Care Home: Abbotts Barton

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What the care home does well The home have maintained a stable staff group which continues to benefit the residents in their daily lives in offering stability and continuity of care. The homes admission and assessment procedures ensure that prospective residents needs are appropriately identified and met and they can visit the home prior to residency. The support, personal care needs, goals and aspirations of residents are well monitored and documented within the residents care plans to ensure that residents changing needs are identified and met. Residents are consulted about matters which affect their daily lives and their choice, dignity and respect is consistently promoted. Residents are able to take part in planned social and recreational activities that are meaningful to them and supported to maintain bonds with family and friends. The home continues to offer residents a healthy and balanced diet. Residents are supported to express their concerns and have access to a complaints procedure. The physical design and layout of the home currently enables residents to live in a generally safe and comfortable environment. The home continues to be run in the best interests of the residents and their views and opinions and those of others associated with the home are sought. What has improved since the last inspection? The commission acknowledge that with the support of a manager overseeing the home Welmede have recognised some of the shortfalls in the service and some improvements have been made prior to the key inspection. What the care home could do better: The management and administration of the home needs to be strenghenned. Prospective residents and their representatives do not currently have up to date information about the home in order that they can make an informed choice about moving to the home. The management of risk assessments needs to be more robust to ensure the safety and wellbeing of residents at all times. Residents health care needs are met yet the recording of health care needs to be improved.Medication procedures need to be further strengthened to ensure that medication is administered to all residents in a safe way at all times. Safeguarding procedures are in place yet all staff must undertake safeguarding training in order to promote residents rights to protection. Some maintenance and repairs need to be undertaken and some aspects of the homes environment are recommended to be reviewed to benefit the residents. Staff in the home are not currently fully trained to support people who use the service. Residents welfare is promoted yet needs to be further strenghtenned through the robust monitoring of health and safety in the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Abbotts Barton 3 Abbey Gardens Chertsey Surrey KT16 8RQ     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: Suzanne Magnier     Date: 2 8 0 9 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 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 34 Information about the care home Name of care home: Address: Abbotts Barton 3 Abbey Gardens Chertsey Surrey KT16 8RQ 01932569455 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): kathy.murphy@sabp.nhs.uk Welmede Housing Association Ltd The registered provider is responsible for running the service care home 6 Name of registered manager (if applicable): Type of registration: Number of places registered: 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/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home Abbotts Barton is a detached house in a quiet residential road in Chertsey which provides accommodation and care to six people with learning disabilities and enduring mental health needs. Each person has their own bedroom. There are five bedrooms on the first floor and one on the ground floor, which has an en-suite facility. All bedrooms include furnishings. Communal areas of the home include a large spacious combined lounge dining room Care Homes for Adults (18-65 years) Page 4 of 34 6 Over 65 0 Brief description of the care home and a separate kitchen which people can access. The home has two bathrooms. One is located on the first floor and includes a shower and another bathroom is situated downstairs. The home has a separate well equipped laundry room. An enclosed garden is available and accessible for people to use for leisure activities and includes a small separate building where people can have a cigarette if they choose. The local amenities include a variety of shops, a park, restaurants and pubs. The home has their own seven seater transport to support people to leisure activities and health care facilities and parking and public transport is available near the home. Welmede Housing Association, own and manage the home and employ all the staff. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is one star. This means that the people who use this service experience adequate quality outcomes. This inspection of the care home was an unannounced Key Inspection carried out by Ms S Magnier Regulation Inspector. The homes area manager and another Welmede manager who has been overseeing the service for two months represented the service throughout the inspection. Welmede had recognised, prior to the inspection, that there were a number of shortfalls within the home and have kept in contact with the commission regarding the efforts made to improve the service which has included a written action plan to address the shortfalls. Owing to the recent review of the whole service Welmede have introduced a new care planning system, health action plans and are developing a more person centred approach to the care and support of residents at Abbotts Barton. Care Homes for Adults (18-65 years) Page 6 of 34 For the purpose of the report the individuals using the service are referred to as residents. The inspector arrived at the service at 08.00 and was in the home for six hours. It was a thorough look at how well the home is doing and took into account detailed information provided by the home and any information that the commission