Care Home: 6 High Street

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What the care home does well Staff working at the home are well trained and have the skills and experience necessary to meet the needs of people living at the home. All care staff working at the home have achieved a minimum qualification of NVQ level 2 in Care. Two out of seven staff have achieved an NVQ level 3 in Care. Staff receive induction and regular mandatory training. People are happy with the care that they receive. Comments made by people that use the service included: "The home is very good. Staff help me when I need help and are nice to talk to" "I am happy. I like to go out to Redcar and to go for a meal" "I like it here. Staff take me to the bingo, sometimes I win , but sometimes I am not so lucky" "I have lived here along time and I like everyone" Staff support, enable and encourage people to be actively involved in the community and enjoy a full social life. One person attends college twice a week. One person works one day a week in a charity shop. People regularly visit the shops, bingo, arts and drama groups and local pubs. What has improved since the last inspection? People that use the service have completed a "Listen to me workbook" with staff. This workbook contained good detail on hobbies, favourite foods, important people in their life, What the person likes to do during the day and at the weekend, information on medication and hopes and dreams for the future. There have been a number of improvements made to the home environment in the last twelve months. The lounge and dining room have been redecorated and new furniture has been purchased. Three bedrooms of people that use the service have been redecorated and new bedroom furniture has been purchased. Bedrooms looked at during the visit were individual to the person and contained many personal possessions. People spoken to said how they had been involved in choosing the colour of the paint for their bedroom. Last inspection highlighted that staff who are responsible for administering medication should have their competency checked on a regular basis to make sure that they are following safe practice. Evidence of medicine competency checks were available for the inspection. What the care home could do better: Care plans need to be developed further to ensure that they are individual and specific to the person. Care plans need to include what the person can do for themselves, assistance needed, likes, dislikes, evidence of personal choice and preferences. This will help to promote Independence, ensure that care needs are met and that care is delivered in such a way that is acceptable to the person. Care plan documentation should be developed/updated to ensure that it is user friendly. This will aid communication and make sure that it can be easily understood by people that use the service. Care Files need be updated to include information specific to the person regarding maintaining a personal relationship and identify any associated risks. Care files must include how to support the person to maintain a personal relationship with people of their choice and detail any action required to minimise risks. Last inspection of the service highlighted that risk assessment documentation was basic and needed further development. This inspection did not show any improvement. When a risk is identified a risk assessment must be developed to include how to support the person and include action that needs to be taken to minimise the risk. This will help to ensure safety. Each person should have a health action plan that details what the person can do to be healthy and any help that they might need. This will help to promote health and wellbeing. Handwritten Medication Administration Records should be checked and signed by two staff to confirm accuracy. Medication carried over from the previous month should be documented on the MAR to enable auditing. The complaint procedure for people that use the service, families and representatives should be updated to include names and contact details of who to contact when making a complaint. This will ensure that complaints are dealt with efficiently. The policy/procedure for dealing with abuse should be developed further to include details of local arrangements and contacts for reporting concerns. Duty rotas should should highlight one to one social and recreational hours that staff have provided to each person that uses the service. Two files of staff working at the home were looked at during the visit. One file contained evidence that a good recruitment procedure had been followed. An application form, two references and a Criminal Record Bureau Check was available within the file. The second file contained an application form and a Criminal Record Bureau Check, however only contained one reference. Portable Appliance Testing was last carried out in July 2008. This must be undertaken on a regular basis to ensure that equipment is in safe working order to use. Examination of records identified that on occasions water temperatures of baths were a little cooler than they should be. Water temperatures should be close to 43 degrees Celsius to ensure comfort and safety. Key inspection report Care homes for adults (18-65 years) Name: Address: 6 High Street 6 High Street Loftus Saltburn-by-Sea TS13 4HW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Katherine Acheson     Date: 2 9 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: 6 High Street 6 High Street Loftus Saltburn-by-Sea TS13 4HW 01516511716 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Potensial Limited 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 who can be accommodated is: 8 The registered person may provide the following category of service only: Care Home only Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Learning Disability, Code LD Date of last inspection Brief description of the care home 6 High Street is registered to provide personal care to a maximum number of eight people who have a learning disability. The home is a converted victorian house providing accomodation to people on three floors. Each person has their own bedroom and has access to lounge, dining and kitchen facilities. There are a number of bathrooms, shower rooms and toilets. The home is situated in the centre of Loftus close to all the local amenities and transport. 