Care Home: 46 Severn Avenue

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What the care home does well The service have worked hard to meet the requirements and recommendations of the last report. The staff team interact positively with the residents. The residents benefit from an environment that is warm and inviting. What has improved since the last inspection? The residents are better informed as the statement of purpose has been reviewed. The residents can be assured that the staff team are more aware of their needs as the care plans have been reviewed. The residents are safer as risk assessments are in place. The staff team can be more assured that the residents are eating a healthy diet as they are recording the food that they eat. The residents health needs are better met as the staff team complete the printed medicines administration record sheets more fully. The residents benefit from a homely environment as the house has been redecorated. What the care home could do better: Residents would have more information if their contacts contained all the necessary information. Residents would be more confident that the staff team were aware of their changing needs if the care plans contained more detail. Residents health needs would be better met if there was a system in place to ensure that the medicine cabinet only contains appropriate medication and health action plans were in place. The registered manager should ensure that staff members have annual assessments in the administration of medication. Residents would have greater opportunities for evening activities if these were further developed. Residents would be better protected if there were a system in place to evidence that complaints are resolved within the appropriate timescales. Residents would be more assured that the staff team are working consistently if staff supervision and appraisals were in place. Residents would be better protected is staff members received training in infection control. The residents would be more assured that their needs are being met if the acting manager made an application to the Commission to be registered as manager. Key inspection report Care homes for adults (18-65 years) Name: Address: 46 Severn Avenue 46 Severn Avenue Weston Super Mare North Somerset BS23 4DQ     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: Jacqueline Sullivan     Date: 0 4 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 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 30 Information about the care home Name of care home: Address: 46 Severn Avenue 46 Severn Avenue Weston Super Mare North Somerset BS23 4DQ 01934626731 01179699000 david.rogers@brandontrust.org www.brandontrust.org The Brandon Trust care home 6 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) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 6 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Severn Avenue is operated by The Brandon Trust and is situated in a pleasant suburban area of Weston-super-Mare. The home provides support for up to 6 service users with varying degrees of learning disability. Fees are negotiated with the placing authority. 0 3 1 1 2 0 0 8 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star this means the people who use this service experience adequate quality outcomes. This was an unannounced visit to the home as part of a Key Inspection of this service. The review of evidence and pre-inspection planning involved reviewing the report of the last Key Inspection and the service history which details all contact with the home including notifications of significant events which they have reported to us. We provided the home with their Annual Quality Assurance known as an AQAA.The AQAA was completed and returned. We gathered additional information during our visit through informal discussions with residents. Interaction and communication between staff and residents was also observed during our visit. Care plans and associated records were examined together with accident and incident reports, risk assessments, complaints procedures and health and safety records. We were also provided with a tour of all communal areas of the home and some of the Care Homes for Adults (18-65 years) Page 5 of 30 residents own rooms. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Residents would have more information if their contacts contained all the necessary information. Residents would be more confident that the staff team were aware of their changing needs if the care plans contained more detail. Residents health needs would be better met if there was a system in place to ensure that the medicine cabinet only contains appropriate medication and health action plans were in place. The registered manager should ensure that staff members have annual assessments in the administration of medication. Residents would have greater opportunities for evening activities if these were further developed. Residents would be better protected if there were a system in place to evidence that complaints are resolved within the appropriate timescales. Residents would be more assured that the staff team are working consistently if staff supervision and appraisals were in place. Residents would be better protected is staff members received training in infection control. The residents would be more assured that their needs are being met if the acting Care Homes for Adults (18-65 years) Page 7 of 30 manager made an application to the Commission to be registered as manager. 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 8 of 30 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 9 of 30 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 residents are more informed as the details of the manager has been included in the statement of purpose. However information about the fees could be further developed to ensure greater clarity. The residents can be assured that the staff team will assess their needs. Evidence: The home has both a Statement of Purpose and a Service Users Guide. We examined the copies which were available in the office on the day of our visit. Since the last inspection both documents have been updated by the manager. At the last inspection we noted that the statement of purpose had all the necessary information except for the managers name. At this inspection we saw that this has been updated. We saw that the residents plans contained a copy of the Brandon Trusts contract.These are written in plain English and have pictures to support the text to Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: help residents understand them. The document has spaces for each residents name, room number and the fees they are expected to pay in relation to accommodation and transport costs. We looked at four of these documents in detail and the letter from the Trust which was with the contract. The contracts were signed by the manager, the resident or their representative or advocate to show that they have has been discussed and agreed with the people who live in the home. At the last inspection it was noted that the documents did not