Care Home: 5-7, Cedars Road

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What the care home does well Findings from this inspection indicate that there is a committed manager and staff team who work to promote the quality of life of the people who live at the home. The atmosphere is relaxed and comfortable, and we observed positive, relaxed interactions between the people who use the service and the staff. What has improved since the last inspection? At the previous inspection there had been three areas where the service had to improve. The service has taken action on all of these areas, which represents a positive response to the findings of the inspection and good developments to the service. In particular, good improvements have been made to the training provided to staff and ensuring that risks to people who manage their own medication is reduced. What the care home could do better: Areas where the home could be doing better are highlighted in the report and were discussed with the manager during the inspection. This includes improvements to the auditing of the medication system at the service to ensure that this is thoroughly checked and any errors managed appropriately. We also need to see improvements in the policies and procedures at the service, as the ones in current use are outdated and provide inaccurate information that does not promote the interests and safety of the people who use the service. We would also like to see positive steps taken to resolve the issue of the head office staff using the games room at the home as an office, and also using the bathroom facilities of the service. We feel that action needs to be taken promptly to secure alternative head office accommodation or facilities at the home, so that people who use the service have more access to internal activities, particularly since the recent closure of day centres in Richmond local authority. In light of the above improvements needed at the service, and the findings from this inspection, the service has moved from being a three star (excellent) service to a two star (good) service. Key inspection report Care homes for adults (18-65 years) Name: Address: 5-7, Cedars Road 5-7, Cedars Road Hampton Wick Kingston-upon-thames Surrey KT1 4BG     The quality rating for this care home is:   two star good 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: Louise Phillips     Date: 2 0 0 4 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 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: 5-7, Cedars Road 5-7, Cedars Road Hampton Wick Kingston-upon-thames Surrey KT1 4BG 02089432668 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): cedars@rhlt.org.uk Richmond Homes for Life Trust Name of registered manager (if applicable) Jackie Harris Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The home can admit one named service user who is over 65 years of age. Date of last inspection Brief description of the care home The property is owned and maintained by the Richmond Churches Housing Trust, and the service is operated and managed by Richmond Homes For Life Trust (RHLT). RHLT is a registered charity operating a number of services locally, including supported living projects and a leisure break scheme. The home is situated in a pleasant residential area, close to the River Thames and within walking distance of community facilities, shops and public transport networks. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 0 8 8 Brief description of the care home The home is tastefully decorated and the property has a large, well-maintained garden. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: When we visited the service we were verbally informed that the organisation is in the process of changing its name to Richmond Homes and Lifestyle Trust, however the CQC had not been officially notified of this at the time of writing the report. This inspection took place over one day and included a visit to the service by a Regulation Inspector. During the inspection we looked at the environment, and at records and relevant documentation held at the service. We spoke to staff that work at the home, some of the people who live there and the manager of the service. We also observed what was going on during our time at the home. We also received surveys from people who live and work at the service, and these are referred to in the report. Care Homes for Adults (18-65 years) Page 6 of 34 Prior to the inspection we also asked the manager to complete an Annual Quality Assurance Assessment (AQAA), which is a written self-assessment document about the service. This is also referred to in the report. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. 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 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment process ensures that the service is the right place for new people to move to. Evidence: We looked at the care files for two people who use the service. The files contain relevant information about the assessment process, along with information from relevant health and social care professionals involved with the person. There is evidence that following a person moving to the home, a review is carried out after six weeks, involving the person who uses the service, to ensure that they are happy at the home and it is the right place for them to stay. Care Homes for Adults (18-65 years) Page 10 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people who use the service are met through good support and care planning. Evidence: During the inspection we looked at the care files of two people who use the service. These contain a support plan and care plan which together give a good indication of the needs of the person and how they are supported to meet these by the service. The care and support plans were seen to be reviewed every six months, or more frequently where needs have changed. They are also signed by the people who use the service, which demonstrates that they were involved in identifying their needs and planning their care. The support plans are person centred and identify significant areas of the persons life, such as what they enjoy doing, activities they are involved in throughout the week and people who are important to them. They also include information about what Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: people do not like to do and how they communicate that they are unhappy about