had received about the service since the last inspection on the 10th September 2007. The commission received five resident survey cards which had been completed with staff by residents, two completed survey from health care professionals and eight surveys completed by staff at the home. The comments of which have been included within the report. The inspector spent time being with and talking to residents and observing the residents and staff members in order to gain their views and opinions about the service. The inspector looked at how well the service was meeting standards and has in this report made judgments about the standard of the service. Documents sampled prior and during the inspection included the homes Statement of Purpose and Service User Guide, the Annual Quality Assurance Assessment AQAA, care/person centred plans, risk assessments, medication procedures, a variety of training records and several of the services policies and procedures including complaints and safeguarding. No staff recruitment files were sampled during the inspection as the commission have been advised no new staff have been employed since the previous inspection. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection and no safeguarding referrals have been made since the last inspection. The home had submitted the Annual Quality Assurance Assessment (AQAA) prior to the inspection, which was very well written to inform the commission about the service and some details of the document have been added to the report. From the evidence seen by the inspector and comments received, the inspector considers that the home continues to be able to provide a service that meets the needs of people who have diverse religious, racial or cultural needs. The final part of the inspection was spent giving feedback to the managers representing the service about the findings of the visit. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The management and administration of the home needs to be strenghenned. Prospective residents and their representatives do not currently have up to date information about the home in order that they can make an informed choice about moving to the home. The management of risk assessments needs to be more robust to ensure the safety and wellbeing of residents at all times. Residents health care needs are met yet the recording of health care needs to be improved. Care Homes for Adults (18-65 years) Page 8 of 34 Medication procedures need to be further strengthened to ensure that medication is administered to all residents in a safe way at all times. Safeguarding procedures are in place yet all staff must undertake safeguarding training in order to promote residents rights to protection. Some maintenance and repairs need to be undertaken and some aspects of the homes environment are recommended to be reviewed to benefit the residents. Staff in the home are not currently fully trained to support people who use the service. Residents welfare is promoted yet needs to be further strenghtenned through the robust monitoring of health and safety in the home. 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 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their representatives do not currently have up to date information about the home in order that they can make an informed choice about moving to the home. The homes admission and assessment procedures ensure that individuals needs are appropriately identified and met and people can visit the home prior to residency. Evidence: The homes Statement of Purpose and Service user Guide were sampled and it was evidenced that both documents were under review yet had not been finalised. It has been required that the documents are updated fully in order that prospective residents and their representatives have accurate information about the home in order that they can make an informed choice about moving to the home. It was confirmed that Welmede have an admission and assessment policy and procedure to ensure that all prospective individuals have a care needs assessment prior to admission to the home to ensure that the homes staff would be able to meet Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: the individuals needs. There has been one admission to the home since the previous inspection and documents sampled evidenced that a variety of assessments had been undertaken by the home with several health care professionals and the individuals other representatives prior to them moving into their new home. Records sampled evidenced that the prospective resident had visited the home prior to moving in in order to meet with other residents and staff and to familiarise themselves with their private accommodation and the home in general. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The support, personal care needs, goals and aspirations of residents are well monitored and documented within the residents care plans to ensure that residents changing needs are identified and met. Residents are consulted about matters which affect their daily lives. The management of risk assessments needs to be more robust to ensure the safety and wellbeing of residents at all times. Evidence: During the inspection three care plans were sampled and each evidenced that the homes staff had made efforts to improve the standard of care planning which had involved the resident and also the individual staff member as the residents key worker. The care plans were well written and clear and gave instructions on how the person liked to be supported, how they chose to communicate through behaviour, sound and body language and how they preferred to receive care and support. Daily written records to document the demeanour of the resident over a 24 hour period were well recorded to give the reader an understanding of the residents welfare and well being. The home has a key worker system which offers a consistent approach to Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: the care and support of residents and supports staff to understand their holistic duty of care for residents in the home. The care plans included written guidelines for