Care Home: 43 Wellington Terrace

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What the care home does well The service has met the requirements from the last inspection and has made several improvements and developments. The people who live in the service are very happy and told me that they love living there and it is a `it is a lovely place`. The home assist people to make lots of decisions for themselves, especially about their daily life. The home make sure that people can go out into the community and use all the local facilities whenever they want, they offer help only if necessary. People are usually free to do whatever they choose. People are helped to keep in contact with their families and friends and are encouraged to make and keep relationships with others. The home makes sure that people get nice and well cooked food, which they help to choose. Staff have worked in the home for along time, have good relationships with people who live there and know their needs very well. What has improved since the last inspection? The home has an up-to-date Statement of Purpose so that people know what care they can expect and from whom. The home have got a new way of assessing peoples` needs to make sure that they get the right care at the right time. Everybody who lives in the home have a `contact` or Statement of Terms and conditions so that they know what they are paying for, how much it costs and who is paying. The home have made sure that they have a safe way of giving people their medicine and staff make sure that they fill in the records properly, so that everyone can check that the proper drugs have been given at the proper time, to safeguard peoples` health. Staff are trained in safeguarding adults and understand how they can protect people from any type of abuse. People who use the service said that they feel very safe in the home. One person said `it is the safest place I have ever lived, it`s wonderful. The home has increased the number of staff available during the day time so that there are two staff to meet the needs of the people in the home during the hours of 9 to 5. Staff have good training opportunities so that they can meet the needs of people in the best way and offer them the best quality care, possible. What the care home could do better: The home must add more detail to the plans of care so that staff all know how to support people,at all times. The home must make sure that they have detailed risk assessments to keep people as safe as possible, whilst they are helping them to be as independent as possible. The home should look at how to get people more involved in the purchase and preparation of their meals, to increase their independence and involvement in daily living. The home should look to see if having the ways that people are helped with any difficult behaviours or are helped to have better independence skills, are written down would make it easier for staff to help people in the same way, and as they prefer. The home must make sure that all areas are safe, clean and hygienic so that the people who live there are kept as safe from accident, injury or illness, as possible. Key inspection report Care homes for adults (18-65 years) Name: Address: 43 Wellington Terrace Kingsclere Road Basingstoke Hampshire RG23 8HH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kerry Kingston     Date: 2 1 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: 43 Wellington Terrace Kingsclere Road Basingstoke Hampshire RG23 8HH 01256473674 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Home Group Limited (Stonham) care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 15 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: Mental Disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home 43 Wellington Terrace is also known as `Portal House. Stonham Housing Association is the registered provider of Portal House. The home is registered to provide care and accommodation to fifteen service users who have mental health issues. Portal House is a detached property set in a residential road within Basingstoke. It is accessible to local services and facilities. The home comprises of fifteen single bedrooms, an open plan lounge dining kitchen area. The garden is well maintained, providing additional recreational space. There is a flat within the home for those service users who are moving onto Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 15 2 2 1 2 2 0 0 8 Brief description of the care home independent living. The fees are from approximately £294 to £402 per week. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This is a report for the key inspection, which included a routine unannounced site visit to the service. This took place between 10.00 and and 4.30 pm on the the 21st January 2010. The information was collected from an Annual Quality Assurance Assessment, a document sent to the service from the Care Quality Commission and completed by the service manager. Surveys returned to us by people who use the service, staff of the home helped some people to complete them. Discussions with the acting manager, two staff members on duty, and three people who live in the service took place. People who use the service are very communicative and I spoke with the majority of people over the course of the day. Reviewing records of the people who use the service and other records and procedures was also used to collect information on the day of the visit. Care Homes for Adults (18-65 years) Page 6 of 31 All information received by the Commission since the last inspection, about this service, was also taken into account when producing this inspection report. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 31 The home must add more detail to the plans of care so that staff all know how to support people,at all times. The home must make sure that they have detailed risk assessments to keep people as safe as possible, whilst they are helping them to be as independent as possible. The home should look at how to get people more involved in the purchase and preparation of their meals, to increase their independence and involvement in daily living. The home should look to see if having the ways that people are helped with any difficult behaviours or are helped to have better independence skills, are written down would make it easier for staff to help people in the same way, and as they prefer. The home must make sure that all areas are safe, clean and hygienic so that the people who live there are kept as safe from accident, injury or illness, as possible. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 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 31 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. The home have improved their assessment processes to ensure that people are properly assessed and they all have a written assessment. They are providing contracts to people so that everyone knows what to expect from the service and what is expected of them. They have up-dated their statement of purpose so that people have enough information to make an informed decision as to whether they wish to live there or not. Evidence: All the fifteen people who live in the home have been there over a year. The Statement of Purpose has been up-dated and people who may want to use the service have a leaflet type service user guide. 13 of the14 surveys received, from people who use the service, said that people were asked if they wanted to move to the home and had enough information to decide if it was the right place for them. Assessments for five people who use the service were seen, the new paperwork called my way forward has been completed with people who use service and form a written record of their individual assessed needs. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: Care managers and other professionals also supply assessments as necessary for new clients. A care manager is currently re-assessing the needs of all the people who live in the home to make sure they are still appropriately placed. Paperwork on the reassessment exercise, is not available, as yet. The AQAA notes that the home and organisation has a new move in procedure for any new people, the new procedure was not seen on the day of inspection. The AQAA noted that everyone now has a contract, all five plans of care seen included a Statement of Terms and Conditions, including the cost of placement and the individuals contribution to the fees. Care Homes for Adults (18-65 years) Page 12 of 31 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. Everyone has an individualised plan of care that they are totally involved in developing, these clearly identify what support people need but do not always include enough detail for staff to know how to offer that support or for people to know how they are going to be supported. People are supported to make their own decisions and choices and have control over their daily lives. Risks are not always identified and risk assessments are not always in enough detail to show how the risk will be minimised. Evidence: Plans of care for five people were seen. The AQAA noted that everyone has up-to-date care plans. The plans of care seen were all up-dated with the new system called my way forward which is also the method used for assessments. They are completed with the full involvement of the people who use the service. Detailed information about the needs of people is included but they lack detail of how to deliver the service and/or support people, that is, it is clearly stated what people need but not always detailed Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: about how to ensure they get what they need. There are no specific behaviour plans or guidelines for staff to assist them to deal with behaviours that may cause themselves or others difficulties. The home use agency and bank staff, whilst those who have worked there for a long time know people and how to support them this may not always be the case. People are very able to communicate their own needs and ask for help when they are well but there needs to be more detail about how to help people and react to requests if they are not in good mental, physical or emotional health. The AQAA noted that assessments and plans of care are reviewed monthly but this is not always the case, although they are reviewed regularly and generally more often than annually. Plans of care include my goals, people who live in the home are always involved in their reviews, if they wish to be. Surveys received from two professionals commented that, staff have good therapeutic relationships with clients and they meet the needs of individuals. Staff record daily notes but under different headings on the plans of care such as, mental health,physical health,housing,meaningful use of time and diversity. The handover sheet refers staff to where the detailed notes about an individual are written,staff said that they felt that as there is no overall,holistic record of the individual on a daily basis things could get overlooked.The records appeared to cover any negative issues or problems noted in specific areas but they contained few references to positive behaviours, issues or about peoples overall well being. Whilst all the information is available it is difficult to put it all together to form a picture of the individuals well being on a daily basis and use the records as a working tool. All of the people who live in the home, are able to communicate and advocate for themselves, when well. They make all the decisions about their day to day living but some felt that for big decisions they do not always have a real say for instance making the building a no smoking building and putting the smoking room outside, two surveys said they wanted and indoor smoking place and four people on the day of the visit appeared to be very concerned about the provision of the outdoor rather than indoor smoking area. People have regular link worker meetings where they are able to communicate on a 1:1 basis with staff who can help them resolve any issues or help them to make informed choices. People are free to come and go as they please and do whatever they want to do. Resident meetings are held and people are very able to put forward their points of view. The last resident meeting was in November 2009 and there was a comment from a resident about some things in the home feeling a bit, regimental, it was not clear how this was followed up. 13 of the 14 surveys received said that people always make decisions about what they want to do each day and one said usually. One person said I get alot of freedom, there are alot of worse places, I am never locked in and can do what I like. Three other people spoken to at a meal time also said that they make their own decisions but can get help from staff, if necessary. People were seen choosing to go out,stay in, go to their rooms or sit in the communal areas. Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: There were few individual risk assessments in the plans of care, most of the risk profiles noted that there was no danger, this included people with some behavioural issues that could impact on their physical or mental health and one person who is becoming frailer as a result of the ageing process. Cupboards in the main kitchen are locked and people who use the service are not allowed to use it, staff advised this was due to safety reasons but there were no individual or generic risk assessments to demonstrate this. It is very difficult to identify, from plans of care, what is a risk to people and what staff do to minimise it and what poses no risk at all. People do not use the main kitchen and , generally, have little to do with the production of their food I was told that this was because of safety but no risk assessment was available to support this. There is no risk assessments to support one person who is beginning to administer his own medication. Care Homes for Adults (18-65 years) Page 15 of 31 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 are offered activities and daily programmes, as appropriate, that involve them in the community and enhance their lifestyle.There is little organised activity for most people as they choose their own daily activities. People are offered a nutritious and well balanced diet, they are involved in choosing their meals but do not get involved in purchasing or producing their food, at this time. Evidence: People, generally,access activities independently, they choose what they want to do and which clubs to join, staff will advise and support them, as necessary. Everyone is free to come and go as they choose and all use the local community and local transport. Some of the older people choose to not have any formal activity programmes and just go to the town,cinema or other local facilities as they choose. A category called meaningful use of time is included in the plans of care and daily recording but entries are made intermittently People told me that they go out Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: whenever they like and several, especially the younger people went to clubs or other organised activities everyday. Everyone spoken to said that they have plenty to do and on the day of the visit it was noted that people were coming and going. Staff were interacting positively,with people who chose to stay in the home and seek out their company. People maintain their relationships with families and friends who are welcome to visit and many visit their family homes, help is given if necessary. People make their own friends independently and develop their own relationships. Although some people are working towards more independent living there are no specific independence programmes noted in plans of care. One person said that they live in a flat they get their own breakfast and lunch and will soon start cooking their own tea. Another said that they had been living in the flat but preferred to live in the main home, when asked if they wanted to work towards a more independent lifestyle they replied that they liked the home and preferred to stay. Comments on surveys included they look after me,good food and drink, I go to bed when I want to, its a lovely place, you can stay up all night and watch tv and its an easy life, no worries. Some other comments included,I would like more organised outings in the summer, I would like to go to London and we could do more trips,meals and games night are very good, I would like to go to the cinema more,staff could have more time to sit and talk with clients and they are good at talking and food. Menus seen were varied and nutritious and everyone spoken to and all surveys said the food was very good. However there are locked cupboards in the kitchen and people who use the service are not allowed to use the main kitchen, they have a minimal input into the buying or preparing of main meals, it is not clear why. Staff felt it would be dangerous for people to be in the kitchen but this has not been risk assessed. People have their own small kitchen which shares space with the laundry, it is in a poor state and there are tiles missing, scratched worktops and cupboards in a poor state of repair (see outcome six). The mealtime was a pleasant social occasion, and appeared to be enjoyed by everyone. Care Homes for Adults (18-65 years) Page 17 of 31 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. People who use the service receive good support with their personal , health and emotional care when needed, although plans of care could include more detail about how this support is given to assist staff to be more consistent. Medication systems have been reviewed they are now safe but there are no written guidelines for the use of medication prescribed to be taken as necessary. Evidence: Five personal care plans were seen, as previous outcome groups they describe what help people need but not how it is given. People are able enough to ask staff for what help they need and want and most people deal with their personal care independently. However issues arise when peoplesmental well being deteriorates, leading to neglecting of personal care and other essential functions. Mental well being is noted in daily notes, but it is not always clear what happens if peoples mental health is deteriorating, on one persons records it noted mental health deteriorating but not what action had been taken or when. There are no written behavioural plans to support peoples Independence or well being. People who use the service said they are looked after well and 14 of the 15 surveys agreed. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: People are encouraged to attend medical appointments, as necessary and notes are kept of any health issues,appointments that staff support people with. Some people are able to access health services themselves and some refuse to attend appointments recommended as necessary by staff. Staff work hard to encourage, persuade people to look after all aspects of their health, as appropriate. There are no risk assessments with regard to people not always attending necessary appointments and no written guidelines in place to assist staff to gain knowledge about what the most effective means of communication are, when working with particular individuals for instance what does encourage or persuade mean for each individual and what is the best way to go about it. The home work closely with mental health and other health care professionals one said that the staff have good therapeutic relationships with the people, who live in the service. All people who use service are able to give or withhold consent. The Boots monitored dosage system is used and the Boots pharmacist visits the home on a regular basis. The last report seen was dated 2007, the notes from further visits could not be located but the manager said that they had visited in 2009, had