2 4 0 3 2 0 0 9 8 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is 1 star. This means that people who use the service experience adequate quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some regulations from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not being put at risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. The manager completed and returned an Annual Quality Assurance Assessment, (AQAA). The AQAA is the services self assessment on how they think that they are meeting National Minimum Standards. This information was received before the inspection and was used as part of the inspection process. Care Homes for Adults (18-65 years) Page 5 of 33 Before this inspection visit we looked at all of the information that we have received since the last inspection of the service on 24th March 2009. Before the inspection surveys for people that use the service and surveys for staff were sent out to the home for the manager to distribute. Surveys sent to people that use the service were asked to comment on care received. Surveys sent to staff were asked to comment on what it was like working at the home and training received. We received five surveys from people that use the service. We did not receive any surveys from staff. Comments in surveys received can be read in the main body of the report. This key unannounced inspection took place on 29th January 2010. The reason for the inspection was to see how good a job the home does in meeting the National Minimum Standards set by the Government for care homes. Numerous records were examined including care records of people living at the home, medication records, risk assessments, complaints and staff records. We looked around parts of the home to make sure that it was clean, safe and comfortable. Requirements and recommendations highlighted at the last inspection were revisited to see if improvements had been made. During the visit we talked with people that use the service, the manager and staff. Care Homes for Adults (18-65 years) Page 6 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Care plans need to be developed further to ensure that they are individual and specific to the person. Care plans need to include what the person can do for themselves, assistance needed, likes, dislikes, evidence of personal choice and preferences. This will help to promote Independence, ensure that care needs are met and that care is delivered in such a way that is acceptable to the person. Care Homes for Adults (18-65 years) Page 7 of 33 Care plan documentation should be developed/updated to ensure that it is user friendly. This will aid communication and make sure that it can be easily understood by people that use the service. Care Files need be updated to include information specific to the person regarding maintaining a personal relationship and identify any associated risks. Care files must include how to support the person to maintain a personal relationship with people of their choice and detail any action required to minimise risks. Last inspection of the service highlighted that risk assessment documentation was basic and needed further development. This inspection did not show any improvement. When a risk is identified a risk assessment must be developed to include how to support the person and include action that needs to be taken to minimise the risk. This will help to ensure safety. Each person should have a health action plan that details what the person can do to be healthy and any help that they might need. This will help to promote health and wellbeing. Handwritten Medication Administration Records should be checked and signed by two staff to confirm accuracy. Medication carried over from the previous month should be documented on the MAR to enable auditing. The complaint procedure for people that use the service, families and representatives should be updated to include names and contact details of who to contact when making a complaint. This will ensure that complaints are dealt with efficiently. The policy/procedure for dealing with abuse should be developed further to include details of local arrangements and contacts for reporting concerns. Duty rotas should should highlight one to one social and recreational hours that staff have provided to each person that uses the service. Two files of staff working at the home were looked at during the visit. One file contained evidence that a good recruitment procedure had been followed. An application form, two references and a Criminal Record Bureau Check was available within the file. The second file contained an application form and a Criminal Record Bureau Check, however only contained one reference. Portable Appliance Testing was last carried out in July 2008. This must be undertaken on a regular basis to ensure that equipment is in safe working order to use. Examination of records identified that on occasions water temperatures of baths were a little cooler than they should be. Water temperatures should be close to 43 degrees Celsius to ensure comfort and safety. 