Care Home: Aaron House

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What the care home does well The staff team has adopted some good practices to support people with communication difficulties living in the home. These practices enable people to communicate more effectively. Information about each person is securely stored in the home`s office. One day a week people are supported one to one with completing domestic chores, this enables people to learn skills to increase their independence. People lead active lifestyles and staff support them to do this whenever it is required. Where required the home makes use of other health professionals to meet peoples needs. The home has a complaints procedure in place and when a complaint was made we were able to see the manager had managed it correctly. None of the people manage their own finances and records seen by us showed that the manager keeps detailed records of income and expenditure. People benefit from living in a homely, spacious and comfortable environment that meets their current needs. The home is well staffed and this enables people to live active lifestyles and live in a safe environment. Staff have received regular supervision with the manager. Staff meetings have been completed regularly. The owner and manager intend to complete a quality assurance process in February 2010 enabling them to identify strengths and weaknesses and plan for the future development of the service. What has improved since the last inspection? Not applicable as first inspection. What the care home could do better: The Service User`s Guide and Statement of Purpose need to be updated to reflect that we the regulator are called the Care Quality Commission now. Care plans need to be reviewed and updated to provide the reader with a level of detail that clearly describes the person`s needs and the actions required by staff to support that person consistently. Person Centred Plans (PCP) had not been started at the time of this site visit and the manager stated they intended these documents would be in place by the end of February 2010. It is important that the manager and her staff team record all of the activities offered to people in the home, including those that people refuse. Each person whose care we examined had a range of risk assessments in place but greater detail was needed in each case to minimise potential risks. How the menu is created should be reviewed to ensure that all people living in the home are empowered to be actively involved in its creation. Care plans to address peoples personal care needs need to be reviewed and updated to accurately reflect their needs and the actions required by staff. At the time of this site visit we found some shortfalls with the medication administration which potentially puts people in the home at unnecessary risks. The majority of the team have completed training in safeguarding adults but refresher training is required due to the length of time since the training was completed. Staff have not received training to support people when they display behaviours that challenge and this is potentially putting both staff and people at risk. Studying recruitment records showed there was a shortfall with obtaining full employment histories for staff and this could potentially put people in the home at unnecessary risks. Key inspection report Care homes for adults (18-65 years) Name: Address: Aaron House Nympsfield Road Nailsworth Gloucestershire GL6 0ET     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: Paul Chapman     Date: 0 8 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 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: Aaron House Nympsfield Road Nailsworth Gloucestershire GL6 0ET 01453833598 01453833598 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Aaron House Care Limited care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 6. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Aaron house is a care home registered to provide accomodation for up to 6 people with learning disabilities. Accomodation is provided in a detached property on the outskirts of Nailsworth, Gloucestershire. There are 6 individual bedrooms that are ensuite and communal accomodation includes a spacious lounge, a soft room and a kitchen/diner. The home is decorated to a high standard throughout. The home is staffed 24 hours a day, 7 days a week. 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 33 Brief description of the care home People living in the home are encouraged and supported to learn new skills, attend college and day services and complete a range of leisure activities. Care Homes for Adults (18-65 years) Page 5 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: Before completing the inspection site visit to this service we (the CQC) sent the registered manager an AQAA (Annual Quality Assurance Assessment) to be completed. This document asks a service provider/registered manager to rate the services performance against the National Minimum Standards (NMS). A service provider/registered manager will be asked to provide evidence of what the service does well, what has improved in the past 12 months and their planned improvements for the next 12 months. What the registered manager tells us in this document helps to form a hypothesis and focus on different areas depending on what the AQAA tells us. In addition to providing evidence about how the home meets the NMS it also provides us with a Dataset (information about staffing, health and safety, complaints, the environment, policies and procedures and the people living in the home). We arrived at the service at 9am to complete the site visit and were greeted by the manager who was on duty. We completed a tour of the premises with the manager and spent some time in the homes kitchen/diner where we were able to observe the Care Homes for Adults (18-65 years) Page 6 of 33 relationship between people in the home and the staff supporting them. This showed us that relationships appeared to be respectful, friendly and supportive. Within 30 minutes of arriving at the service the responsible individual arrived and spent the rest of the day working with the manager and us. Firstly we examined the care of 2 people in depth looking at the needs assessments, care plans, health care, risk assessments, financial management and activities. Whilst looking at these documents we discussed the findings with the manager and responsible individual. After examining peoples care we looked at the management of the service with the manager. We assessed the training and management of staff and the policies and procedures that minimise potential risks to people. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The Service Users Guide and Statement of Purpose need to be updated to reflect that we the regulator are called the Care Quality Commission now. Care plans need to be reviewed and updated to provide the reader with a level of detail that clearly describes the persons needs and the actions required by staff to support that person consistently. Person Centred Plans (PCP) had not been started at the time of this site visit and the manager stated they intended these documents would be in place by the end of February 2010. Care Homes for Adults (18-65 years) Page 8 of 33 It is important that the manager and her staff team record all of the activities offered to people in the home, including those that people refuse. Each person whose care we examined had a range of risk assessments in place but greater detail was needed in each case to minimise potential risks. How the menu is created should be reviewed to ensure that all people living in the home are empowered to be actively involved in its creation. Care plans to address peoples personal care needs need to be reviewed and updated to accurately reflect their needs and the actions required by staff. At the time of this site visit we found some shortfalls with the medication administration which potentially puts people in the home at unnecessary risks. The majority of the team have completed training in safeguarding adults but refresher training is required due to the length of time since the training was completed. Staff have not received training to support people when they display behaviours that challenge and this is potentially putting both staff and people at risk. Studying recruitment records showed there was a shortfall with obtaining full employment histories for staff and this could potentially put people in the home at unnecessary risks. 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 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. The service has produced information for prospective residents and their carers to enable them to make an informed decision about whether the service can potentially meet their needs. Before people are admitted to the service the manager obtains assessments from the appropriate professionals and this minimises the risk of people being admitted to the home whose needs may not be met. Evidence: The home has a Statement of Purpose and a Service Users Guide. We examined both documents and this showed that they provided prospective residents and their carers/relatives with a good range of information about the service they could expect if they decided to live in the home. The Service Users Guide makes good use of photos to enable people with communication difficulties to understand the information more easily. The only shortfall we found with both of the documents was the need to update them to reflect that we (The regulatory authority) are now called the CQC. This was brought to the attention of the owner and manager and becomes a recommendation of this report. Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: 4 people have been admitted to the service since it opened and we examined the care of 2 people in depth. Examining their care files showed that both people had assessments completed by their funding authority and the manager had also completed assessments. 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 living in the home have a range of care plans in place but they are in need of review to ensure that they accurately reflect peoples needs and the actions required by staff to meet them consistently. People living in the home are given a range of choices from day to day but further development of how choices are communicated and recorded is required to ensure that all of the people are empowered to make choices. Risk assessments do not accurately reflect the potential risks to people and are therefore putting people at unnecessary risks. Evidence: The service has only been open for 5 months. Both of the people whose care we studied had a range of care plans in place. We read and discussed these plans with the manager and owner. Although there was a good range of plans in place we felt that greater detail was needed in the plans to accurately reflect the persons needs and what actions staff must take to meet those needs consistently. We stressed the importance being able to provide an audit trail of how peoples needs are met and how peoples needs change over a period of time. The owner and the manager agreed with Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: this. It becomes a requirement of this report that all care plans are reviewed by the manager and care plans are re-written to provide a greater level of detail accurately reflecting peoples needs. People in the home have different degrees of communication difficulties and there are some good practices by staff to enable people to communicate effectively. We saw an example of 1 person being supported by staff using pictures and photos to support their communication. The manager stated they are in the process of obtaining a greater range of pictures for people to use to support their communication. Another good practice was a person with a chatterbox, this is a bag with significant items to be used as prompts that they can refer to remind them of things they have been doing. The manager stated the person uses it when they are on the phone. It is important that where a person has a communication difficulty they have a care plan detailing their needs and how staff will meet them. It becomes a requirement of this report that where required these care plans are in place. At the time of this site visit the manager and staff had not created Person Centred Plans (PCP) with people. A PCP enables a person to identify goals they wish to achieve and the support they require to do that. The manager stated that this was a goal they intended to achieve in the new year and gave their assurance that they would be implemented by the end of February 2010. As with the care plans we stressed the importance of creating an audit trail to support the progress towards achieving the goal. We discussed with the manager how people are enabled to make decisions in their day to day lives. Examining records in the daily notes showed that people lead active lifestyles and have the opportunity to take part in a range of activities each week. When speaking with the manager we suggested that as well as recording the activities people take part in they should also record when they have offered an activity and a person has decided not to do it. This becomes a recommendation of this report. Another area where people get a choice is the food they eat. Speaking with the manager we suggested the way people make choices could be reviewed and improved. (See evidence for Standard 17) Both people had a range of risks assessments in place. We examined the assessments and discussed them with the manager. Although they covered a range of areas we felt that greater detail was necessary to accurately reflect potential risks and the steps that would be taken to minimise those risks. The manager agreed with this and stated they would review the format risk assessments would be completed in. It becomes a requirement of this report that each person has a range of risk assessments in place Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: that accurately reflect the potential risks and the steps staff will take to minimise those risks. In addition to this the manager must also ensure that there is a missing persons procedure in place for each person. At the time of this site visit all of the confidential information was stored securely in the homes office. The manager shows good awareness of the need not to share all of a persons confidential information with all parties. 