something. The support plans include photos of the person being involved in different activities, their family, significant friends and of places that they like to go to. Each person also has a care plan that provides information about any physical or medical needs and any support they might need with personal care and taking their medication, such as them being reminded to clean their teeth or change their clothes (where necessary). This information is very individualised and gives specific information about the support each person needs at different times of the day. The care plans also give information on the social networks of the person and details of the support they need with areas such as managing their money, travelling and the way they communicate. Risk assessments are in place to minimise risks for people in their individual areas of need. These were seen to include risk management plans around people travelling independently, road safety and their staying home on their own. Each person who uses the service has an annual review of their needs, and a link worker at the home who oversees the care and support they receive. Care Homes for Adults (18-65 years) Page 12 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported to pursue individual interests and activities to enhance their life. There is a relaxed, warm atmosphere at the service which is enhanced by the positive relationships between the staff and people who use the service. Improvements need to be made to the food storage at the service, and ensuring that privacy is respected for the people who live at the home. Evidence: The staff spoke fondly about the people who use the service and have a good understanding of their needs. Throughout the inspection we observed genuinely caring and positive interactions between the staff and people who use the service. Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: Feedback we received from staff is that the service works to creat a real hom efor the people who live their, rather than it being a care home. They also said that they like the way the service tries to support people to be as independent as possible. However, a number of staff said that thee still needs to be more staff to provide more individual support. During the inspection the manager spoke about the recent closure of the day centres by Richmond local authority and the affect this has had on people who live at the home, particularly because they miss seeing the friends that they had made at the centres. The manager also spoke about how one person is unable to see their girlfriend regularly anymore, as they used to meet at the day centre. She said that they have been supporting the person to maintain their relationship and see their girlfiend, but that this is hindered by the lack of money of the people involved, and also any meeting is very structured and dependent on the availability of staff to enable this. The manager also explained that since the closure of the day centres the service has had to adapt to ensure that each person has activities they can be involved in. She said that to enable this the service has employed more support workers to their bank staff to support people to pursue activities in the community. An extra staff member now works each Friday evening to support people with a leisure activity of their choosing, such as going to the pub or bowling. The manager described the different activities that people get involved in, such as golf lessons and that one person goes to college. One person who uses the service also spoke to us about a concert that they had recently attended. The manager told us about a book club that had been set up by RHLT, where people get together to discuss different books and have books read to them if they wish. During the inspection one person told us they were going to this club that afternoon. During the inspection we were pleased to observe one support worker informing the manager that she, and the other support worker were taking a small group of people out to Bushey Park on an impromptu trip. People who live at the home are involved in keeping their bedrooms tidy and doing their laundry with the support of staff. People are also supported to access different groups in the community, such as arts and crafts and singing groups. The manager said that more people would like to join some of the groups, but these can often be quite expensive and people are not always able to afford them, with peoples levels of Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: activities depending very much on their individual budgets. At the previous inspection of the service (in 2007) we were informed that RHLT was considering using the homes games room as temporary office accommodation. The manager said that letters were sent to people who use the service about these plans, and at the time she explained to them what was happening. When we carried out our Annual Service Review (ASR) of 5-7 Cedars Road in November 2009 we were informed that the games room was being used by the head office staff, and that it was unclear what alternative accommodation was being looked at. In response to the ASR, the Responsible Person informed us that the Trustees of RHLT were looking at a variety of options regarding this. Findings from this inspection has increased our interest in the future plans for the games room, particularly in light of the recent closure of day centres and the increased emphasis on residential services to provide more activities. The games room is a valuable resource as it is a good size and could be adapted for flexible use as a room for games, discos, parties, training accommodation for people who use the service to maximise their independence, or for any other clubs that RHLT plan to introduce for people to be involved in. The manager also said that, through agreement with the people who use the service, the room could also be used for the occasional team meeting or staff training. The use of residents bathrooms and toilet facilities by head office staff and people who attend their meetings also needs to be addressed, and separate facilities provided, as staff told us that occasionally they have encountered members of meetings (that have taken place in the head office) in different areas of the home, looking for the bathroom. Ideally the head office would be at a location separate to a residential service, to promote that the homeliness