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. Care Homes for Adults (18-65 years) Page 8 of 33 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 33 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 33 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. Assessments of people that are to use the service take place before they move into the home to ensure all needs can be met. Evidence: The manager said that before people move into the home she does an initial assessment to determine if the persons needs can be met at 6 High Street. People receive other assessments from a social worker and/or other health care professionals. People are then invited to visit the home to meet the other people that use the service, stay for a meal and even stay overnight. The manager said that following assessment a detailed care plan would be drawn up and funding levels would be agreed with the purchasing authority. The homes statement of purpose and service user guide is given to people that are thinking of using the service to help them and their family in the decision making process. The manager said that there hasnt been any new people who have come to live at the Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: home since last inspection of the service. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service are involved in everyday decisions and choices about their lives. Some care plans are insufficiently detailed and although risks to people have been identified, risk assessments have not been developed to detail support required and any action needed to minimise identified risk to ensure safety. Evidence: The manager said that each person that uses the service has a person centred plan that details the support needs of the person and choices about their life style. She said that care plans are regularly reviewed to ensure that any changes in need are highlighted . Care plans are records that are used by all care services to show what sort of help each person needs and how staff will provide that care. The care files of two people that use the service were looked at during the visit. Care files contained a listen to me workbook. This workbook contained good detail on Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: hobbies, favourite foods, important people in their life, What the person likes to do during the day and at the weekend, information on medication and hopes and dreams for the future. People that use the service had participated in completing the workbook. Care plans looked at during the visit had been rewritten since last inspection. Care plans were inconsistent some were better than others. One plan of care gave good detail on the help the person needed with washing and dressing and what the person could do for themselves. Another plan of care for another person did not include what the person could do or help needed. The manager advised how she supported people to maintain personal relationships; however care files did not include information specific to the person regarding maintaining personal relationships nor did it include any associated risks. Not all of the care plan documentation was user friendly. This was discussed with the area manager after the inspection who said that she was aware of the need to improve care plan documentation to aid communication and make sure that it could be easily understood by people that use the service. Records were available to confirm that the area manager of the home had looked at care files of people that use the service and highlighted that care plans were out dated and did not include enough information. Last inspection of the service highlighted that risk assessment documentation was basic. One care file looked at during this inspection identified that the person was at risk when shaving, when in the kitchen and when out in the community; however did not detail what the specific risk was or action that should be taken to minimise/prevent the risk. The manager said that a daily record/statement/evaluation is made at the end of the day for each person that use the service. Daily evaluations looked at during the visit contained very little information such as, fine and in a good mood. The daily evaluations did not state how the person had spent their day or comment on wellbeing or any problems encountered. Four out of five people that use the service were spoken to during the visit. People said that they liked the staff and living at the home. People said that they could make their own choices about their lives with the support of staff. Comments made included: Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: I am very happy. I am a very happy person. I have lived here about ten years and get on with the staff well The staff are always good to me I have live here a long time, its very good. I can speak out and say what I want I get on with everyone During the week I get up at 7am because I need to go to work. On a weekend I like to sleep in until 8am The manager said that advocacy support is available for those people that need it. Care Homes for Adults (18-65 years) Page 15 of 33 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 that use this service are enabled to make choices about their life style and are supported to develop their life skills. Social, educational and recreational activities meet individuals expectations. Food provided is varied and enjoyed by all, this helps to ensure wellbeing. Evidence: Care files of people that use the service contained information about what they liked to do in their leisure time. The manager said that people are supported to access a range of appropriate activities. One person that uses the service attends a day centre Monday to Friday. During this time this person is also supported by outreach staff to access the local community. One person is supported to go to college twice a week to do a cookery and arts and crafts course. Another person is supported to work one day a week in a charity shop. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: The home has its own transport and regularly takes people to Redcar. On the day of the unannounced inspection people had been taken to Redcar to do some shopping. People use the local community facilities such as bingo, arts and drama groups and the local pub. One person spoken to during the visit said how they liked to bake with staff. People that use the service have an annual holiday. The manager said that last year everyone chose to go to Blackpool together. She said that this year two people have expressed a wish to return Blackpool to see the lights, however one person has said that they would like to go to Torquay. The AQAA advises that all people are registered to vote and that one person actively votes in elections. Visitors are welcome at anytime and people that use the service are encouraged and supported to visit their families. People are encouraged and supported to participate in housekeeping tasks. One person said, I love doing my own ironing. I hoover and polish my own bedroom. On the day of the inspection two people were observed to be setting the tables for tea. People spoken to during the inspection said that they like the food that is provided. The manager said that people choose what they want to eat on a daily basis. People take it in turn to choose what they would like to have for tea and most of the time the others have the same. People are supported and encouraged to join in the meal preparation and cooking. Records of food served are kept. Examples of food served at teatime include, beef stew, pie and peas, sausage casserole, pork chops and spaghetti bolognese. Comments made by people that use the service included, We take it in turns to choose and make our own dinners on different days of the week and I like fish, chips and mushy peas. People said that they like to go out for a meal. One person said, I went for a meal to the Black Bull at Ugthorpe, I had a cheeseburger and it was lovely. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. Support provided is flexible, consistent, reliable and responsive to their changing needs. Some improvement is needed in medication recording to ensure safe practice. Evidence: People that use the service are involved in planning their care and enabled to make day to day decisions about their life. One person spoken to said, I like to get up at about seven and go to bed at about nine another said, I can do what I want to do and can speak out if Im unhappy. Staff were observed to promote the independence of the person whilst respecting preferences and dignity. One person said, I have a key worker who helps me a lot. People are supported and enabled to choose and purchase their own clothes and hairstyle which reflects their own personality. The manager said that people are supported to visit the chiropodist, dentist and GP and to attend hospital appointments. Of the two care files looked at during the visit, Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: one file contained a health action plan the other did not. A health action plan is a personal plan about what a person can do to be healthy and lists any help the person might need. The manager advised that this person had received regular checkups and would ensure that a health action plan was developed. Files contained evidence of assessment from consultants and community psychiatric nurses. The manager said that all care staff who are responsible for administering medication have received training and have had their competency checked. Since last inspection the home have purchased a controlled drugs cupboard and lockable fridge in which medicines requiring cool storage can be kept. The manager said that people that use the service have their medication reviewed by their GP on a yearly basis. A Medication Administration Record (MAR) is a chart that details prescribed medication and is signed by staff to say medication has been given. Most MARs are printed by the pharmacy, however on occasions need to be handwritten particularly if there is a change to medication in the middle of the months supply. Last inspection of the service highlighted that hand written MARs were not always checked and signed by two staff to ensure accuracy. Examination of MARs at this inspection highlighted again that two staff were not signing to confirm accuracy. During the inspection an audit of medication was carried out for one person that uses the service. On the day of the inspection visit the home was on day twenty five of a twenty eight day supply of medication. Twenty eight tablets were documented as being received at the beginning of the month, which meant that there should have been three tablets left. A count of this medication identified that there were twelve tablets remaining. The manager said that she thought that stock had been carried over from previous months, however had not been documented on the MAR. The last inspection of the service identified that individual protocols for those people receiving PRN (as required) medication needed to be reviewed and updated. The manager said that protocols for four out of five people that use the service had been reviewed and updated. She said that she was in the process of reviewing the last protocol with the GP of the person. Care Homes for Adults (18-65 years) Page 19 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service are confident that their complaints would be listened to and acted upon. Updating the complaint procedure to include who to contact and timescales for action would ensure that complaints are dealt with efficiently. Evidence: The manager advised that a new complaints procedure had been developed in picture format that can be easily understood by people that use the service. This complaints procedure could be improved by giving the name and contact details of who to complain to. The procedure advises that the complainant can contact advocacy and social services but does not include names and contact details. People who use the service said that they would feel comfortable in raising any concern that they have with staff and that it would be acted upon. There is a separate complaints procedure for the families and representatives of people that use the service, however this needs to be updated to include names and contact details of who to complain to and timescales for action. The last inspection of the service highlighted that the home did have procedures in relation adult protection and safeguarding people from abuse, however the policy/procedure needed to be updated to include local arrangements and contacts for reporting concerns. The manager said that this policy/procedure had not been updated, however she intended to do so in the next couple of weeks. Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: The manager said that staff working at the home had received adult protection training week commencing 25th January 2010, however was awaiting certificates to come in the post. Care Homes for Adults (18-65 years) Page 21 of 33 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 standard of the home environment is good. The provider has a refurbishment programme, which highlights further redecoration and maintenance work that is required. This will enhance the environment further and ensure that people live in an attractive, homely and comfortable place. Evidence: 6 High Street is registered to provide care to a maximum number of eight people. The home is a converted Victorian house providing accommodation on three floors. Each floor is accessed via a staircase, there is not a passenger lift. Bedrooms are for single occupancy. There is a lounge and dining room. People that use the service also have access to the domestic kitchen. There are a number of bathrooms, shower rooms and toilets. The home is situated in the centre of Loftus making it close to all the local amenities and public transport. During the inspection we walked around the home with the manager. There have been a number of improvements in the last twelve months. The lounge and dining room have been redecorated and new furniture has been purchased. Three bedrooms of people that use the service have been redecorated and new bedroom furniture has been purchased. Bedrooms looked at during the visit were individual to the person and contained many personal possessions. People spoken to said how they had been Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: involved in choosing the colour of the paint for the bedroom. A walk around of the home identified that further redecoration and maintenance is still required. The wallpaper in the first floor shower room is peeling off the walls and the seals of the shower are permanently marked with black mould. The laundry is in need of painting and new flooring The manager advised that further redecoration and maintenance work is to take place over the next couple of weeks she said that both the shower room and and laundry are to be refurbished. She said that all corridors and staircases are to be redecorated and new carpet is to be purchased and fitted. The last inspection of the service highlighted that radiators in the home should be guarded to ensure safety of people. The manager said that this was not an area where people that use the service were identified as being at high risk of burns, however guarding of the radiators is on the homes refurbishment plan and will be undertaken within the next twelve months. On the day of the inspection the home was observed to be clean and odour free. The AQAA advised that nine staff working at the home have received training in infection control. Care Homes for Adults (18-65 years) Page 23 of 33 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 working at the home are well trained and have the skills and experience necessary to meet the needs of people living at the home. Evidence: Staff have the skills and experience necessary to meet the needs of people living at the home. Staff on the day of the inspection were observed to be good listeners and communicators. All seven staff that work at the home have achieved a minimum qualification of NVQ Level 2 in Care. Two of the seven care staff have achieved an NVQ level 3 in Care. Six out of seven staff working at the home have recently attended learning disability training. At the time of the inspection there were five people that were using the service. Duty rotas looked at during the visit confirmed that there are three care staff on a morning until 3pm two of who start work at 07:30am and one that starts work at 9:00am. On an afternoon until 9:00pm there are two care staff on duty and on night duty there is one person who looks after people until they go to bed then can be woken during the night if needed. On occasions there can be an additional staff member on an afternoon if activities are taking place. Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: All of the people that use the service have agreed one to one hours with staff to do recreational and social activities, one to one hours for each person were not highlighted on the duty rota. Two files of staff working at the home were looked at during the visit. One file contained evidence that a good recruitment procedure had been followed. An application form, two references and a Criminal Record Bureau Check was available within the file. The second file contained an application form and a Criminal Record Bureau Check, however only contained one reference. Records of supervision and appraisal were available on files examined. The manager said that all new staff complete and induction that meets with the standards as set by Skills for Care. Evidence of induction was available on files looked at during the visit. The manager advised that mandatory training is provided to staff on a regular basis. Records were available to confirm that staff had attended recent training in infection control, COSHH, fire awareness, moving and handling and health and safety. Care Homes for Adults (18-65 