made a few recommendations that had been complied with. The medication is safely stored in a locked cabinet in the locked staff office, there is appropriate provision for controlled medication (only one currently.) Five people have medication, prescribed as necessary, to assist them to control their behaviour and emotional well being. The home have no guidelines for staff for when they administer this medication. People who use the service will ask staff if they feel the need to take it but it was discussed that it would be safer and more effective if written guidelines were produced with the individual about when and how it should be administered. Staff cannot administer medication until they have completed medication administration training, they administer with two staff. People go to the office to get their medications, they have been consulted and chosen this way even though it does not afford them very much privacy. Many people have been in the home over a number of years and appear used to the lack of privacy, for instance one person was heard and observed talking to staff about bowel issues in a loud voice in a communal lounge, the staff member did not discourage this conversation. One staff member said that some staff try to encourage people to be more private about personal issues but some dont. Care Homes for Adults (18-65 years) Page 19 of 31 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. People know how to make a complaint and are confident that their views will, generally, be listened to and acted upon, if appropriate. Staff are trained in safeguarding procedures and the people who use the service, feel safe in their home. Evidence: The complaints procedure is up to date, all 14 surveys received said that people know how to make a complaint. Five people spoken to said they knew what to do if they had a complaint.The AQAA noted that no complaints have been recorded since the last inspection the acting manager confirmed that there have been no complaints since she has been in post. All staff receive safeguarding training and a copy of Hampshires safeguarding procedure is kept in the office. Staff spoken to confirmed they had received safeguarding (abuse) training and are very aware of their legal and moral obligations to keep people safe. They clearly described what action they would take if they had any concerns about people being mistreated in any way. They knew where to go, external to the organisation, if necessary. One person spoken to said the best thing about this place is that you feel safe, it is the safest place I have ever lived another person said its safe here, there arent any back wards. The home has no specific programmes for addressing behaviours that may cause Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: individuals safety to be compromised but the current staff team know the people in the home very well and appear to deal with them in a fairly consistent way. More detailed recording would be of benefit so others can see how it is done and what is most effective. Developing behaviour guidelines for those less familiar staff to follow would assure consistency and an effective method of dealing with behavioural issues. The home does not use any form of restraint. People in the home deal with their own finances only one person is supported by the home keeping his personal money locked in the office. The Commission have received no information with regard to complaints or safeguarding issues about this service. Care Homes for Adults (18-65 years) Page 21 of 31 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. People live in a homely and comfortable environment but there are some areas that need improvement such as bathrooms and the small kitchenette. There are some hygiene and security issues that need addressing. Evidence: Some areas of the home are in need of attention because they look grubby and of poor quality for instance the residents kitchenette, two bathrooms and some communal furniture. Some sitting and some dining room furniture looks in need of replacement, one person who uses the service was very concerned about the condition of the dining room chairs. There was some concern among residents that their smoking room has been moved outside because the home is a no smoking building, this causes some people to smoke more in their bedrooms although they are aware that this is not allowed and smoke detectors are fitted. There are three bathrooms upstairs shared by approximately 11 people one is not functioning and is used for storage, another has a shower but no shower curtain had damp/mould is showing through at the top of the wall causing a smell of mould, the other bathroom was functional, although not attractive. The kitchen facilities used by the people who live there to make drinks and snacks shares space with the laundry machines, which needs reviewing as there could be a Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: cross infection issue. The worktop is scratched and pitted, there are tiles missing off the wall and the cupboard is in a poor state of repair. People are very happy with their own rooms which reflect their individuality and personality and staff work hard to get people to accept responsibility, to keep them in a reasonable condition. There are no specific aids or adaptations, currently as there are no specific physical needs however one person is becoming frailer, staff are aware of their increasing needs and they have a ground floor room. Fire doors to 1st floor corridors are not alarmed and lead directly onto a public road, staff and people who use the service said that people sometimes go out of the fire doors and they are not always locked again when they return. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are protected by the services robust recruitment procedures. Staff are well trained and have a good knowledge of the people who live there so that they are, currently, able to meet their needs. Staffing levels have been reviewed so that adequate numbers of staff can be on duty at the right times. Staffing numbers need to be regularly reviewed to ensure peoples need for support with gaining independence, or increased dependency needs, can be met. Evidence: On the day before the site visit the rotas of the home changed, after a lengthy staff consultation period it was agreed that one extra staff could be appointed to assist with this change. There are now,generally, two staff per shift, with a minimum of two staff between 9 and 5. The shifts are 7.30 to 3.30, 1.30 to 9.30 and 9 to 5, with one person sleeping in. People are able to call the sleeping in person if there any problems during the night. A cook is available for five days per week (four hours a day) and a cleaner also works part time. One survey said that staff need more time to sit and talk with people although this was not evident on the day of the visit when staff were seen in long conversations with people and were supporting them, as necessary. 