Care Home: 8 Turketel Road

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What the care home does well People have free access to the garden so can get fresh air when they want to. People have the support they need to access the community and stay in touch with family and friends. We found detailed guidelines for staff on how to get people out and about so they do not get anxious. For example what hand to hold to support a person getting out of the car. This means that people are supported in the way they prefer. Staff are getting to know service users. We observed some patient positive support. We observed people looking relaxed with staff. We observed that one staff noticed there could be a problem and distracted the person so they did not become stressed. People have support to go food shopping to encourage them to choose and try different foods. What has improved since the last inspection? The AQAA says they are planning to train staff in how to use a communication system used by one resident. This means that staff will know how to use the system and therefore communicate more effectively with people. What the care home could do better: There have been several incidents over the past four months since the home opened. These have been mostly due to problem behavior. Staff and service users have been hurt during some incidents. Staff need training and specialist support for incidents to reduce and to keep people safe. The manager plans to address this. There has been an incident of a person climbing out of a first floor window onto the roof. Things have also been thrown from windows. The manager must ensure that the home, including windows and fittings, is safe for everyone but also ensure ventilation is sufficient. Currently medication is stored on the first floor at the end of a corridor. This means that staff have to transport medication around the home. There is no safe transportation provided for the medication so staff are carrying bottles, tablets, pots and syringes. Due to some peoples problem behaviors there is potential for an accident. The manager said he will look into safe transportation or a more suitable storage site. We found a gap on a medication administration record. We found that staff had administered medication but had not signed the record to say the drug had been given. This had not been picked up even though three more doses had been administered. This is not good practice and could place service users at risk of being given medication twice. The daily audit of medication practice needs to improve. The manager said he will look into this. Some people need medication on a when needed basis. Due to communication and behavioral needs, clear guidelines are needed so staff know when to give this extra medication. We found one set of guidelines do not have enough detail for staff and are out of date as some medication dosage has been changed recently. The manager agreed to update and improve these guidelines. We found that no staff meetings have been held and of three staff sampled two have had no supervision. This means that staff have not had the opportunity to meet either as a group or on a one to one basis to get support, mentoring and coaching. This is especially important due to the amount of incidents staff have been managing. We found that communication guidelines for some people are not very detailed. For example one service user plan did not mention that a person uses Makaton, a sign language when they do. Not all of the staff have had training in Makaton. The manager said he hopes to improve communication but realises he needs support from specialists like speech and language therapy services. Key inspection report Care homes for adults (18-65 years) Name: Address: 8 Turketel Road 8 Turketel Road Folkestone Kent CT20 2PA     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: Kim Rogers     Date: 1 7 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 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 32 Information about the care home Name of care home: Address: 8 Turketel Road 8 Turketel Road Folkestone Kent CT20 2PA 01303 256516 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Turketel.road@craegmoor.co.uk Parkcare Homes (No 2) Ltd Name of registered manager (if applicable) None Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: 1. 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) 2. The maximum number of service users to be accommodated is:6 Date of last inspection Brief description of the care home This service is registered to provide accomodation and personal care support to up to 6 people who have a learning disability. The house is detached and has parking to the front and on the road outside. There are gardens to the front and rear. Each bedroom is single and has en suite facilities. There is a lounge, quiet room and kitchen diner. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 6 Brief description of the care home The home is near to shops and local services. The fee is in the region of about 2,000 pounds per week. For more information about the fees and services please contact the provider. Care Homes for Adults (18-65 years) Page 5 of 32 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 peterchart Concerns, complaints and protection Environment Staffing Conduct and management of the home Poor Adequate Good Excellent How we did our inspection: This was a key inspection of the service which included an unannounced site visit. We assessed the key Minimum Standards. The home has been open for about four months and is a newly registered service so this is the first key inspection. The registered manager has left and there is a new manager from another company home. During this inspection we met and spoke to the two people who use the service. We spoke to three staff and the manager and sampled various records. We also spoke to the area manager who called into the service during the visit. The manager showed us around the home and we made observations. We looked at the Annual Quality Assurance Assessment or AQAA. The manager completed this and it gives information about staff and service users and says what Care Homes for Adults (18-65 years) Page 6 of 32 could be better and how they intend to improve. They sent the AQAA to us when we asked for it. It gave us most of the information we need. We look at notifications from the home about accidents and incidents. There have been several incidents since the home opened. There is currently a safeguarding alert that is being investigated by the safeguarding coordinator at social services. This means that we suspected that one or more service users is at risk of harm or abuse so we made an alert to safeguard people. During our visit service users, for most of the time, looked happy and relaxed. Staff said We want to improve the service We are struggling for staff We are hoping to get people out more. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: There have been several incidents over the past four months since the home opened. These have been mostly due to problem behavior. Staff and service users have been hurt during some incidents. Staff need training and specialist support for incidents to reduce and to keep people safe. The manager plans to address this. There has been an incident of a person climbing out of a first floor window onto the roof. Things have also been thrown from windows. The manager must ensure that the home, including windows and fittings, is safe for everyone but also ensure ventilation is sufficient. Currently medication is stored on the first floor at the end of a corridor. This means that staff have to transport medication around the home. There is no safe transportation provided for the medication so staff are carrying bottles, tablets, pots and syringes. Due to some peoples problem behaviors there is potential for an accident. The manager said he will look into safe transportation or a more suitable storage site. We found a gap on a medication administration record. We found that staff had administered medication but had not signed the record to say the drug had been given. This had not been picked up even though three more doses had been administered. This is not good practice and could place service users at risk of being given medication twice. The daily audit of medication practice needs to improve. The manager said he will look into this. Some people need medication on a when needed basis. Due to communication and Care Homes for Adults (18-65 years) Page 8 of 32 behavioral needs, clear guidelines are needed so staff know when to give this extra medication. We found one set of guidelines do not have enough detail for staff and are out of date as some medication dosage has been changed recently. The manager agreed to update and improve these guidelines. We found that no staff meetings have been held and of three staff sampled two have had no supervision. This means that staff have not had the opportunity to meet either as a group or on a one to one basis to get support, mentoring and coaching. This is especially important due to the amount of incidents staff have been managing. We found that communication guidelines for some people are not very detailed. For example one service user plan did not mention that a person uses Makaton, a sign language when they do. Not all of the staff have had training in Makaton. The manager said he hopes to improve communication but realises he needs support from specialists like speech and language therapy services. 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 32 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 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is some information about the home with text, pictures and photographs. Assessments are carried out before a person moves in. Evidence: We found that there is information about the home. This is produced in text and has some colour photographs of the home. There is a Statement of Purpose giving information about what the home has to offer. This is produced in text with pictures to make it more user friendly. There is some information on display in the hallway showing photographs of the manager and staff. There is information and pictures of what the service has to offer. This information may not be fully accessible to current service users. The manager said because of this, peoples family have been involved in making visits to the home and looking at the information. The manager said that people can visit the home to have a look around before they move in. He said that moves are arranged to suit peoples needs. The manager said Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: staff have visited people in current and previous placements to get to know them before they moved in. We sampled a service user plan and found that an assessment of a person needs is carried out. This assessment is in the persons file. The assessment says the person was asked about their aspirations for the future. Some information has been transferred to the persons service user plan or support plan. We found that some important information has not been transferred yet. For example one persons life history page is blank. There is no mention of any siblings yet the manager said the person has brothers. Staff thought the person has a brother and a sister. If this basic important information is not recorded clearly, staff will not know about peoples lives and backgrounds. We found no evidence that reviews are held after a short while to see if things are going well and whether to make changes or make the placement permanent. The manager did not know if reviews had been held. This means that no discussion has been held with people and their significant others about whether they want to stay or not. We found no evidence that people have been told about the terms and conditions of their stay in a way that is meaningful. Care Homes for Adults (18-65 years) Page 12 of 32 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. Peoples needs are recorded and some risks assessed and managed. People need better support with communication so they can make choices and decisions. Evidence: We found that each person has a service user plan or support plan. We found that these are in