understand the individual service user. What the care home could do better: Following a `chaotic` and poorly managed transition programme, relating to a service user moving into the home earlier this year, it is essential that improvements are made to the admission process. The current pollicy and procedure, including pre admission assessment, was evidently not adhered to. Identified shortfalls, including the lack of any direct involvement of the manager and concerns over staffing levels, must be addressed. It is also important that service users` support plans, including risk assessments and staff guidelines, are regularly reviewed and updated so as to accurately reflect the individual`s changing care and support needs. Despite menus evidently reflecting individual choice and preference, the meals, often consisting of ham sandwiches or similar, could hardly be described as varied, balanced or nutritious. Therefore, as discussed during the inspection, advice from a dietician should be sought. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 3a The Droveway 3a The Droveway Hove East Sussex BN3 6LF     The quality rating for this care home is:   two star good 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: Nigel Thompson     Date: 1 3 0 8 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 34 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 34 Information about the care home Name of care home: Address: 3a The Droveway 3a The Droveway Hove East Sussex BN3 6LF 01273541229 01273541229 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) : Care Management Group Ltd 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/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home 3a The Droveway is a care home, which is registered to provide personal care and accommodation for up to three people with learning disabilities. The home is owned and run by Care Management Group (CMG) who are a large national organisation. The home is a newly purpose built two storey property, which has been designed and adapted specifically for one named person. It is located in Hove, near Brighton. There is nearby access to some local amenities and public transport. A small car parking area is available at the home, although on street parking is permitted in the surrounding areas. Accommodation is provided over two floors, although individual bedrooms, bathrooms Care Homes for Adults (18-65 years) Page 4 of 34 Brief description of the care home and communal areas are on the ground floor. All bedrooms have en-suite facilities. The home provides personal care and support to people who are funded by Social Services and/or the local primary health care team. The homes fees as of August 2009 range between £2,699 - £6,800 per person per week. Additional costs are charged for hairdressing, toiletries and external leisure activities. Written information regarding the services and facilities provided at the home are available on request. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place over five hours in August 2009. It found that all of the key National Minimum Standards that were assessed had been met or partially met and the overall quality of care provided was good. The purpose of this inspection was to assess compliance with the requirements of the previous inspection and to generally monitor care practices at the home. On the day of the inspection there were two service users living at the home. Care Homes for Adults (18-65 years) Page 6 of 34 The inspection process involved viewing both service users rooms and all communal areas, observation of working practices and examination of the homes records. Discussions were also held with two service users relatives, two members of staff, a service users advocate, the registered manager, the deput manager and a Regional Director. Information about the service, contained in the recently completed Annual Quality Assurance Assessment (AQAA), has also been included in this report. The focus of the inspection was on the quality of life for people who live at the home. What the care home does well: What has improved since the last inspection? What they could do better: Following a chaotic and poorly managed transition programme, relating to a service user moving into the home earlier this year, it is essential that improvements are made to the admission process. The current pollicy and procedure, including pre admission assessment, was evidently not adhered to. Identified shortfalls, including the lack of any direct involvement of the manager and concerns over staffing levels, must be addressed. It is also important that service users support plans, including risk assessments and staff guidelines, are regularly reviewed and updated so as to accurately reflect the individuals changing care and support needs. Despite menus evidently reflecting individual choice and preference, the meals, often consisting of ham sandwiches or similar, could hardly be described as varied, balanced or nutritious. Therefore, as discussed during the inspection, advice from a dietician should be sought. Care Homes for Adults (18-65 years) Page 8 of 34 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. 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 34 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 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission policy and procedures are not always adhered to, resulting in service users being admitted on the basis of inconsistent and inaccurate assessment. Prospective service users cannot be sure that the home is able to meet their individual care and support needs. Evidence: Information is evidently made available to prospective service users, their relatives and representatives. The Statement of Purpose provides an introduction to CMG including the homes aims and objectives, details of the Registered Provider and Manager, organisational and staffing structure and colour photographs of the accommodation provided. The Service Users Guide offers a good level of information regarding the services and facilities provided, Both documents are presented in an easy to read and understand format, which incorporate the use of colour pictures and symbols. However, as discussed, both documents are to be reviewed and updated to accurately reflect the current situation within the home. Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: The first person moved into the home in December 2006. A detailed pre admission assessment form was seen for this person. It was noted to be exceptionally detailed and covered the following areas, general background, physical and emotional healthcare, communication, activities of daily living, community presence and participation, occupational education, relationships and spiritual needs. There was clear evidence to demonstrate that this had been undertaken with the persons previous place of residence, family members and multidisciplinary team. Historically CMG has employed a team of centrally based assessment and referral officers, who have been responsible for considering and assessing all initial referrals for each of the services across the South East region. However in protracted discussions over recent months, with Regional Directors and Home Managers, it has been acknowledged and agreed that managers should have direct involvement in the pre admission assessment process. They are clearly best placed to decide on an individuals suitabilty for the home and compatibility with existing service users. It was therefore disappointing to find that this evidently had not been the case in a recent admission to the home. In documentation examined relating to a service user admitted in May, there was no evidence that the manager had been consulted or involved at any stage of the assessment process. The Initial Assessment of Need and Compatibility had been completed by an Assessment and Referral Officer on 21.04.2009. It was noted that the form had not been signed off by the Home Manager. The manager himself confirmed his lack of involvement in the assessment process: No I did not get consulted about the assessment, it was presented to me as a done deal. I wasnt very happy about it. There was also outdated information, inaccuracies and discrepancies noted in the assesment, including Dietary requirements and Continence, which has clearly proved unhelpful to staff working hard to manage the service users complex care and support needs. Other aspects of the chaotic transition programme were poorly coordinated and simply not thought through. The deputy manager commented that the process, certainly could have been handled better. This included preliminary visits to the home by the prospective service user, when the only two staff on duty were involved in 2:1 support of the existing service user. Consequently staff at the home did not get the opportunity to meet and effectively get to know the individual, which was the main objective of the visits. Care Homes for Adults (18-65 years) Page 12 of 34 Care Homes for Adults (18-65 years) Page 13 of 34 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. Individual support plans enable staff to meet service users assessed needs in a structured and consistent manner, however they do not always reflect changing circumstances and care needs. Systems for consultation and participation are effective. Service users are treated with respect and encouraged and enabled to make decisions about their day-to-day living. Evidence: Person centred support plans, guidelines and risk assessments have been developed and implemented, ensuring that the individual needs of both service users can be met in a structured and consistent manner. Appropriate choices are offered and personal preferences are evidently respected. The manager confirmed that the ability of the service to operate in a genuine person centred way allows frequent discussion and reflection on all elements of the support plan. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: Individual needs and choices are clearly documented within an individual plan of care called All about Me. This plan is evidently developed from a comprehensive assessment of the individuals care and support needs. At the front of the plan can be found a personal profile with an up to date photograph. The personal profile is written in the first person and gives an overview of the persons background, their needs and likes and dislikes. Staff spoken to during the inspection confirmed that, despite the limited communication of the service users, effective and regular interaction and consultation takes place constantly throughout the home. This was evident from direct observation of staff supporting service users in a professional, sensitive and respectful manner. Clear guidelines are in place for staff to follow based on detailed risk assessments. These are aimed at supporting staff to meet the persons needs whilst helping to promote and maintain their independence. Examples of guidelines seen include supporting a person with their preferred daily routines such as how they communicate, bathing, activities, going out in the car, mealtimes, making choices and watching TV. The manager confirmed that service users care plans are formally reviewed annually, however they would be updated as necessary should there be any change in the individuals support needs or circumstances. Routinely involved in the annual review are the service user, their Care Manager, a family member, key worker and the manager. However, it noted that in the case of a service user recently admitted to the home, certain details and staff guidelines referred to a previous placement and clearly had not been reviewed and updated since his admission to 3A The Droveway. Since the previous inspection it is evident that the Person Centred Plan has been produced in a picture format, My Plan. A Communication Passport has also been developed which is a useful and practical guide to help