contain sufficient information about the actual rooms that the residents occupied and charges for the use of the homes vehicle. At this inspection we saw that this information has now been included. We saw the contracts included a statement that the actual charges the residents will pay will be included in the letter sent to them by the trust. A recommendation has been made that the detail of this information is included in the contracts. There have been one new admission to the home since the last inspection. We saw that there was an assessment from the placing authority which contained the appropriate information in order for the staff team to meet their needs. Care Homes for Adults (18-65 years) Page 11 of 30 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. The residents can be assured that they have care plans in place but the content of those plans is variable.Therefore further work is needed to ensure they are completed consistently. The residents are supported to take risks as part of an independent lifestyle. Evidence: Each resident has a care plan and we examined four of these during our visit. At the last inspection it was noted that the care files had been reviewed to include person centered planning. However, we noted that the information was difficult to find and the quality was variable. At this inspection we saw that all the care plans had been updated and were very detailed. It was clear a great deal of input took place in the care files after the last inspection. The manager told us that the senior at the time completed this work. However there has been less work completed since that date. We saw that some Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: information was not dated or signed. We saw that one person had a detailed person centered plan which was kept in his room. This plan identified the residents goals and aspirations. The manager said that the other residents would have a similar plan but he had difficulties finding a independent assessor/facilitator. At the last inspection it was noted that work was in place to identify the residents goals but the monitoring system was not consistent in the files seen. At this inspection we saw that this remains the case. At the last inspection it was noted that the review processes used within the home was inconsistent. We noted that the plans were more consistently reviewed but not in sufficient detail. We also noted that the staff team frequently write no change in the plans without any further information. At this inspection we saw some improvements in the review process as the staff have started to review the plans every two months. But we saw that the formal, more detailed,reviews were not up to date for all residents. At the last inspection we noted that each individual has a person centered risk assessments in place which is designed to support them to take risks as part of their lifestyle. In one persons file, we read that they had fallen from their bed and then bean bags were used to protect the resident. We were concerned that full risk assessments and alternative strategies to protect this person were not in place. At this inspection we noted that this work had been completed. Care Homes for Adults (18-65 years) Page 13 of 30 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. The residents are encouraged by the staff team to take part in activities at home and in the community but these could be further developed to include more evening activities. Evidence: As noted at the last inspection, residents have the opportunity to attend sessions at local day centres and colleges. Facilities available in the wider community are also used including walks and trips to local pubs, cafes and shops. On the day we visited some residents were wrapping Christmas presents for another resident. We spoke with these residents and one said ,I like it here.. The staff member was seen to encourage each resident to take part in the activity. Since the last inspection it was noted there were some improvements in the support for individuals to develop or work toward their goals and become involved in Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: determining their own lifestyle. We saw there was an activity plan but the activities in the evenings was sparse. The manager said he plans to improve this. A recommendation has been made that the activities for the residents are further developed. As noted at the last inspection residents are supported to maintain regular contact with their family and friends and visitors to the home are welcomed. Staff have worked hard to ensure each service user is supported to choose organise and attend a holiday. This remains the case. Discussions with the staff team and observations made at inspection confirmed that staff members ensure that each person who lives in the home is treated with respect and dignity. The kitchen was seen to be clean and tidy. The staff team record the temperatures of the fridge and freezer. Both were seen to be appropriately stocked with a variety of foods. The menus showed us that the residents eat healthy meals. At this inspection it was noted that the staff now record what the residents eat and two residents we spoke with told us that they eat their favourite foods. On the day of inspection the meal was chicken curry which was well presented and a resident said that he was looking forward to eating it. Care Homes for Adults (18-65 years) Page 15 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents can not be fully assured that the staff team are meeting their health needs. Evidence: We looked at the systems that are in place to ensure that medicines are handled safely in the home and the systems for recording health information about people. We saw that some improvements have been made since the last inspection. However they could be further developed to ensure residents health needs are more fully met. We looked at the information in residents care files about their health and medication and saw that the residents did not have health action plans in place. This would have not been a major deficit if the information in the health section of the care plans was detailed. However, we read that this information, for the majority of residents, was limited. For example, there was no explanation as to why the residents were taking particular medicines. We could see from looking at the MAR ( medicine administration record ) sheet that the dosage of a medicine for one person was sometimes changed by the GP but the information was hard to find in the daily recording. This means that information if not easily at hand could be overlooked. We read that this person had his Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: medication returned to the pharmacy and it was not clear why this was until all the recording was read through. A health action plan would make this information more easily accessible to staff members. We looked at handling of medicines in the home during the inspection. We read that people living in this service are registered with a local doctors