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 lead active lifestyles supported by the staff team. People are supported to learn new skills that will contribute to increasing their quality of life through greater independence. The home provides people with a healthy nutritious diet but people must be empowered to have a greater choice. Evidence: Whilst completing this site visit we examined a sample of the daily notes for each of the people in the home to identify what activities they take part in regularly. To support this we also spoke to staff asking them what activities people complete. As identified earlier in this report people in the home have communication difficulties making it difficult for us to speak to them about activities. Every week people have a house day where staff support them to complete chores around the home. Staff explained they will support people do to clean their bedroom, Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: do their washing, cleaning around the house and they then prepare the meal for the evening. This is a good practice as it is important for people to be involved in the day to day running of the home and learn skills to increase their independence. Due to the short period of time that people have been living in the home holidays were not arranged this year. The manager explained that in the new year they intend to obtain a range of holiday brochures for people to look at and choose where they would like to go on holiday. A number of activities take place regularly each week in and outside the home. Weekdays are busy with people attending local colleges and staff support them to do this by attending college with them. Other activities in the community include people using local shops and other facilities in Nailsworth. Staff explained that people enjoy going out for walks locally and this happens regularly. 1 evening a week people attend a local social club with staff. In house people are supported to maintain their hobbies by staff and we saw examples of people enjoying puzzles, having film nights, listening to music and doing arts and crafts. The manager stated that none of the people in the home have indicated wanting to go to church or follow any other faiths. The manager stated that they have asked people whether they want to attend a carol service at a local Church during the Christmas period and is awaiting a response. It is recommended that the manager makes a record of asking people about their religious needs. All of the people in the home have contact with their relatives and records showed that people have visits from them regularly and also visit their relatives at their homes. As identified earlier in this report people have a choice about the food they eat. The current system employed for the homes menu is to have a rolling menu. Looking at the menus showed that people have 3 choices for breakfast and 2 choices for lunch and tea. Daily notes confirmed that the meals provided are varied and provide people with a wide range of healthy nutritious meals and snacks. Looking at peoples daily notes showed that all 4 people tended to eat the same meals, we spoke to the manager about this who was aware of the need to empower people to be able to make a greater choice. We suggested that a system of pictures/photos could be introduced enabling people to choose what they would like to eat by choosing a picture, we also suggested moving away from a rolling menu. Both the manager and the owner agreed with this and it becomes a recommendation of this report that the manager reviews how the menu is created to empower people to have a greater choice. 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. Care plans to address peoples personal care needs do not provide sufficient detail about their needs and the required actions of staff to meet those needs. This means that peoples needs may not be being met consistently by the staff team. Peoples medical/health needs are addressed by the appropriately trained professionals. Medication administration is adequate but some practices are putting people at potential risk. Evidence: As identified earlier in this report care plans require greater detail to identify peoples needs and the actions required by staff to meet those needs. This is also true of care plans to meet peoples personal care needs. As a result the requirement for peoples care plans to be reviewed also relates to this section as well. Records in the files we examined showed that the appropriate health professionals are involved in meeting peoples needs as required. All people are registered with the local Doctors surgery. When speaking to the manager and owner about meeting peoples health needs we did identify 1 area where the professional input of a psychologist should be sought and the manager agreed that she would ensure this was addressed. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: We examined the management of medication in the home. This showed that staff signed confirming medication had been administered and that only the senior support workers administered medication. We did identify some shortfalls in practice, these included; Medication was not being checked when entering the home and this may potentially put people at risk of people not receiving the correct dosage of medication and the wrong quantity being delivered unknown to staff. The manager must ensure that all medication is checked when it enters the home to ensure that it is the correct dosage and quantity, this becomes a requirement of this report. Staff have not completed training in medication administration since starting at the home. The manager was able to provide certificates confirming that 2 staff had completed training in their previous employment. It was agreed with the manager and owner that all staff that administer medication will receive refresher training in this area. This becomes a recommendation of this report. Another good practice recommendation is for the manager to create a list of example signatures and initials for staff that administer medication to make it easy to see who has administered medication. None of the people in the home have care plans to address the criteria of standard 21 (increased mental and physical frailty). Speaking to the manager she stated that whilst addressing the issues with other care plans she will ensure that information to support this standard will be obtained. This becomes a recommendation of this report. 