support workers, health care professionals and others in the community to communicate with and better understand the individual service user. Care Homes for Adults (18-65 years) Page 15 of 34 Care Homes for Adults (18-65 years) Page 16 of 34 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. Service users maintain contact with family and friends as they wish and have the opportunity for appropriate leisure activities. Menus, although reflecting their individual likes and preferences are limited and unimaginative. Evidence: Both Service users are evidently enabled to partake in structured activities within a relaxed and homely atmosphere. However, as discussed during the inspection, the consistency of such support is dependent on there being sufficient trained and competent staff on duty. The manager confirmed that service users are supported to take part in daily activities, within the home and the local community, to encourage personal development. 3a The Droveway is very much considered to be the service users own home. The Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: staff team are clearly mindful of this and have evidently worked hard to create a friendly atmosphere coupled with a culture of respect for the service users and each other. Staff provide sensitive and flexible support to maximise service users privacy, dignity and independence. The manager confirmed that visitors are welcomed into the home at any reasonable time, in line with the visitors policy and with agreement from the service users. Service users are encouraged and supported to maintain positive relationships and regular contact with family members. Through speaking with relatives, social care professionals and staff it was evident that the home continues to work hard to provide increased opportunities for personal development. Based on the individual needs of the service users, all activities need to be structured and based on routine. It was evident throughout the inspection that care staff recognise the importance of routine within the home and have worked hard to develop a clear understanding of the service users individual and often complex care and support needs. In house activities, observed on the day of the inspection, include watching TV, reading books and doing jigsaws. Service users relatives, spoken with as part of the inspection process, confirmed that they are kept well informed by the manager and staff either when visiting the home or by telephone. Staff confirmed that all meals are planned on a weekly basis, based on the preferences and likes of the person accommodated. Meals are prepared by care staff, all of whom have received the appropriate food hygiene training. Service users are supported to make snacks and on occasions help with food preparation with hand over hand support. Staff explained that mealtimes continue to be a stressful time for one of the service users and consequently meals tend to be eaten separately. Of some concern were the bland and uninspiring diets for both service users. Despite them evidently reflecting individual choice and preference, the meals often consisting of ham sandwiches or similar, could hardly be described as varied balanced or nutritious. As discussed during the inspection, it is recommended that professional input, including advice from a dietician should be sought. Care Homes for Adults (18-65 years) Page 18 of 34 Care Homes for Adults (18-65 years) Page 19 of 34 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. Staff have worked hard to develop positive relationships with service users and demonstrate an awareness and understanding of their individual care and support needs. Service users are protected by improved policies and procedures in place for the control and safe administration of medication. Evidence: In accordance with their individual support plan, service users are fully supported and enabled, as far as practicable, to exercise control over their lives and maintain maximum levels of independence and individuality. During the inspection, service users were observed being supported in a sensitive, professional and respectful manner by members of staff. Documentary evidence was in place to demonstrate that the health and emotional care needs of service users continue to be met within the home. Individual support plans that were examined were found to contain detailed information, clearly developed through close consultation with and direct involvement of service users and their relatives. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: Comprehensive needs assessments and details of staff intervention and action to be taken, ensures a structured and consistent approach to individual care and support. All service users are registered with local GPs and have access via the CLDT to other health care professionals, including physiotherapists, psychologists and occupational therapists, as required. It was noted, in support plans that were examined, that all appointments with, or visits by, health care professionals are recorded. The manager confirmed that close and effective working relationships between service users, their key worker, relatives and advocates, ensured that any subtle change in an individuals mood or behaviour can be identified and addressed at an early stage. Service users physical health and emotional wellbeing are constantly monitored and recorded. Potential complications or problems are therefore identified and dealt with at an early stage, including prompt referral to an appropriate healthcare professional. Improved, up to date and detailed policies and procedures relating to the control of medication are in place. Medicines are stored and recorded appropriately. Prescribed medication is regularly reviewed. The manager confirmed that all staff responsible for administering medication have received appropriate training and are individually assessed and authorised to do so. Care Homes for Adults (18-65 years) Page 21 