13 of the 14 surveys received noted that staff always treat you well, one said sometimes. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: The new staff member appointed is male to try to increase the number of male staff as it is a predominantly male population. There is currently only one male staff member and 12 of the people who use the service are male. The home was using large amounts of agency staff as there is alot of sickness but they are now trying to use bank staff to minimise the amount of people unknown to the residents working in the home. Staff numbers need constant reviewing to ensure that there are enough to meet the needs of resident group, with particular regard to the development of independence programmes and some peoples increasing dependency needs because of the ageing process. The acting manager said that all the current staff had been in post since the last inspection, recruitment records were therefore not looked at as they were judged to be robust at the last inspection. All staff will have new job descriptions which are being finalised, staff are to be called care assistants and senior care assistants rather than project workers. Staff are supervised approximately six weekly, and regular staff meetings are held. Sickness rates are high, explained by the acting manager as due to the current situation, rather than being a usual ocurence. Individual training records are kept and show good opportunities for training, staff confirmed that those opportunities extend to bank staff. The AQAA stated and records confirmed that all mandatory training courses are up-to-date. The AQAA noted that five of the eight permanent staff have NVQ 2 or above in social care. Care Homes for Adults (18-65 years) Page 25 of 31 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 registered manager is absent from the home, which is being temporarily managed. The provider is trying to ensure that a robust management system for the home is maintained. The home has a quality assurance process that enables it to continue with developments and improvements. There are some Health and safety issues that need to be reviewed and assessed. Evidence: The manager is in post for a short time, as the registered manager is not working in the home, currently. The acting manager has a background in residential care with adults. The organisation is advertising for a manager on a 9 month contract as it is not clear how long the registered manager will be away from the home. The acting manager works for an agency and will leave the home when the new manager is appointed on the short term contract. There have been developments and improvements since the last inspection, particularly with assessment and care planning systems but further development in some areas, is needed. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: People who use the service have resident meetings and all are able to verbalise their views. Most are very able to advocate for themselves and do so. The home has a changing focus/culture and is beginning to develop peoples ability to follow more independent lifestyles although some people who use the service are resistant to this idea. The lack of a permanent manager is hampering the overall development as an acting short term manager can only focus on a few issues at a time. The home has a regular regulation 26 visit and an annual quality review system. From the annual quality review, which involves surveying people who use the service and other interested parties aswell as talking to people, a business plan is developed which notes developments for the coming year. The home complete regular health and safety maintenance checks as recorded on the AQAA and confirmed by a sample of records seen, however water temperature records could not be located and one tap in a bathroom had very hot water. The manager had all the water temperatures checked by a professional the day following the inspection. She confirmed this by E-mail and undertook to ensure water temperature checks are completed as necessary. Radiators are not covered and there are no risk assessments to support this, they were not felt to be hot on the day of inspection. Fire exits are not secure (see outcome 5) and the kitchenette is sited with the laundry machines (see outcome 5). Accidents and incidents are recorded but do not detail actions being taken to minimise the risk of recurrence. Records of a system for monitoring accidents and incidents were not available in the home. Care Homes for Adults (18-65 years) Page 27 of 31 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 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 To review the amount of detail included on plans of care, with particular regard to how to support people with their identified needs. So that staff can offer consistent and effective care to people. 01/04/2010 2 9 13 To ensure that risks are properly identified and detailed risk assessments are developed, as necessary. So that people can be supported to maintain and enhance their independence, as appropriate, as safely as possible. 01/03/2010 3 17 16 To look at involving people in the preparation and serving of food and to ensure that the kitchen they have access to is properly provisioned and safe to use. 01/05/2010 Care Homes for Adults (18-65 years) Page 29 of 31 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 So that people can be more involved in the preparation of their main meals and have access to adequate facilities for the preparation of snacks and drinks. 4 18 12 To look at ways of 01/04/2010 establishing a culture, within the home, that promotes peoples privacy and dignity. So that people who use the service can be encouraged to uphold and value their own privacy and dignity. 5 42 13 To develop systems to make 22/02/2010 sure that the home is as safe as possible, to include safe water temperatures, safe radiator temperatures, the kitchenette and security of the building. Risk assessments should be in place to describe how to eliminate or minimise risk. So that staff and people who live in the home are as safe as is possible. 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 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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