of for the people who live there and to ensure that their privacy and dignity are respected. Alternatively, RHLT should consider installing a lodge in the garden at 5-7 Cedars Road that could be used for the head office or the games room. However, whatever the purpose this would be used for, separate toilet facilities need be installed for the use of head office staff and their visitors. Following our inspection we received information from the Responsible Person for RHLT, where she informed us that the Trustees are currently considering two options for resolving this situation and providing appropriate head office facilities, plus a Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: games room for people who use the service. The Responsible Person outlined the options to us, either of which would appear to address the issues we have raised above in relation to this. She also informed us that they are currently in consultation with the landlord of the service (Richmond Churches Housing Trust) regarding this. Due to the issues raised, we have recommended that RHLT keeps us informed of the progress of these plans and of the timescales involved, so that we can monitor this aspect of the service through our inspection and review processes. The manager told us about different holidays that people have been involved in planning for themselves. She said that people choose where they wish to go on their holiday and who they want to go with, and we saw records and photographs of previous holidays that individuals and small groups of people had been on to Eastbourne, Portugal and Devon. The manager said that people pay for their own holiday and that RHLT fund the travel and most expenses of the staff who accompany them. We were told by the manager about further steps that have been taken to increase the independence of some people who use the service, where some people stay at the service for up to two hours on their own or with each other, whilst staff are out with other people who use the service. We saw detailed risk assessment and risk management plans in place for this, which include opening the door to strangers, what to do in the event of fire and people preparing their own drinks and snacks during this period. These had been signed by the people to whom they relate. The manager told us about positive relationships that the service has developed with the relatives and friends of people who use the service, and she said that people are welcome to visit at all times. We also observed on the wall in the office area a list of not just the birthdays of the people who use the service, but of significant friends and family in their life, including the year that younger children were born on, to ensure that no birthdays get missed. When we looked at the meals provided by the service, we observed a variety of foods that were fresh, frozen and dried. We saw that improvements need to be made to the storage of these, with the labelling of jars and food packets which have been opened, to ensure that the food provided is nutritious and healthy. The service must ensure that where jars and food packets have been opened, or decanted into other containers they need to be labelled with the date of opening and date to be disposed of, according to the manufacturers instructions on the label. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: The manager said that staff prepare the meals except for once a week when a person who uses the service is supported to cook a meal for all the people who live there. Meals are planned on a daily basis, and a record of these maintained. There is a folder in the kitchen that contains a record of particular food and drink likes and dislikes of each person who uses the service. The kitchen and dining area is open-planned, where we observed some people who use the service preparing their own snacks and drinks. Care Homes for Adults (18-65 years) Page 17 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to meet their health and social care needs. Some improvements need to be made to the medication auditting and recording at the service. Evidence: People who use the service need different levels of prompting and support with their personal care, and this is detailed in their care plans. Each person has a health action plan which details such information as their physical health needs, communication skills, any mental health needs and any medication that people take. Individualised health records detail all health care appointments that people attend with their doctor, chiropodist and dentist, etc. Regular reviews of peoples care takes place with the involvement of the relevant health and social care professionals and the person who uses the service. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: The in-house care plans and support plans are reviewed six monthly, or more frequently where the persons needs change. We looked at the medication held for three people who use the service. The service uses the Boots chemist Monitored Dosage System, and receives a twice yearly inspection from the Boots pharmacist, who provides the home with a report of their findings and recommendations to improve the system. The medication we looked at is appropriately stored and the information on the Medication Administration Record (MAR) corresponds with that on the medication labels. We saw that risk assessments are in place for people who self-medicate. We found some discrepancies in the medication system that the service needs to address. One of these is for service to ensure that the staff use the correct coding on the MAR chart. This is because we found that on two of the three MAR charts that we looked at, staff had been using the coding N, which on the MAR refers to offered PRN (as required) not required. This is inappropriate recording as was being used for a regularly prescribed medication that had not be given. Similarly, we found some gaps where staff had not signed to say that medication had been given. We were informed that deputy manager carries out a weekly check of the MAR and puts a list of errors found on display in the office area. However, the errors we identified were not picked up during the checks dated 7th and 14th April 2010, and more thorough checking is needed to ensure that medication is given properly and recording appropriately. The medication checking and auditing needs to be improved and expanded upon to demonstrate