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. The home has a complaints procedure produced in a format to enable people to have a better understanding of how to make a complaint. Where a complaint has been made to the manager they have managed it correctly. Although staff have completed training in safeguarding adults refresher training is required to minimise potential risks further. None of the people in the home are able to manage their own finances and safe working practices are employed by the manager to minimise potential risks. Evidence: The manager has produced a complaints procedure in an easy-read format for people with communication difficulties. It uses plain English and is supported by pictures. The manager stated that since the home opened they have reminded people about the complaints procedure. Attached to the wall outside the office is a post box that if people have a complaint they can post it there. This has not been used as yet. There has been 1 complaint made to the manager since the home opened. We examined how the manager had dealt with this. It showed that they had investigated the complaint, written to the complainant with their findings and received confirmation that the person was satisfied with the outcome. The manager stated that the majority of staff had completed safeguarding adults training in their previous employment. Looking at records showed that this training had not been completed recently and we recommended that all staff should complete refresher training every 3 years. We also recommended that the manager should Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: complete the enhanced safeguarding adults training run by the Gloucestershire Safeguarding Adults team. This becomes a recommendation of this inspection report. None of the people in the home manage their own monies and peoples parents/relatives are their appointees. In house the manager and owner are the only people who have access to peoples finances. We examined the records supporting peoples income and expenditure which were seen to be comprehensive and accurate at the time of this site visit. Some people in this home can display some behaviours that are challenging. When examining paperwork to support their care we found some guidelines explaining what behaviour may be displayed and what actions staff should take. When these incidents take place staff record what has happened in a traffic Light System. The manager stated that staff have not received training in this area yet but they are trying to arrange some at the moment. It becomes a requirement of this report that all of the staff receive training in behaviour management. 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. People live in a homely, comfortable and warm environment that meets their current needs. Evidence: Aaron House is situated on the outskirts of Nailsworth in Gloucestershire. It is a large detached property with a garden and parking for cars to the rear. We completed a tour of the premises with the manager. Communal areas in the home include a large lounge, a sensory room and a kitchen/diner. The manager explained they are still in the process of finishing the sensory room, our visit showed that it had a range of soft furnishings, a music system and lights. The manager stated that people enjoy using the room to relax. Looking around the home we found it well maintained. Each person has their own bedroom and all of them are en suite. At the time of this site visit 4 people were living in the home but it is registered to provide accommodation for 6 people. The manager was in the process of assessing 1 other person to fill a vacant bedroom. The manager explained that they have asked each person what colour they would like their bedroom painted and this will be done when people go to their parents for a few days. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: Bathrooms and toilets were seen and no issues were identified. On the whole the home is clean and hygienic. We did find that 1 bedroom en-suite smelt. The manager stated that the owner was going to remove the carpet and replace it with a new waterproof floor covering. The only other shortfall we found was with the steps at the front of the property that were in need of repair. The owner stated that due to the poor weather recently they had not been able to repair these steps but it would be done as soon as the weather improved. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff in sufficient numbers to support and meet their needs appropriately. Staff training needs must be assessed and training arranged for staff in all of the areas identified to maintain peoples safety and meet peoples needs. On the whole staff recruitment is robust but the manager must ensure that these Regulations are followed. Evidence: We examined the staffing rota for December, it showed that there are 2 staff on each daytime shift (late an early) and that at night there is a waking night staff. Speaking to staff about the rota they confirmed this was the case and that they are rarely short staffed. All of the staff completed an induction period when they started at the home. The manager should look at the common induction standards for care to ensure that the homes induction meets the criteria of those standards. Looking at the training records showed that there is a range of training needs that the manager must ensure are addressed. We recommended that the manager creates a training programme for all of the staff that identifies what their training needs are and the dates when they will attend the course. It becomes a requirement of this report that the manager ensures that all of the staff have the necessary skills training to meet the needs of people in Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: the home. We sampled the recruitment records for 4 staff employed at the home. We found that each of the files contained the information required by the Regulations including enhanced Criminal Records Bureau disclosures (CRB). A shortfall we identified was staff employment history, the application form stated that people should provide their history of employment for the past 20 years. The Regulations state that a full employment history should be recorded for each member of staff, this was brought to the attention of the manager and owner. They gave their assurances this would be addressed in any future recruitment. The manager stated since the home has been open staff have received 2 supervision sessions each. This was confirmed buy the staff we spoke with. We saw minutes from 2 staff meetings. The manager stated that another meeting had been held and they were in the process of writing up the notes. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Considering the short period of time the home has been open and people have been living there the service is making good progress towards identifying and meeting peoples needs. People living in this service are supported by staff in sufficient numbers as to minimise potential risks and meet their assessed needs. Procedures are in place to minimise potential risks to health and safety around the home but the manager must ensure that all of these procedures are followed consistently. Evidence: The service has a registered manager in place. The manager and the owner were present throughout this site visit. When speaking with the manager and owner we felt they were receptive to ideas of home the service should be improved and how improvements should be documented. The service is still in its early days of development with the manager and staff still getting to know people and accessing training to meet needs as they arise. When speaking to members of the team we asked what it was like to work in the home. They made comments including; Its a brilliant place to work, There is a Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: really good atmosphere, Its a good staff team, We have learned together. We spoke to the owner about quality assurance and how they will address this. They explained that in February 2010 they plan to send surveys to people in the home, their families, staff and other professionals involved in the home. The surveys will ask people what they think of the service and enable the owner/manager to develop the service to address any shortfalls and further develop practices that are seen as positive. The service has a range of policies and procedures in place. We did not examine them on the occasion as we were aware that as part of the homes registration process they were seen. There are a range of procedures in place to minimise potential health and safety risks to people. We saw evidence of checks being completed of fire safety equipment, water temperatures and the staff use Safer food, better business when addressing food safety. Unfortunately when looking at records for food safety we were unable to find records of staff using a food probe to check the temperatures of cooked food, and of staff checking the temperatures of the fridge and freezer. This was brought to the attention of the manager/owner. It becomes a recommendation of this report that the manager ensures this is addressed in the future. COSHH data sheets are available for cleaning chemicals used in the home. We noted that the Portable Appliance Testing (PAT) had not been completed. The owner said that they were planning this would be completed in the near future. Care Homes for Adults (18-65 years) Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 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 13 The manager must monitor the medication administration to ensure that staff are following the agreed procedures and not increasing potential risks of errors. Failure to monitor medication administration may present unnecessary risks to people in the home. 29/01/2010 2 6 15 The manager must ensure 19/02/2010 that care plans are reviewed and updated to accurately reflect peoples needs and the actions required by staff to meet those needs consistently. If care plans are not detailed enough staff will not be able to meet peoples needs consistently 3 6 15 The manager must ensure that where people have communication difficulties 19/02/2010 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 care plans must be in place detailing the persons needs and the actions required to support them. If peoples communication difficulties are not clearly identified it may mean that their opportunity communicate effectively is ignored. 4 9 13 The manager must ensure 19/02/2010 that risk assessments are reviewed and provide sufficient detail to the reader that enables them to minimise potential risks. Failure to identify potential risks and strategies to minimise them may put people at unnecessary risks. 5 18 15 The manager must ensure that where people require support with their personal care that care plans are in place that detail the support people require. Failure to provide care plans with sufficient detail may mean that peoples needs are not met. 6 23 13 The manager must ensure 26/03/2010 that all staff have completed training in behaviour management to minimise 19/02/2010 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 the potential risks to people in the home and the staff. I f staff do not complete this training they could put people living in the home and themselves at risk. 7 34 19 The manager must ensure that in future they obtain a full employment history from new staff. Failure to obtain a full employment history from potential staff puts people living in the home at potential risk. 8 35 18 The manager must ensure that all staff receive the appropriate training to meet the needs of the people living in the home. Failure to provide staff with the training to meet peoples needs puts them at unnecessary risks. 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 29/01/2010 30/04/2010 1 1 The Service Users Guide and Statement of Purpose should be reviewed and updated to reflect the regulator is now named the Care Quality Commission. The manager should ensure that each person has a person Page 31 of 33 2 6 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations centred plan (PCP) in place. 3 4 5 7 9 17 The manager should ensure that staff record when they offer a person an activity and they refuse it. The manager should ensure that there are missing persons procedures in place for each of the people in the home. The manager should review how the menu is created with the aim of empowering all of the people in the home to have choice of what they eat. The manager should create a list of sample staff signatures/initials to be kept with medication records. The manager should ensure that where staff have not completed medication administration training in the past 3 years that this is now completed. The manager should ensure that issues around increased mental and physical frailty are addressed for each person living in the home. The manager should ensure that all staff complete training in safeguarding adults. The manager should complete the enhanced safeguarding adults training provided by Gloucestershires safeguarding adults team. The manager should ensure that staff are monitoring all the aspects of food safety as required, failure to do this puts people at unnecessary risks. 6 7 20 20 8 21 9 10 23 23 11 42 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. 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