staff in order that they could maintain the residents abilities and independence for example the residents abilities with household tasks and independence in their daily lives with personal care. It was observed that the routines in the home centred around the needs of the residents and staff were on hand to support residents in the choices they made during the time of the inspection which included going out for a cigarette, having a lie in, not going to the planned activities as the resident was not feeling well enough and also choosing to go back to bed if the resident wanted to. There was evidence during the inspection that some residents had had their care and support needs reviewed by the local authority representatives yet some had not received reviews for several years. The representatives confirmed that the local authority has assured the service that reviews of residents care would be being undertaken during the next several months. The care plans sampled identified that some residents risk assessments were not up to date and did not accurately reflect the hazards being presented in the residents life. There was some evidence to support that staff had, whilst updating care plans, identified areas of risks in residents lives yet the service representatives during the inspection advised that they had not yet had sufficient time to document all residents risk assessments yet were aware of the shortfall. It has been required that any activities in which a resident participates and any unnecessary risks to the health and welfare of residents must be identified and documented and so far as possible eliminated to ensure the safety of residents. Care Homes for Adults (18-65 years) Page 14 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to exercise choice in their daily lives and take part in planned social and recreational activities that are meaningful to them. Residents are generally supported to maintain bonds with family and friends. The home continues to offer residents a healthy and balanced diet. Evidence: It was evidenced through sampling several daily record books that staff have continued to support residents to be included within their local community and promote opportunities for people to take part in social activities. Several residents told the inspector about what they enjoyed doing and what they had done which included going to shows, visiting family members and going on holiday. A written activities programme was available during the inspection which indicated that planned activities also take place regularly at specific day services and staff transport residents, in the homes people carrier to a variety of places of interests. The AQAA identifies that staff Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: are investigating and trying to access a wider range of activities which would also include more in house activities for residents to choose from. It was observed that staff were flexible during the inspection to provide a service which was led by the residents rather than led by tasks undertaken by staff. It was observed that residents were able to have their breakfast when they chose to and to have a choice of what they wanted to eat. The staff on duty spoke with residents in a manner which was observed as respectful and polite and several residents told the inspector that they liked the staff. It was observed that the kitchen door in the home was locked and the risk assessment sampled indicated this was because of the potential hazard of overcrowding. The risk assessment was discussed with the service representatives and concluded that the current assessment did not document the full hazards identified and the assessment would be reviewed. It was also observed that the laundry room door was locked and the service representatives advised that they would investigate the reason why the door was locked. Staff on duty confirmed that they were aware of residents rights to exercise choice, fairness, dignity, respect and freedom of movement in the home and demonstrated good professional relationships with residents throughout the inspection. Written comments received from residents included I am happy in my home but would like to go out for more walks, I have known my key worker for twelve years and we know each other well, my key worker took me to Disney land Paris as I really wanted to go there and I enjoy many outings of my choice. I like art work and my key worker makes sure I have plenty of art materials. Ive been to Littlehampton twice this year and I caught four crabs, Im going to the theatre soon and I am happy at Abbotts Barton. I would like to go out on a train. I go on holiday every year with staff, I would like more outings and meals out but cant always as we are told there is not enough staff. There was evidence to support that staff continue to support residents to maintain links with family and friends and people significant to them yet whilst sampling one residents care plan it was observed that there was no indication that the residents next of kin had been contacted for several months and the service representatives gave assurances that this would be rectified without delay. The breakfast mealtime was observed and as previously documented all residents were supported individually to have their breakfasts as they chose to. The home has a large lounge dining area which was observed to be a comfortable setting for residents to enjoy their meals. It was observed that there was adequate crockery and cutlery and staff on hand to support residents during the mealtime. Staff confirmed that some Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: residents help with the food shopping for the home at the local supermarket. Colourful pictures of meals remain available for residents to use in order that they can choose what they would like to eat and add to the weekly menu. The staff confirmed that residents would be referred to the local authority dietitian for additional nutrition and dietary advise when needed. The AQAA indicates that the staff are going to improve their practise and seek nutritional screening for all