clearly what is looked at during the checks, and evidence of where this has been followed up with staff, to ensure that it does not happen again. Care Homes for Adults (18-65 years) Page 19 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training reduces risks to people who use the service, however, improvements need to be made to the safeguarding policy and procedures at the service. Evidence: The home has a complaints procedure and format for the logging of complaints. However, the complaints procedure is dated as last having been reviewed in 2002, and contains old information about the Commission. This must be updated and in place at the service so that people have access to relevant information. This is the subject of a requirement detailed later in the report. No complaints are recorded as having been received by the service this year. The training records indicate that staff have received training in safeguarding vulnerable adults, and that this is ongoing. The abuse policy currently in use at the service is dated 2002, is inaccurate and gives incorrect information. Examples of this is that it states that the manager has responsibility for investigating any alleged or suspected incidences of abuse, and that the manager is to investigate safeguarding issues and contact the NCSC (National Care Standards Commission, which is a previous regulator of social care services, and has not been in existence since 2006). The policy also makes no reference to informing the local authority, who take the lead on all safeguarding incidences. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: Fortunately, staff have received recent training in safeguarding, and when we asked the manager about what she would do if a safeguarding issue arose, she was able to tell us the correct procedures to follow. However, the policy must be updated to ensure that it is accurate and an up-to-date guidance for staff to use. Care Homes for Adults (18-65 years) Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is welcoming, homely and suitable for the people who live there. Evidence: 5-7 Cedars Road is situated on a quiet residential street, with good access to local community facilities and public transport links. There is a large garden to the rear of the home. On the ground floor there is a homely lounge and kitchen/ dining area for use by the people who use the service. The bedrooms and bathrooms are on the ground and first floors, and are appropriate to meeting the needs of the people who use the service. They are tastefully decorated, with people being able to personalise them with their own belongings. We saw that people who live at the home had their own televisions, stereos, gaming equipment and fish bowl, and some had brought in their own furniture from where they used to live. We saw that the recently refurbished ground floor bathroom had exposed pipework, that could be a risk to people who use the service, and a requirement has been made for this to be boxed in to minimise risks. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: Also, as stated earlier in the report, the head office of RHLT is currently using the games room as office accommodation. The head office staff, and their visitors also use the bathroom facilities in the home. As highlighted previously, there are plans for this to be resolved and it is anticipated that this will happen as a matter of priority, as the service does not currently meet the National Minimum Standards for care homes for adults, which states that the bathrooms in a service should offer people who live at the home sufficient personal privacy. The home was observed to be clean throughout and fresh-smelling in all areas. Care Homes for Adults (18-65 years) Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive training relevant for their role, and appropriate recruitment checks minimise risks to people who use the service. Evidence: The manager informed us that they have recently recruited more staff to the support worker care bank to ensure that people who use the service can be supported with activities outside the service. We looked at the recruitment files for three staff, which were seen to contain the required information about recruitment checks, such as two references and copy of a Criminal Records Bureau (CRB) check. They also contain information regarding the staff members application, a copy of the records of their interview and correspondence relating to the offer of their job. We saw evidence to confirm that new staff receive an induction to working at the home. We looked at the training records for two staff. There are records to indicate that staff receive a good amount of training, which is provided through attendance at courses and on-line training. Staff receive training in areas such as fire safety, moving and Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: handling, food safety, equality and diversity, mental capacity, first aid, medication and safeguarding adults. The manager said that all staff are currently trained to National Vocational Qualification (NVQ) level two or three, and we saw correspondence in their files relating to this. In the surveys we received from staff, some of them said that they would like to have more training on how to deal with challenging behaviour and agression. Care Homes for Adults (18-65 years) Page 25 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is competent and understands the responsibilities of their role. Findings from this inspection indicate that the service is run in the best interests of the people who use the service. Health and safety checks are carried out to minimise risks to the people who use the service. However, the policies and procedures in use at the service are insufficient for the running of the service as they are outdated, inaccurate and do not cover all aspects of running a care home. Evidence: The manager is registered with the Commission to be the Registered Manager for 5-7 Cedars Road. She has worked at the service since it opened in 1991, initially starting as a support worker and then progressing her way up to being the manager of the service approximately ten years ago. She informed us that she has completed the Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: Registered Managers Award and the National Vocational Qualification (NVQ) level 4 in Management. Staff say that they feel supported by the manager and that there