the process of being developed with people so some pages are blank. Service user plans are produced in text with some pictures and have a photograph of the service user. The format used is not individual to each person and so may not be meaningful to everyone. Staff have access to some background information about people from their previous placements. However staff were not clear about some details of some peoples background. This means that staff may not have the basic information they need to know about people. We found that peoples needs have been identified and recorded. The action that staff Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: need to take to meet peoples needs is recorded. We found no evidence that plans have been reviewed even though the manger said that some peoples needs have changed. This means that some guidance staff follow may now be out of date or no longer relevant and new guidance may be needed. We found that people have been asked about their dreams and aspirations. As these aspirations have not yet been established they are not recorded. The AQAA says they plan to develop a person centred plan with each person. We found that cultural needs are recorded and staff are aware of these needs. We found that some risks have been identified and assessed. The action that staff need to take to reduce risks is recorded. We found some potential risks to people have not been assessed. For example two toilets have been broken. Broken parts of one toilet were thrown from a first floor window onto the patio below during our visit. One person has climbed from a first floor window onto the roof. We found no risk assessment in the persons plan to say what staff need to do to keep this person and others safe. The manager said he has taken steps to secure a window but needs to ensure that all parts of the building are safe and that all potential risks to people are assessed and reduced. Because of the potential risk of harm to people we made a requirement that all parts of the building are safe. We found that some risk assessments focus on how to react to a risk occurring rather than how to prevent it happening. For example for a person who is at risk of self harming an additional care plans says self harms, if this happens take them to the walk in health centre. It does not tell staff what to do to be proactive and the manager may want to review this. We found that there is some information about how people prefer to communicate. Although plans are at an early stage of development, as some people have only been at the home for about four months, more detail is needed so staff can communicate effectively with people. For example we observed one person using Makaton, a sign language. There was no mention of this in the persons plan which says they use two key words and a picture exchange system. There was not much detail about the picture exchange system and how to use it. This means that staff may not have enough information to support communication with people. At least one person uses Makaton, a sign language, to communicate. We found that only one staff has had Makaton training and that was five years ago. This means that Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: staff may not know Makaton signs and therefore may be unable to communicate effectively with people. We found that they are in the process of improving the environment so it supports communication. For example activity planners are on display that has text and symbols, there are photographs of staff and the manager, the complaints procedure has some symbols. The manager agrees that they need more specialist support with communication to meet peoples individual needs. The manager said that referrals for support have been to the local speech and language therapy service. The manager said that training will be held in September about the picture exchange system that some people use to communicate. Care Homes for Adults (18-65 years) Page 15 of 32 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 have the opportunity to take part in activities and have support to access the community. People have support to keep in touch with family members and to be involved in planning and preparing meals. Evidence: We found that each person has an individual activity plan. This is displayed and has text and symbols. This covers Monday to Sunday and includes mornings, afternoons and evenings. The activity planner shows that some planned activities are in house and some are in the community. The manager said he is hoping to get people out more when they have settled into their new home. We found that people have been on walks and to the beach. We found detailed guidelines for staff on how to get people out and about so they do not Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: get anxious. The manager plans to support people to enroll at a local college to enable opportunities for life long learning. We found that people have support to be involved in planning and preparing meals. One person was making cakes during the visit and had made them previously. The manager said that staff have taken a person to the supermarket so they have the opportunity to choose and try different foods. We found that written information in one plan sampled gives staff directions of how to include people in making their own meals. We found information about special diets and food allergies recorded in individual plans. Support needed with eating and drinking is also recorded in service user plans. We observed staff giving people the time they need to eat and drink. We found that some information about peoples family and friends is recorded although, as mentioned, some needs more detail so staff have the right information. We found that people have support to keep in touch with family members. Some family members have been involved in having a look around the home before the person decided to move in. The AQAA says due to peoples communication needs they intend to work closely with family members and advocates. This means that service users will have support from people who know them well to