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The open and inclusive atmosphere and effective communication systems within the home enable service users, staff and visitors to feel able to express any concerns, confident that they will be listened to and acted upon. Service users are safeguarded from abuse through relevant staff training and robust policies and procedures. Evidence: An up to date complaints procedure is in place in the entrance hall for the benefit of service users relatives and other visitors to the home. All complaints are recorded and include actions taken and outcomes achieved. However, it was noted that there have been no formal complaints received by the home since the last inspection. The manager confirmed regular and effective communication with service users relatives ensures that any issues or concerns are raised and can be addressed before they become complaints. Service users relatives and members of staff confirmed that they would have no hesitation in speaking to the manager or making a complaint if necessary and each person was confident that they would be listened to. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: The organisation has produced detailed policies and procedures relating to safeguarding vulnerable adults, including a whistle blowing policy. The manager confirmed that a new e learning programme has been developed by the Learning and Development Team. This includes a Safeguarding Vulnerable Adults module, which all staff have completed. This was supported through discussions with members of staff during the inspection and evidenced through individual training records. Care Homes for Adults (18-65 years) Page 23 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is accessible, safe and clean and remains suitable for its stated purpose. Service users benefit from accommodation that is comfortable, generally well maintained and decorated to a satisfactory standard. Evidence: It is evident that, apart from some redecoration of service users rooms and communal areas, there has been little change in the physical environment at 3A The Droveway since the previous inspection and standards remain satisfactory throughout. The premises, including the lounge, kitchen, dining area and rear garden are accessible, safe and clearly meet their stated purpose. Having been shown around the premises and after viewing all rooms and communal areas, it is evident that the generally well maintained decor and adequate furniture and furnishings continue to provide a safe, comfortable and pleasant environment for service users. The manager confirmed that independence and individuality continue to be promoted within the home and this is evident from the personalising of service users individual Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: rooms, which, although cluttered and functional rather than homely, clearly reflect individual tastes, personalities and interests. One service users anxiety levels have evidently decreased significantly since the previous inspection. This has lead to a reduction in episodes of challenging behaviour and consequently there is no longer a need for the padding on the walls, which has resulted in the house feeling more homely. A maintenance book is kept, ensuring that prompt action is taken to deal with any issues in this area. A detailed cleaning schedule is in place that staff are expected to sign daily when they have completed the tasks. Infection control procedures are in place and clearly adhered to. On the day of the inspection, levels of cleanliness and hygiene throughout the home were found to be satisfactory. Care Homes for Adults (18-65 years) Page 25 of 34 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. There is not always sufficient trained and competent staff on duty to meet the assessed needs of the service users in a structured and consistent manner. Service users are protected by satisfactory staff recruitment policies, procedures and documentation. Evidence: As part of the inspection process, discussions were held with service users relatives, advocates, the manager, deputy manager, staff and the Regional Director. There are clearly some real concerns regarding the minimal staffing levels currently operating within the home and the potential impact that this has on the care and support of service users, as well as the inevitable affect on their welfare and social and recreational opportunities. The situation is not helped by the fact that the manager was due to leave on the day of the inspection and staff drafted in from another service are going back and have left or are due to leave in the coming week. I do think that they need more staff. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: Turnover of staff is very unsettling for everyone. The home needs some stability. High morale in a staff team is crucial for the welfare of the service users. The present unsatisfactory and unacceptable situation has evolved since the most recent admission to 3A The Droveway. In an evidently poorly managed transition programme, three support workers from his previous placement were suposed to come with the service user to be familliar faces and provide continuity and support for him and the new staff team. They didnt, as they were all on annual leave during the very week that he moved into the home. As previously documented, the pre admission assessment process was also unsatisfactory and consequently, in what was a difficult and significant week for both the service user and the staff team at 3A The Droveway, they were left to deal with an individual with complex and very challenging needs without accurate information, guidelines or adequate support. This situation is unsatisfactory and unnecessary and clearly does not ensure that the assessed needs of individual service users are being met, or that their best interests are being served. A Regional Director did confirm that the matter is being addressed and