is good communication of relevant information. One staff member told us that she is always willing to listen and help them, whilst another said that the suport they receive helps to enhance the quality of life of the people who live at the home. During the inspection the manager and staff demonstrated a committed approach to ensuring the people who use the service have a good quality of life. The manager and staff spoke with genuine fondness about the people who live at the home and we observed positive, respectful interactions between them whilst we were at the service. Regular staff meetings take place and meetings with people who use the service occur every month. Visits in accordance with Regulation 26 of the Care Homes Regulations 2001 take place monthly, with a record of these maintained at the home. However, there is no policy on quality assurance at the service, and we found that the policies and procedures in use are not sufficient for the running of a care home. In the AQAA that we received for the service it was recorded that the home does not have all policies and procedures in place, and for those that are, a majority were last reviewed in 2002. We looked at this during our visit to the home and found that due to the date that the policies were last reviewed, they contain out of date and inaccurate information. Examples of this have been highlighted earlier in the report, under complaints and protection. However, another example is that the food hygiene and safe storage of foodstuffs policies do not mention the labelling of foods, which we found does not happen at the service, and can be a risk to people who use the service. We also found that there are no policies or procedures regarding areas such as fire safety, dealing with accidents of people who use the service, admission to the home and recruitment of staff. We looked at the minutes of the executive committee meeting and found that the review of policies and procedures for RHLT has been planned for at least a year prior to our inspection, yet no progress has been made in this area. It is of concern that staff do not have access to up-to-date policies and procedures of the organisation, and the lack of these does not ensure that the rights and best interest of people who use the service are safeguarded. Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: Requirements have been made for the service to address this, as well as a recommendation for the service to seek guidance from an external policy maker, to ensure that the information provided is up-to-date, and covers all relevant policies. The service holds most relevant certificates and records to indicate that appropriate checks are carried out on areas of health and safety, including the fire system, electrical appliances and gas safety. The date of the last electrical installation test was 2003, and we were informed that a more up-to-date inspection is being planned to take place shortly. Care Homes for Adults (18-65 years) Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 17 16 Opened packets of food must be labelled with the date of opening and date to be disposed of, according to manufacturers instructions. So that food provided is nutritious and healthy for the people who live at the service. 31/05/2010 2 20 13 The MAR chart must have a 30/04/2010 clear record of all medication administered, and those that are not, with appropriate recording to reflect this. So that the MAR chart accurately reflects medication administered at the service. 3 23 13 A robust up-to-date safeguarding policy and procedure must be in place at the service 30/06/2010 Care Homes for Adults (18-65 years) Page 30 of 34 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 To ensure that appropriate information is available for dealing with any issues that may arise. 4 24 23 The exposed pipework in the 30/06/2010 ground floor bathroom must be boxed in to minimise risks to people who use the service. To minimise risks to people who use the service. 5 39 12 Policies and procedures at the service must be kept under regular review and updated as necessary. So that information is current and best practice is promoted. 6 40 12 Full up-to-date policies and procedures must be developed for all aspects of the service. So that the best interests of people who live at the home are safeguarded. 7 42 23 The service must ensure that periodic servicing is carried out on the electrical wiring at the service, and a certificate maintained at the home to evidence this. 31/05/2010 30/06/2010 30/06/2010 Care Homes for Adults (18-65 years) Page 31 of 34 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 To ensure that the home is safe for people to live in. 8 42 13 The service must ensure 30/06/2010 that full policies and procedures are implemented at the service in relation to all aspects of health and safety and safe working practices, including fire, first aid and food hygiene. So that risks to people who live and work at the home are minimised. 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 16 RHLT should install a lodge in the garden that could be used for the head office or the games room. However, whatever the purpose this would be used for, separate toilet facilities need to be installed for the use of head office staff (and their visitors), to ensure the privacy of the people who use the service. RHLT should keep the CQC informed of the progress of the plans for the head office and games room, and of the timescales involved, so that we can monitor this aspect of the service through our inspection and review processes. A clear, structured auditing of medication needs to be implemented at the service to ensure that medication is managed properly and appropriate actions taken to minimise errors. People who use the service should be provided with bathrooms and accommodation that respects and ensures Page 32 of 34 2 16 3 20 4 27 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 their privacy. 5 6 35 40 Staff should receive training in dealing with aggression and challenging behaviours. The service should seek guidance from an external policy maker, to ensure that the information provided in the policies and procedures is up-to-date, and covers all relevant policies for the running of a care home. Care Homes for Adults (18-65 years) Page 33 of 34 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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