establish their hopes and needs for the future. We observed people being offered choices of what to eat and how to spend their day. With improved communication support, staff training and clearer guidelines for staff people will have better support with making choices and decisions. The manager is aware of this and plans to improve communication and choice making by seeking specialist support from speech and language therapy services. Care Homes for Adults (18-65 years) Page 17 of 32 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. People know their personal and health needs will be supported. Some aspects of the medication system need to improve to protect people. Evidence: We found that personal care needs are recorded in individual plans. This is written in detail so staff know how people prefer to be supported. We found that personal care guidelines are written so as to enable people. For example one plan tells staff to use a hand over hand technique when supporting a person to clean their teeth. Each bedroom has en suite facilities and there is also a separate communal bathroom. We found peoples health needs are recorded. In the service user plan sampled was a booklet called my health booklet. This gives information about the persons family health history and their present health needs. Staff have supported people to register with a local doctor. The manager said that referrals have been made for health and behavioral support to ensure people have the support they need. We looked at the storage, receipt and administration of medication. We found that Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: storage is away from communal areas. The manager said that at present staff control medication and take medication to service users. We found no safe transportation system in place so staff are carrying medication, pots, syringes and records around the home. Due to the nature of some peoples behavior this practice is not safe. The manager agreed to either move the storage of the medication so it is closer to communal areas or to provide a suitable safe transportation system. We found that the receipt of medication into the home is recorded. The Monitored Dosage System, MDS, is used. We looked at records of administration and found a gap on one persons record. We found that the tablet had been dispensed from the MDS. This means that staff had dispensed the persons medication but had not signed the record to confirm this. This could lead to the person having the same medication twice and places people at potential risk. This is not in line with good practice guidance. The manager agreed to look into this. We found that some people have medication on a when needed basis. Guidelines are in place so staff know when they should administer the when needed medication. We looked at the guidelines for one person and found that they do not tell staff how much medication to give and when and if to give a second or third dose. We found that the guidelines are not up to date as there had been a change to the persons medication on 12.8.09. This places the person at risk of being given too much medication. The manager agreed to update the guidelines. Care Homes for Adults (18-65 years) Page 19 of 32 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. More support with communication is needed to enable service users to air their views. People are at risk of harm due to the use of unplanned restraint, lack of staff training and support and from parts of the environment. Evidence: We found they have a complaints policy and procedure. Details of this are displayed in the home in text with some colour pictures. Due to the complex needs of some of the people using the service this may not meaningful to everyone. Staff said they look for clues to see if people are not happy about something, like behaviors and expressions. The AQAA says they plan to improve communication support which will benefit service users with communication needs. We found that there has been one complaint made to the service. The manager and area manger have taken steps to address the issues raised. We found details of the complaint and the action that has been taken is recorded. We found that they have a whistle blowing policy and a policy and procedure to safeguard vulnerable adults. We found that this procedure was not followed as the home made no alert when a service user was at risk of harm following the use of an unplanned emergency restrictive physical intervention by staff. To ensure that people are safe, the Care Quality Commission made an alert to the safeguarding coordinator Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: at social services so that the circumstances surrounding this incident can be investigated. We found that staff use restrictive physical intervention. Five staff out of six have attended 2 day training in physical intervention. More training is planned for 28.09.09. We found that the manager has no accredited qualification relating to challenging behavior so may not be up to date with best practice. We found that guidelines are in place to support problem behavior. These are clearly written and show triggers to behaviors and distraction techniques. We found that guidelines focus on how to react to behaviors. This means that staff have no proactive strategies to follow to prevent the behavior from happening. We found that guidelines in place to support problem behaviors instruct staff to use a two man escort hold. Yet, from incidents reported by staff, on two occasions a person was held on the floor and on one occasion suffered an injury as a result. The manager said this sort of restraint would only be used as a last resort. However to protect staff and service users this must be clearly documented and agreed with the person. We found no evidence that the person has consented or agreed to the use of restrictive physical intervention. We found that staff complete incidents reports after each incident. These are filed and are being monitored by the placing authority and the company. The placing authority has gathered some baseline data and are checking the patterns