years) Page 25 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvement is needed to make sure that the health, safety and welfare of people that use the service is promoted and protected. Portable Appliance Testing is out of date and weekly tests of the fire alarm system are not taking place. Water temperatures need to be increased to be close to 43 degrees Celsius to ensure comfort and safety of people that use the service. Evidence: The manager has many years of experience of working in a residential care home setting. She is both experienced and qualified. People that use the service said that they could talk to the manager if they have a problem. One person said, She is easy to talk to and helps me another person said, If I need to talk to someone I can. Appropriate quality monitoring systems are in place to ensure that the home is run in the best interest of people that use the service. Regulation 26 visits are carried out on a regular basis. The purpose of the visit required under regulation 26 is to inspect the premises, its record of events, complaints and speak to people and staff about the home. Staff at the home seek the views of people that use the service on a regular Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: basis to ensure that they are happy. Examination of records highlighted that the fire alarm system was not being tested on a weekly basis. The last recorded test of the fire alarm system was 30th September 2009. The last recorded fire drill was 20th August 2009. A sample of health and safety records were examined. Records were available to confirm that the fire alarm and emergency lighting had been tested, however the Portable Appliance Testing for the home was last done in July 2008. Water temperatures are taken and recorded on a weekly basis to ensure that they are within safe limits. It was observed that some water temperatures of baths were too cool on occasions. Care Homes for Adults (18-65 years) Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13 Risk assess must be 30/06/2009 developed to ensure information recorded is relevant and reflects that persons current circumstances. Information should be reviewed and evaluated on a regular basis. To minimize the risk of injury to service users. Care Homes for Adults (18-65 years) Page 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Care plans must be 31/03/2010 developed for each assessed need. Care plans need to be individual and specific to the person. Care plans need to developed to include what the person can do for themselves, assistance needed, likes, dislikes, evidence of personal choice and preferences. This will help to promote Independence, ensure that care needs are met and that care is delivered in such a way that is acceptable to the person. When a risk is identified a risk assessment must be developed and detail how to support the person and include action that needs to be taken to minimise the risk. 31/03/2010 2 9 13 Care Homes for Adults (18-65 years) Page 29 of 33 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 This will help to ensure safety. 3 15 15 Care Files must be updated 31/03/2010 to include information specific to the person regarding maintaining a personal relationship and identify associated risk. Care files must include how to support the person to maintain a personal relationship with people of their choice and detail any action required to minimise risks. To ensure wellbeing and safety. Two written references must 29/01/2010 be obtained before staff start working at the home. This will ensure that a robust recruitment procedure is followed and ensure safety of people that use the service. Portable Appliance Testing must be undertaken on a regular basis. To ensure that equipment is in safe working order to use. 6 42 23 Weekly testing of the fire alarm system must take place. 29/01/2010 29/03/2010 4 34 17 5 42 23 Care Homes for Adults (18-65 years) Page 30 of 33 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 make sure that it is in good working order 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 6 Care plans documentation should be developed/updated to ensure that it is user friendly. This will aid communication and make sure that it can be easily understood by people that use the service. Each person should have a health action plan that details what the person can do to be healthy and any help that they might need. This will help to promote health and wellbeing. Handwritten Medication Administration Records should be checked and signed by two staff to confirm accuracy. Medication carried over from the previous month should be documented on the MAR to enable auditing. The complaint procedure for families and representatives should be updated to include names and contact details of who to complain to and timescales for action. This will ensure that complaints are dealt with efficiently. The complaint procedure for people that use the service should be updated to include names and contact details of who to contact when making a complaint. This will ensure that complaints are dealt with efficiently. The policy/procedure for dealing with abuse should be developed further to include details of local arrangements and contacts for reporting concerns. Radiators in the home environment should be guarded to ensure the safety of people that use the service. Duty rotas should should highlight one to one social and recreational hours that staff have provided to each person that uses the service. 2 19 3 4 5 20 20 22 6 22 7 23 8 9 24 33 Care Homes for Adults (18-65 years) Page 31 of 33 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 10 42 Water temperatures of baths should be close to 43 degrees Celsius to ensure comfort and safety. Care Homes for Adults (18-65 years) Page 32 of 33 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). 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