that additional, permanent staff are currently being recruited. She was able to make assurances that the existing staff would be fully supported and that new members of staff would be supernumery during their induction period. Much of the staff training is currently being provided on line ( E Learning) and is proving to be very successful and very popular: The training is excellent and doing it online means you can work at your own pace, which suits me. However a health care professional, spoken with as part of the inspection process, had some concerns about the specialist training necessary for staff working with such complex needs: I have been aware, not just in this service, that staff do not receive adequate specialist training to deal with such vulnerable people with such complex care needs. In accordance with company policy, the manager confirmed that formal supervision is Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: provided for all care staff on a regular basis. Individual staff files that were examined, relating to recently appointed members of staff, were found to be well maintained, containing all relevant and necessary information, including two satisfactory references, proof of identity and satisfactory Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) disclosures. Care Homes for Adults (18-65 years) Page 28 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from an improved and effective management structure, satisfactory quality monitoring systems and are protected by thorough health and safety checks and guidelines. Evidence: The Registered Manager, who has been working at the home since it first opened, recently resigned and the day of the inspection coincidentally corresponded with his last official day in the service. The Regional Director confirmed that a new manager had been appointed and would be starting work at the service on 14 September. In the interim period the deputy manager will be taking over responsibility for the running of the home, in her temporary role of acting manager. Positive feedback from relatives, health and social care professionals and staff indicated that the deputy manager is dedicated, professional, approachable and Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: supportive: I have absolute confidence in Ann-Marie. She (the deputy manager) is dedicated and totally committed to the service users. Relatives also commented on the appointment of a new manager: I hope that the new manager runs the home along the same lines as Mark. (the outgoing manager) The management approach is evidently to provide an open, positive and inclusive atmosphere within the home for the benefit of the service users. Quality assurance clearly remains a priority wihtin the service and regular and effective communication is evidently maintained with service users relatives: I certainly feel well informed. I am regularly consulted about everything regarding ...... either by phone, email or in person, when I go in to visit. The home undergoes regulation 26 visits on a monthly basis, which highlight any areas or issues that may need attention. As a direct result of previously documented concerns, raised during the inspection, the Regional Director is to ensure that a copy of future regulation 26 reports will be forwarded to the commission. The manager confirmed that the health, safety and welfare of service users and staff remains of paramount importance within the home. Staff training is provided in many aspects of safe working practices, including food hygiene, fire safety and first aid. All staff training is recorded. COSHH assessments and guidelines are in place. Regular fire drills are undertaken and recorded. Temperature regulators are fitted to all hot water outlets, accessible to service users. All accidents, incidents and injuries are recorded and reported, as required. Care Homes for Adults (18-65 years) Page 30 of 34 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 31 of 34 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 2 14 It is required that no service 30/09/2009 user is admitted to the home unless a full and accurate assessment of their care and support needs has been carried out. The admission policy and procedures are not always adhered to, resulting in service users being admitted on the basis of inconsistent and inaccurate assessment. 2 6 15 It is required that service users support plans, including risk assessments and staff guidelines be regularly reviewed and updated. So as to accurately reflect the individuals changing needs and circumstances. 30/09/2009 3 33 18 It is required that sufficient, appropriately skilled staff are employed at all times to meet the assessed suport needs of the service users. 30/09/2009 Care Homes for Adults (18-65 years) Page 32 of 34 Service users must be supported by an effective staff team. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 It is recommended that infromation made available to prospective service users, including the Statement of Purpose and the Service User Guide be reviewed and updated so as to accurately reflect the current situation within the home. It is recommended that the manager of the home be consulted and directly involved in the pre admission assessment process for prospective service users. It is recommended that more thought be put into coordinating introductory visits to the home by prospective service users, enabling support staff to meet, spend time with and generally get to know the individual. It is recommended that professional input, including advice from a dietician should be sought, to ensure and promote service users health and wellbeing. It is recommended that all care staff receive the necessary specialist training to meet the complex care and support needs of the service users. 2 2 3 4 4 17 5 35 Care Homes for Adults (18-65 years) Page 33 of 34 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. 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