Care Home: 56 Chart Lane

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What the care home does well The home continues to provide a homely and welcoming atmosphere. Detailed and comprehensive support plans have been completed, which are provided in formats accessible to the service users. It is clear individuals have been involved in the writing of their support plan. The home has individual health action plans and risk assessments for the people living there to ensure they enjoy an independent and healthy lifestyle. People using the service are supported to access a range of activities, which meets their individual needs and choices. A survey respondent said......The staff help me do what I want to do. Another respondent records.....Staff are good to me, they help me go out and to visit my family. Good relationships were observed between people using the service and staff who were able to evidence a through knowledge and understanding of the needs of the people living in the home. A survey respondent records.....Food and staff are good. Some people living in the service have communication difficulties and the manager has implemented a number of documents in easy read, accessible formats using pictures and symbols. The manager and her staff team were observed to be committed to ensuring that people using the service experienced a good quality of life. What has improved since the last inspection? All three statutory requirements issued in the last inspection report have been addressed and will be removed from this report. Staff have changed the way they support people to prepare their meals, by offering pictorial shopping lists and menus. A wooden building has been erected in the garden to provide additional recreational and day space for service users. A large snooker table is now available in this area for people to enjoy. What the care home could do better: Service users would benefit if staff had access to an up to date copy of the Surrey Multi-Agency Procedure for Safeguarding Adults to guide and direct them. The home`s complaints procedure should be revised to include the contact details of the local Social Services Department. Social Services hold statutory powers to investigate complaints and safeguarding issues raised with them about registered homes. During this inspection issues relating to the environment have impacted on the home`s overall quality rating judgement using KLORA and have raised concerns about safe working practises. Service users would benefit from staff having received up to date infection control training. Key inspection report Care homes for adults (18-65 years) Name: Address: 56 Chart Lane 56 Chart Lane Reigate Surrey RH2 7DZ     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: Marion Weller     Date: 1 6 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 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 31 Information about the care home Name of care home: Address: 56 Chart Lane 56 Chart Lane Reigate Surrey RH2 7DZ 01737224592 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.mencap.org.uk Royal Mencap Society Name of registered manager (if applicable) Ms Alison Jane Porteus Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 8. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home The service at 56 Chart Lane is administered by Royal Mencap (Housing and Support Services.), and is one of many services managed by the organisation throughout the country. The home is registered to accommodate a maximum of eight adults, all of whom have a learning disability. The home is located in a residential road with a range of facilities and amenities close by. Parking on the premises for visitors is limited. Service user accommodation is provided over three floors and bedrooms are for single occupancy. No en suite bedrooms are available at the service. A large garden is Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 8 Brief description of the care home provided to the rear of the premises. The home does not have a stair or passenger lift and would be unsuitable for service users who have mobility problems. The weekly fees range from £345 - £475. Please speak to the registered manager for more detailed information. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspector, who was unaccompanied during the site visit, arrived at the service on Friday 16th April 2010 at 10:40 am and was in the home for just over five hours. During the site visit the inspector spoke briefly with some of the support staff, members of the service user group and at considerable length with the Registered Manager. A number of documents relating to service users were sampled including individual support plans, health action plans, risk assessments and medication records. Two staff files, including recruitment and training records were checked and documents and reports relating to the homes quality assurance systems were viewed. The inspection report takes into account all the information obtained about the service. This includes any formal notifications, reports, phone calls and letters received and any information we have concerning complaints or allegations. In addition, 13 completed surveys were returned to us by service users and staff before the inspection took place. The manager was also asked to complete the homes Annual Quality Assurance Care Homes for Adults (18-65 years) Page 6 of 31 Assessment (AQAA) prior to the inspection. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. The completed document gave us information which provided a reasonable but somewhat limited picture of what was happening in the service, and their plans for further development. During the site visit the inspector looked at how well the service was meeting the standards set by the government and has, in this report, made a judgement about the quality of service provided by the home. Two legal requirements have been made as a result of the inspection. Other good practice recommendations were discussed with the registered manager. During this inspection shortfalls in the homes environment and subsequent health and safety issues have impacted on the overall quality rating judgement using KLORA. This has resulted in the homes quality rating being reassessed using a rules based approach. Where areas for improvement emerged as a result of the inspection however the registered manager recognised these and spoke of her firm commitment to manage the necessary changes to service users benefit. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Service users would benefit if staff had access to an up to date copy of the Surrey Multi-Agency Procedure for Safeguarding Adults to guide and direct them. The homes complaints procedure should be revised to include the contact details of the local Social Services Department. Social Services hold statutory powers to investigate complaints and safeguarding issues raised with them about registered homes. During this inspection issues relating to the environment have impacted on the homes overall quality rating judgement using KLORA and have raised concerns about safe working practises. Service users would benefit from staff having received up to date infection control training. Care Homes for Adults (18-65 years) Page 8 of 31 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users and their representatives have access to most of the information they need to enable them to make an informed decision about using the service. People moving to the home would have a full assessment of their needs before they were offered a place at 56 Chart Lane. Evidence: The homes information documents are designed to ensure that any prospective service user, their family or their representatives have enough information to make an informed choice about moving in. In this respect the home has developed a written statement of purpose and service users guide that is made available in widget format (a method of communicating using pictures and symbols.) The documents contained a copy of the homes last inspection report dated 2007. People wanting more up to date information would have benefited further from the inclusion of the homes last two annual service review reports, written by the CSCI/CQC in 2008 and 2009. The manager records in her AQAA......as a service provider organisation, we place great importance on supporting people and their families in making an informed Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: choice about where and how they live. We have policies and processes that guide staff in ensuring that people receive good and reliable information before they move and are supported in making a successful transition. The registered manager stated that most service users have been living at the home for a number of years. As explained at previous inspections, service user pre assessments were not comprehensively undertaken for people transferring at that time. The home has since undertaken their own assessments and these are ongoing. Evidence was seen in care documentation viewed and covered all the areas of support the individual needed. The home has not had any new admissions since the last inspection and currently has no vacancies. The manager explained that in future prospective service users would have a full assessment of their needs in which they would be fully involved before they were offered a place at the home. The manager also said that the assessment would take into account the needs of the existing service users, to ensure that the home is the most appropriate place for the person to be and they can fully meet their needs. In addition, prospective service users would be given the opportunity to visit the home, so they can make an informed decision about moving in. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are involved in making decisions about their lives, and play an active role in planning the care and support they receive. Some environmental risks should be reassessed to meet individual need and help people using the service to lead the life they choose, without risk of harm. Evidence: Each person in the home has an individual support plan. Two were inspected at this site visit and were seen to be detailed documents, written in a user friendly format and covered all aspects of the individuals personal, social, and emotional needs. Health action plans and hospital passports are also in evidence for service users. Reviews of individual support plans are undertaken regularly. Funding authorities review care placements annually. Our records show the manager has plans for further improvement in this area.....We will be further developing pictorial support plans and more robust auditable trails to show that all service users needs and choices are recognised recorded and supported by the whole team. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: The manager said they encourage relatives and other people who matter to the person to be involved in care planning meetings and reviews. Staff appeared knowledgeable about service users choices, needs and views. Each service user has a named keyworker who works closely with them. Survey responses from service users evidenced high levels of satisfaction with the service and they were keen and motivated to be involved in all aspects of life in the home. Some people living in the home have communication difficulties and systems have been implemented to assist them to access and use information, which have been developed in pictures and symbols. It was evident during the inspection that some individuals also use makaton sign language which staff are supported to learn to enable them to meet the needs of everyone living at Chart Lane. Service users are being supported to make wider decisions in their lives, for example, where and how they wish to live in the long term and their future hopes and dreams. The manager records that.....Changes are in the air for supported living at this home in line with the government white paper, Valuing People Now.....We will endeavour to meet this challenge along with the service users to their best of our abilities. Any restrictions to service users choices are managed through their personal support plans and risk assessments, which are reviewed every six months and updated regularly. Risk assessments were generally observed to be satisfactory and to secure the individuals welfare and safety. A risk assessment should however be completed in respect of the aged lounge carpet, which is a potential trip hazard. A generic risk assessment concerning uncovered radiators seen throughout the home should also be reviewed in light of service users specific health needs and a client group that are generally becoming older. It was discussed with the manager that some individuals may need more consideration to be given in this respect to ensure risks continue to be managed positively and to help people using the service to lead the life they want, without risk of harm. The manager spoke of her clear intention to review the risk assessment. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported to lead busy and interesting lives that meet their social and leisure needs. They are supported to identify their responsibilities in the home and their rights to privacy and personal space are respected. A varied and nutritious menu is available and people are supported to choose the meals they enjoy. Evidence: Central to the homes aims and objectives is the promotion of the service users right to live an ordinary and meaningful life. The manager records in her AQAA......We aim to enable and support people who use the service to actively engage with and participate in their local community and to develop and lead lifestyles that enable them to achieve the things that matter to them. Individual support plans indicate that people living in the service have the opportunity Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: to attend a wide range of social and recreational activities which include attendance at sports clubs, visiting restaurants, going to the pub and cinemas, visiting the library and going bowling. People living at the home are supported to go on holidays and have regular breaks away. Holidays are usually arranged individually, with the full involvement of the service user but the manager also spoke of arranging a group holiday to Dymchurch soon, which people living at the home were eagerly looking forward to. Observation showed that people living in the home choose when to be alone or in company, and when not to join in an activity. Records of all activities undertaken are maintained in individual support plans and daily records. The home has its own transport to enable service users to access community based facilities and activities. Satisfactory risk assessments are in place in to ensure the welfare of individuals and to allow then to take assessed risks in their lifestyle. People using the service are supported to increase their independence. The manager said that service users who wish to be are regularly involved in household chores. One individual was observed doing their washing, assisted where necessary by staff. Routines of daily living were observed to be flexible and people clearly had access to all communal parts of the home, which included a large dining room/lounge area and a garden with a new summerhouse. They have access to the kitchen with staff support. Service users have the opportunity to assist with cooking, ironing, food shopping and are supported with travel training. All people living in the service are issued with a key for their bedroom and the front door. Survey respondents spoke highly of the staffs efforts to increase their independence and daily living skills. Saying......I like shopping for dinner independently. Another person records.....They have helped me to become independent with travel and my shopping. I like the food and the staff. The home supports service users to maintain family links and friendships and people involved with service users are encouraged to visit as often as they wish and are always made welcome. Our records show that the home has a six weekly menu plan. Records of meals eaten by service users to monitor the provision of a healthy diet are maintained. Service users are involved in planning the menu by the introduction of a pictorial meal planner. The menus seen were nutritious and offered both variety and choice. Care staff undertakes the cooking duties. The manager confirmed that training in food handling and food hygiene is regularly arranged for staff. The main meal of the day at 56 Chart Lane is taken at night. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive personal support in the way they prefer and can be confident their medication administration needs will be met by the service. They would benefit further from improvements being made to environmental shortfalls and infection control measures that have the potential to compromise their health and safety. Evidence: Service users personal care needs are assessed and recorded in their individual support plans. Two support plans were looked at on this visit. Health action plans have also been introduced as recommended in the Valuing People white paper. This supports people to identify their own health needs in a holistic way and gives them more control over managing them. The manager records in her AQAA.....All service users have health action plans reflecting their individual needs; these are supported and monitored by the support team and medical professionals. The team are working on the development of hospital passports for all the service users. Staff are aware of individual support plans and therefore people living at the home receive personal care in the way they prefer and want. All service users are registered with local GPs and attend the surgery for appointments when required. Health records Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: show that appointments are made and records kept regarding a health care professionals involvement with residents. Records seen recorded visits to the chiropodist and the local optician. Some issues were discussed with the manager in relation to improving environmental factors and infection control measures in the home to ensure that service users health and welfare is fully protected. This aspect is more comprehensively recorded in the environmental outcome area of this report. There is a policy in place for the administration of medication and all staff receives training. The manager said they have ongoing competency assessments. Medication is provided by a local pharmacy, some in blister pack format. The manager also explained that the dispensing pharmacy undertakes regular audits of medication within the home. One individual self-administers a vitamin supplement, which was supported by a risk assessment. The medication charts were seen for two residents and these were being satisfactorily maintained, with no obvious gaps. It was discussed with the manager that it was good practice for topical medicines to be kept separately from those intended for oral administration in the medication storage cupboard. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service can be assured their concerns will be taken seriously and acted upon. Service users are safeguarded in the home from harm but would benefit further if staff all had access to an up to date copy of the Surrey Multi-Agency Procedure for Safeguarding Adults to further guide them and the complaints procedure is revised to include the contact details of the local Social Services Department. Evidence: The home has strategies in place to ensure that those who live there and those that visit can make their views and complaints known. The complaints procedure is available to service users in an easy read, widget format. Some service users however have difficulty with communication and therefore staff rely on their skills of observation and knowledge about the people they support to inform them of a service users level of satisfaction or unhappiness. The homes AQAA records that no formal complaints have been received by the service over the last year and minor concerns are dealt with quickly. The manager records......As a service we keep a minor complaints log and support the service users to use this to address day to day issues within the home. The manager has a good understanding that the quality of the service provided is the responsibility of the provider and concerns and complaints should be raised with the home in the first instance. It was discussed that contact details for the local social Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: services department should be clearly included in the homes complaints procedure. Social Services hold statutory powers to investigate complaints and safeguarding issues raised with them about registered homes. There have been no safeguarding alerts or investigations in which the home has been involved over the last year. There is a safeguarding adults policy in place and all staff undertakes training in adult protection issues during induction and mandatory training. There is a copy of Surreys Multi Agency Policies and Procedures document for the Safeguarding of Vulnerable Adults in the home, but this is not the most up to date version. The manager spoke of her firm intention to obtain a current copy and to ensure it is made accessible to all who may wish to see it or need to use it. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Cleaning schedules need improvement to ensure the provision of a safe and hygienic environment for service users. In addition, further specific environmental improvements should be made to eliminate hazards to people living and working in the home and to ensure the homes food safety and infection control measures are not compromised. Evidence: At the last inspection a statutory requirement was issued to refurbish a communal bathroom on the first floor. In response to this the housing association, who owns 56 Chart Lane installed a new shower room. The managers AQAA records......The bathroom upstairs has been worked on but the environment is very poor and regular complaints are sent to the housing association to try and resolve this. On inspection the refurbished bathroom evidenced significant mould growth to the grouting and seal that runs around the base of the shower area. This mould growth extended to wall tiles. In addition, the wall tiles were seen to be bowing outward, away from the wall. The mould and damp extended across the bathroom ceiling. The paint finish to the adjacent wall was peeling. The manager said the extractor fan installed does not adequately remove condensation and therefore the room is perpetually damp and unpleasant to use. The shower curtain has to be replaced regularly as it becomes Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: stained by mould growth fairly quickly. The bathroom door had warped and could not be closed properly. It was discussed with the manager that although the bathroom has clearly received the required refurbishment required in the last inspection report. The work is not satisfactory and does not benefit the people living in the home or secure their health and safety. It was discussed that the registered persons are responsible for providing a safe, hygienic well-maintained and comfortable environment for service users, which demonstrates the suitability of the premises for the provision of service, as detailed in the homes Statement of Purpose. The registered persons must continue to work closely with the housing organisation to resolve outstanding issues to the benefit of the people who live in the home and to fully discharge their regulatory duty. A further statutory requirement will be issue in this inspection report to that effect. The homes kitchen had also been refurbished by the housing association since the last inspection. This area was seen by the inspector. The manager reports some outstanding issues of concern in relation to the installation. The floor finish has a join down the centre in an area of particularly heavy tread, which she feels has the potential to cause problems. Some worktops are not sealed properly and consequently are blowing near the sink area where water has seeped into the seal. This makes the area difficult to keep clean and compromises the homes environmental and food hygiene safety controls. The manager spoke of her intention to pursue a resolution of the outstanding problems. The service users lounge area evidenced an aged fitted carpet that was badly worn in places. This had the potential to cause a trip hazard and could compromise the safety of people living and working in the home. No risk assessment was in place to reduce the hazard. A request for a replacement carpet had been made by the manager to the provider organisation. This had been turned down due to budget constraints in the previous financial year. The manager had quotes for replacement costs and has been asked by the provider organisation to resubmit her request in this financial year. Resolution of this matter will be monitored. All service users bedrooms are for single occupation and those seen had been personalised to reflect the tastes and the interests of the occupants. Some bedrooms offered limited space to the occupant. The homes AQAA records......We aim to encourage and support people to be involved in the upkeep of their home and to take pride in where they live. This statement is in variance to evidence seen in relation to some furniture and effects in service users bedrooms. Some items had not been cleaned properly and evidenced accumulated dust and debris. Tiles in one bedroom Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: were missing from a sink splash back, which made it difficult to clean the area properly. Some curtains were not properly attached to curtain rails and appeared aged. The manager spoke of her intention to arrange for some areas of the home to receive extra attention to ensure that service users were adequately supported in the upkeep of their home. A communal toilet on the ground floor evidenced liquid soap for hand washing. However, a well used communal cotton hand towel was provided for people to dry their hands. It is not always possible to identify people who may spread infection to others; therefore precautions to prevent any spread of infection must be followed at all times when care is provided in a residential home. It was recommended that the use of disposable paper hand towels in all areas would ensure the homes infection control policy was not compromised and the home could better evidence good practice. The manager stated her firm intention to address this issue. Communal areas and service users bedrooms did not evidence radiator covers. The manager advised that risk assessments were in place which managed and limited the risk to service users. It was discussed that in light of a service user who had specific health issues and a service user group who are generally becoming older, together with staffing rosters that provide for one sleeping member of staff only at night, that it would benefit service users if environmental risk assessments were reviewed. The home has an accessible garden to the rear of the house, which provides a patio area and garden furniture for service users. The garden was overgrown and in need of attention. Some work to the installation of a wooden summer house remained outstanding. The manager stated that the gardener had not been available, but work to address all the issues was planned. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a competent and qualified staff team who are properly supervised in their work. They would benefit further from all staff having received updated infection control training. Service users are protected in the home by robust recruitment practices. Evidence: Two staff files were seen and contained the necessary documentation to meet the demands of regulation and evidence appropriate checks are made before employing people to work in the home. This safeguards service users from any potential for harm. The managers AQAA records.....The staff team have been expanded by two part time staff members recently who have transferred from the Royal Mencap relief list, both were selected by the people living at the home because they had worked regularly with them. This evidences that service users are involved in the homes recruitment procedures and clearly have a say about the people who support them. The home could evidence that over 50 of staff employed are NVQ qualified, at either levels 2 or 3. The homes AQAA records.....All the team have personal development plans, ensuring the training needs of the staff team are identified. Also regular formal supervision, appraisals and team meetings are recorded. Inspection of training records showed that staff have largely completed the mandatory training courses they need to Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: carry out their roles safely and to meet the specific care and health needs of people living in the home. The staff training records did not evidence staff had received infection control training. The manager spoke of her intention to address this shortfall. Staff have regular supervision with the registered manager and records seen evidence that supervision covers many areas of their work, practice and responsibilities in the home. The manager explained that supervision sessions and staff meetings are also used as a means of updating staff with any changes in legislation and good practice guidance. The manager spoke particularly about the demands that The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards has placed on their work since the last inspection. Surveys received from service users prior to the site visit spoke well of the staff. One respondent records....Staff are good to me. Another states....Food and staff are good. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users and their representatives can be confident that their views will be regularly sought to inform planning and development. The manager knows where improvements must be made to the homes environment and safe working practices to benefit and protect people living and working at the home. Effective organisational monitoring, action and support for the manager will bring about the necessary resolution to the shortfalls evidenced. Evidence: The registered manager has worked at the home for the last nine years and was able to demonstrate a good understanding and insight into the individual needs of the people living in the home. She has considerable experience in social care and has completed the Registered Managers Award. In line with a requirement issued in the last inspection report. A representative of the registered provider organisation visits the home to monitor standards. Regulation demands that visits focus on the outcomes for the people who use the service with regard to quality of care, safe working practice, environmental issues, safe staffing Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: levels, adult protection, staff training and ensuring requirements awarded by the regulator are progressed satisfactorily to timescale. Along with speaking to staff and service users and recording their comments or concerns. To confirm compliance with the requirement the inspector viewed two reports, generated from recent provider visits. These were printed by request from an electronic file on the managers PC. They evidenced monitoring by the providers representative of issues about the worn and aged carpet in the residents lounge, but record no action taken in relation to the poor bathroom environment or liaison with the housing association or indeed solutions and guidance to other environmental factors. The reports are not easy to follow or audit and should be further developed to evidence good practice and be readily available for inspection purposes. Other methods of auditing quality standards were evident, such as regular meetings and placement reviews with service users, their relatives or advocates and holding staff meetings. The provider organisation also conducts annual quality assurance exercises. Feedback was given to the manager in relation to the homes AQAA return to CQC. The manager fully understands the importance of the AQAA return but should consider developing the content. Good practice suggests that the AQAA should contain excellent information which is fully supported by appropriate evidence about the specific service. The data section should also be fully completed. During this inspection issues relating to shortfalls in the homes environment have impacted on the overall quality rating judgement using KLORA and raise concerns about safe working practices. There is evidence of the manager being proactive and seeking to address some of the issues. Shortfalls need to be fully resolved however to better evidence that people living and working in the home and visitors health, safety and welfare are being consistently promoted and protected. In relation to The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, assessments of capacity and decision making for residents are being undertaken in a way that complies with published codes of practice. There is no one living in the home who is currently the subject of a deprivation of liberty authorisation. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 23 The upstairs bathroom must receive sufficient work and attention to eliminate and fully resolve the environmental issues described in the inspection report. This will ensure that people using this service have pleasant, safe and hygienic bathrooms to use. 22/08/2010 2 30 13 The service must ensure satisfactory standards of hygiene in the home. To protect service users health and safety and ensure they have a comfortable and safe environment. 28/07/2010 Care Homes for Adults (18-65 years) Page 29 of 31 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 35 It is strongly recommended that the manager fulfils her stated intention to arrange for all staff to receive updated infection control training. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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. 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. Care Homes for Adults (18-65 years) Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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