of behavior. They have reported incidents to us as required. We found no evidence of any staff meeting since the home opened. The manager confirmed this. Only one staff out of three staff sampled have had a one to one meting or supervision with a line manager. Staff are supporting problem behavior on a daily basis which could be stressful as some staff have been hurt. There must be opportunities for staff to de brief incidents so that behavior support strategies can be reviewed and changed if necessary. Staff need mentoring, coaching and support to ensure that service uses are receiving good support. Care Homes for Adults (18-65 years) Page 21 of 32 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. The home is clean but improvements are needed to make it safe. Evidence: We had a look around the home with the manager and found that the home is clean. Each room is single and has en suite toilet and shower facilities. There is a lounge, quiet room and kitchen diner. There is a separate laundry. This means that there are separate areas that people can relax in. There is free access to the garden that is not overlooked. This means that people can get fresh air when they want to. There is seating and a patio area and activities in the garden for service users to use like a trampoline. We observed service users enjoying activities in the garden. The garden gate to the front of the house is currently kept locked in service users best interests. We found that there has been some damage to the house due to problem behaviors. For example there are no curtains in one bedroom and in the quiet lounge. To maintain peoples privacy and dignity the manager may want to look at more suitable window dressings like magnetic curtain poles or curtains with Velcro. We found that Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: this had been suggested as a need for the environment at the assessment stage. Two toilets have been damaged. There were two maintenance men on site during the visit making repairs. There have been incidents of a person climbing from a first floor window and throwing things from first floor windows. The manager said that one window has been screwed shut but the other windows have not. The manager must ensure that the building is safe for service users also ensuring that ventilation is adequate. One person has support to use a key to their room. The manager said he will look into more suitable locking devices as the locks and keys provided are not suitable for current service users needs. This means that people cannot lock their rooms when they want to. This has lead to people going into other peoples rooms and causing damage. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff to meet peoples needs. Recruitment checks are carried out protecting service users. New staff have an induction but need more training and better support to support service users more effectively. Evidence: We found that there are three staff on duty with the manager. There are two staff on duty at night, one awake and one asleep who can be called on in an emergency. The manager is having some support from a deputy manager from another home. This has been for three days a week and will now reduce to one day a week. The manager says he is on call for advice and support when not at the home. There are a team of support workers and team leaders. The manager said there are six permanent staff and another four staff have been recruited. Staff from other company homes are covering current shortfalls. We observed four staff interacting with service users. We found staff use techniques like singing and clapping and dialogue to support, encourage and calm service users. The manager said that staff are getting to know service users and visa versa. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: The AQAA says that staff are checked before they start work at the home. A new staff confirmed this saying they gave references, completed an application form and had a Criminal Records Bureau check. In three staff files sampled we found no identification, references or job descriptions for staff. However, we found a checklist showing that references and checks have been carried out. The manager may want to check that references have been received and that they are satisfactory, that staff have up to date job descriptions and that identity can be confirmed. We found that staff complete a health declaration .One seen says that the person has not been vaccinated against Hepatitis. Due to the nature of some peoples behaviors, staff have been hurt. The manager may wish to ensure that staff are fully vaccinated so they are protected. A new staff said they had the opportunity to come to the home and meet current staff and service users before they started work. The AQAA says that staff have an induction in line with the Minimum Standard. We found that staff go through an induction which includes emergency procedures and the companys aims and objectives during their first day at the home. They then attend a week long induction covering mandatory subjects like first aid, food safety, fire awareness and managing problem behaviors, called CPI. We found that 5 out of 6 staff have been trained in CPI. The area manager said he is looking into more service specific training for staff like how to manage challenging behaviors more positively. Training for staff in the use of the PECS , a communication system is planned for September. As mentioned only one staff has attended training in Makaton, a sign language. We found no evidence that a staff meeting has been held since the home opened. The manager confirmed this. Of three staff files sampled only one staff has had supervision with a line manager since the home opened. Staff are dealing with incidents on a daily basis of problem behavior which can be stressful. Staff have been hurt during some incidents. Without staff meetings and supervision staff do not have the opportunity to de brief and review incidents and their practice. This means that guidelines and strategies may not be reviewed and staff may not get the support, coaching, group discussions and mentoring they need. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is adequately managed. The health and safety of staff, service users and visitors could be better protected. The quality assurance system needs to be developed to take account of service users views. Evidence: The home has been open for about four months. In this short time there have been two managers so no real period of stable management. The current manager has been in post since about mid July 2009. He is not registered with us, for this home, so has not passed the fit person process. The manager said he plans to apply to be the registered manager. The manager was previously a registered manager at another company home. He has the experience and qualification required by the Minimum Standards. He has no qualification relating to learning disability or challenging behavior. This means that he may not up to date with the latest research and best practice in this area. The manager said he is starting a year long course in October 2009 to gain the Certificate in Person Centred Support at the Tizard centre, University of Kent. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: The manager completed the Annual Quality Assurance Assessment and returned it when we asked for it. Some of the sections on the AQAA did not give us much information. For example what could be better and how they have improved. The manager said on the AQAA that this is due to this home being newly registered and newly open. The manager did not identify any barriers to improvement on the AQAA. Without identifying barriers there will be no strategies to overcome them when they arise like for example, inconsistent management, staff shortages, lack of service specific training, time constraints dealing with incidents. This means the service may not improve for people. The AQAA shows that health and safety checks are carried out on the building and facilities. There were two maintenance men in the home during the visit. One to fix two toilets and the other to fix fire extinguishers in boxes back to the wall. We observed a service user being upset by the sound of drilling. Staff dealt with this well by singing and clapping their hands loudly to distract the person. However, this sort of work should be planned for and potential risks assessed to protect service users, staff and visitors. Some parts of the home need to be safe for service users. This includes ceramic fittings like toilets and windows. As mentioned there have been incidents with first floor windows that place service users at risk. The manager has taken steps to make one window safe but must ensure that all areas of the home are safe. We found that staff have training in areas related to health and safety including fire awareness and food safety. Staff have been hurt in some incidents of problem behavior. The manager and provider have a duty under the Health and Safety at Work Act to ensure that staff are safe at work. This includes that they have any vaccinations they need and that they have the training and support they need to meet peoples needs. We found there is no call alarm system for staff to summon help in an emergency. This could place people at risk. The AQAA says due to peoples communication needs they plan to talk to family members and advocates about the quality of the service. However, the manager told us that no review meetings have been held with service users, their care managers and family since they moved in to see how things are going and if people want to stay. This means that people have not had the opportunity to air their views. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: We found that care plans have not been reviewed so outcomes for people have not been recorded and monitored. The manager said one persons needs have changed but this has not been reflected in the care plan making it out of date. Staff need the most up to date relevant information to give the right support. An area manager makes regular visits to the home. The area manager said they plan to provide service specific training for staff. The manager said that they have had support from the company quality development manager. They have met with service users and staff although not with the manager yet, and have put some initial guidelines for staff in place on how to manage some problem behaviors. The company has audit systems in place. The AQAA shows they have the policies and procedures they need. These are not currently produced in a variety of formats so may not be meaningful to the people who use the service. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 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 20 13 Guidelines for when needed 30/09/2009 medication must be up to date and give staff the detailed information they need. Audit systems should be in place to check that staff sign the administration record when they have administered medication to a person. There must be a safe way of transporting medication around the home. To ensure that people get the right amount of the right medication at the right time. To ensure that people do not get too much medication. To ensure that medication is not dropped or spoiled. 2 24 23 All parts of the home including fixtures like toilets and fire extinguishers and fittings like windows and 30/09/2009 Care Homes for Adults (18-65 years) Page 30 of 32 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 curtains must be safe and suitable for peoples needs. To ensure that people are safe and not harmed and that people have fixtures and fittings to suit their needs. 3 35 18 Staff must have the training and support they need by way of staff meetings, supervision meetings and training related to peoples needs. To ensure that staff have the skills and competencies to meet peoples needs. To ensure that staff have the support, mentoring and coaching they need. To ensure that staff have the opportunity to de brief any incidents. 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 31/10/2009 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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