practice. Staff request prescriptions from the doctors and these are sent straight to the pharmacy for dispensing. The pharmacy supply medicines using a monthly blister pack system. At the last inspection it was noted that advice from the Pharmacist to have the homely remedy policy for treatment of minor ailments agreed with the doctors was not fully to be acted. At this inspection we saw that one homely remedy was not stored appropriately but the manager disposed of it at the inspection. A recommendation has been made that the cabinet is regularly examined for these kind of items so they are stored appropriately or disposed of. At the last inspection we noted that that one person was prescribed a special toothpaste, which is kept in their bedroom. We saw that there was no information about this in the persons care records. At this inspection we noted that this remains the case. However, there was a record made on the medicines administration record of whether it is used. The instructions for its use were those on the packet of the toothpaste. There was no other record. We recommend that this information should form part of the health action plan. Secure storage is available for medicines. A medicine fridge is not needed at the moment. Systems are in place to allow staff to audit medicines and check that they have been given correctly. Staff told us that they check the medicines every week. We checked a small sample of medicines and found that records were correct. The disposal of any unwanted medication is now recorded. At the last inception saw that an excess supply of some prescribed inhalers were still in the cupboard. At this inspection we noted that these have now been removed. At the last inspection we saw that some medicines which had been prescribed to be given as directed. We noted that this increases the risk that the wrong dose of medicine is given. We stated that action should be taken to ensure that all medicines supplied have the full dosage instructions. At this inspection we noted there were no medicines of this nature. Photos are kept of each person living in the home to help make sure that medicines are given to the right person. Staff told us that two members of staff are always involved in giving the medicines and both sign the medicines administration record. This helps to reduce the risk of mistakes being made. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: The pharmacy provides printed medicines administration record sheets for staff to complete. These had been completed fully. At the last inspection one of the printed record sheets was confusing and could have resulted in the person being given a medicine twice by mistake. At this inspection we noted that this has now been rectified. We looked at the staff training records for medication administration. The registered manager told us that he does an annual assessment with each member of staff to check that they are able to safely give medicines. We looked at three training records and saw only one record of assessment of competence carried out in 2008. All staff involved in medication administration should have documented annual assessments. This is to make sure that they can carry out this task safely and protect the health of the people using the service. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their views are listened to and acted upon by the staff team. Residents can be assured that there are systems in place to protect them from any abuse. Evidence: At last inspection we noted that the home has a formal Complaints Policy, an Adult Protection Policy and a Whistle Blowing Policy, which staff can use in confidence to raise any issue or concern they have regarding the service, this remains the case. Discussion with staff members, the manager and the residents confirmed that residents know who to speak to if they were unhappy. Each individual spoken with at inspection confirmed that they felt safe living at the home. There is a rolling programme of staff training in relation to the Protection of Vulnerable Adults and they are subject to Criminal Record Bureau enhanced disclosures before they start work in the home. There is very little challenging behavior displayed by people who live in the home and support plans contain guidelines which explain how to support individuals if they become distressed or present behaviors which may be perceived as challenging the service provided. We looked at the complaints folder and noted that the recording of the complaints needs to be revised so that it evidences that the complaints are resolved within the Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: required timescales. A resident told us that they would complain to the staff if they had a problem. The home maintains records of accidents and incidents. It also notifies us of any significant event which occurs within the home. Care Homes for Adults (18-65 years) Page 20 of 30 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 residents benefit from a homely and clean environment. Evidence: Severn Avenue is a detached property situated in a pleasant suburban area of Weston-super-Mare. The garden area at the front and side of the house is paved including parking area for the homes vehicle. There is a reasonably large rear garden which residents are free to use. There is a communal lounge on the ground floor, a dining room, kitchen entrance hall and lobby and one bathroom which also contains a walk in shower. On the first floor there is the laundry one bathroom a small office and the sleeping-in room which staff use. Since the last inspection the house has been redecorated and looked fresh and clean. A camera has been installed at the front door so that staff members and residents can see who is at the door. We saw some of the residents own rooms. These are all decorated and furnished differently to reflect the taste and choices of each individual. They contained many personal items pictures and photographs which helped to make them personal to each individual. There are six single bedrooms some on the ground floor and others on the first floor. There are sufficient communal bathrooms showers and toilets which the residents share. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: At the last inspection we noted that the procedures in place for infection control were in need of development. We saw a urine bottle containing urine on a radiator in the bedroom of a resident and another was seen on top of the toilet in the bathroom. Although this was noticed in the middle of inspection the bottle in the bathroom was still there at the end of the inspection until it was removed by the manager. At this inspection we noted that the bottles were hygienically stored. At the last inspection we were told that the bathroom downstairs is due for refurbishment and that the shower will be altered so that a resident who has restricted mobility can use it. At this inspection we saw that this work had been completed. Care Homes for Adults (18-65 years) Page 22 of 30 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. The residents needs are better met as the staff team are now trained to work in a person centered way. The residents are protected by robust recruitment policies and practises. The residents do not benefit from clarity of staff roles and responsibilities as not all staff job descriptions clearly describe what they do. The residents do not benefit from being cared for by a staff team that received regular supervision. Staff yearly appraisals are not all in place. Evidence: At the last inspection we noted that the home had undergone a period of change and again this was the case.Since the last inspection the senior has returned to his post one staff member has left and the previous manager and senior are no longer working at the home. We spoke to the senior staff member who confirmed that there had been some issues around the staff interactions with each other but he felt that these are now resolved Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: and that staff morale is higher. Two other staff members confirmed this. Each member of staff acts as a Key worker to one service user. Staff spoken with were able to evidence that they understood their own roles and accountability. The role of the senior has changed since the last inspection. He is now acting as manager in the managers absence. We noted that his job description was unchanged to account for his new role. We looked at the supervision records and saw that the staff team were not frequently supervised. As there have been so many staff changes staff supervision is particularly important to ensure every- one is working consistently. We looked at the staff training records and saw that there has been limited training for staff in the last year. We noted that staff members have received training in person centred planning but we noted that one area that should have been prioritised is staff training in infection control as there were concerns raised about staff practise in this area at the last inspection. We were concerned that this has not taken place. A recommendation has been made in the following section although it is also relevant to this section. We noted that information in the staff recruitment files was appropriately maintained. Care Homes for Adults (18-65 years) Page 24 of 30 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. These residents have benefited from having a manager and senior that listen to their views and implement their decisions. But they have not been fully protected as the manager has not been registered with the Commission and there has been little guidance from the Trust on how the new managerial systems will work in practise. The residents can be assured that they live in a safe environment. Evidence: Since the last inspection a new manager has been appointed. His role is to manage this home and another similar home locally. He started this post in April 2009. He is not currently the registered manager for this home. An application should be made to the Commission for him to complete the registration process as manager for this home. He said he has started the process but is awaiting his CRB (Criminal Record Check). With such a large remit he has ensured a full time senior care worker is in post. As previously stated,the senior is in effect completing all the day-to-day managerial Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: responsibilities within the home with the manager over seeing their work. The senior staff member was able to describe to us his roles and responsibilities within the home. As previously stated these have not been formalised by the Trust in a job description. Therefore there are no clear lines of deputisation in the managers absence. There is also little guidance from the Trust on how the situation would be managed in practice. The other home that the managers manages is very complex and demands a lot of his attention. Whilst remaining loyal to the organisation it was clear that he has large demands on his time. He is a very experienced manager and told us that he has ensured that there are positive outcomes for the residents written into the care plans. He has ensured that the care staff review the care plans every two months so he can keep an overview of what is happening in the home. However, it was clear that he cannot keep as careful an eye on this home as the other is so complex. Systems like staff supervision have broken down therefore he cannot be fully assured that the staff team are working consistently to meet the needs of the residents at this home. We spoke with the senior who is running the home in his absence who told us that, It feels now that things are starting to come together. However there have been ups and downs. We are aware that the home will shortly be changing its remit which will be challenging for the staff team and impact on the residents. For this home to be run successfully which is well within the manager and staff teams ability it will demand a great deal of his time and attention. We are concerned that much of his time and attention is diverted elsewhere. We asked the residents if the staff changes effected them , one person said it makes you feel unsettled. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 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 14 The residents care plans are 11/04/2010 regularly reviewed to ensure they contain detailed information about the residents wishes and aspirations. This will ensure the residents information is up to date. 2 36 18 Staff members receive frequent supervision and appraisals This will ensure that the staff team is working consistently. 11/03/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 2 14 The contracts contain detail about the actual charges residents pay to live at the home. The registered manager further develops the evening Page 28 of 30 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations activities for the residents. 3 4 19 20 The registered manager ensures that health action plans are in place. The registered manager ensures that there is a system in place to ensure that the medicine cabinet only contains appropriate medication. The registered manager should ensure that staff members have annual assessments in the administration of medication. 5 22 The registered manager ensures that there is a system in place to evidence that complaints are resolved within the appropriate timescales. The registered manager ensures that all staff members have job descriptions that detail the work they actually do. The registered manager ensures that staff training in infection control takes place. The registered provider should ensure that there is guidance for staff members about how the new managerial roles will work in practise. There should be clear lines of deputisation in the managers absence. The registered person should ensure that the acting manager makes an application to the Commission to be registered as manager. 9 42 Staff members receive training on infection control 6 7 8 31 32 37 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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