residents. The homes fridges and freezers were well stocked and food stored and prepared was observed to be in compliance with food hygiene standards. Care Homes for Adults (18-65 years) Page 17 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health care needs are met yet the recording of health care needs to be improved. Residents choice, dignity and respect is consistently promoted. Medication procedures need to be further strengthened to ensure that medication is administered to all residents in a safe way at all times. Evidence: It was observed that residents were supported by the staff in a way which respected the persons rights of choice and where a resident wanted support immediately the staff member was on hand to provide the support. It was observed that residents skills and independence was promoted by staff and objects of reference were used to support residents in their home with daily living skills. Records within several health action plans evidenced that residents are supported to attend health care appointments in order to ensure their health and well being. The service representatives advised the commission that all residents had recently met with their general practitioner and had had thorough health care checks. The recording of the appointments was generally well managed yet some shortfalls identified had Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: been recognised by the homes staff who were addressing the shortfall. Written comments received from residents included They make sure that I am on time with my appointments to the doctor, and I have my medication when Im supposed to. The staff make sure I attend my hospital appointments, dentist and opticians. I attend the monthly residents meetings where I am encouraged to talk about things and I am involved in planning the menu and have a choice what I like to eat and going clothes shopping and choosing what I like to wear. It was observed that residents were supported in a safe and methodical manner with regard to the administration of their medicines. The home have a monitored dosage system and have an up to date medication policy and procedure in place. The service representatives advised that the medication system in the home has been reviewed which has resulted in safer practise and weekly stock taking has been implemented. Staff confirmed that the home is not currently supporting any residents with the administration of controlled medicines and no residents are currently self medicating. Records evidenced that systems were in place for the ordering and safe returns of medication. During the sampling of the medication administration charts it was observed that they were well recorded and contained no gaps. Shortfalls were identified which included out of date guidelines regarding medicines to be given when required and homely remedies administered by staff need to be authorised by the residents general practitioner. It has been required that arrangements must be made that medicine procedures in the home must be strengthened in order to promote the safety and well being of residents receiving medicines. Written comments from two health care professionals stated that the service cares well for residents and seeks medical advice when appropriate. Care Homes for Adults (18-65 years) Page 19 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to express their concerns and have access to a complaints procedure. Safeguarding procedures are in place yet all staff must undertake safeguarding training in order to promote residents rights to protection. Evidence: The home have an up to date complaints procedure which is also in a pictorial format to support residents on how to make a complaint or raise a concern if they are dissatisfied. The AQAA identifies that one complaint had been received by the home since the previous inspection and had been satisfactorily concluded. The local authority multi agency procedures for safeguarding adults dated 2008 were available and the AQAA identifies that no safeguarding referrals have been made. The Welmede policy statement regarding reporting abuse which was sampled and was noted to be in accordance with the local authorities multi agency procedures. A whistle blowing policy and procedure was in place in order to safeguard residents and inform staff of their duty of care to report any incidents which may cause harm or abuse to residents in their care. Training records evidenced that some staff had undertaken safeguarding vulnerable adults training yet not all staff had received safeguarding training. The service representatives assured the commission that training would be undertaken however a Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: requirement has been made that the home must make arrangements, by training staff or by other measures to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. As previously documented the use of restricting residents access to areas in their home was discussed with the service representatives who advised that the restrictions would be reviewed and appropriately risk assessed and feedback would be available through the improvement plan requested by the commission following the homes receipt of the final report. Care Homes for Adults (18-65 years) Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home currently enables residents to live in a generally safe and comfortable environment. Some maintenance and repairs need to be undertaken and some aspects of the homes environment are recommended to be reviewed to benefit the residents. Evidence: During the tour of the premises it was observed that the communal areas of the home for example the lounge dining area and residents rooms were well furnished and offered comfortable surroundings for residents in their home. The home was generally clean and tidy yet the corridors due to low lighting were observed as drab and would benefit being a lighter colour and the net curtains throughout the home were old and would benefit from being replaced. The lounge dining room carpet was heavily stained in areas despite the staff making efforts to keep the carpet free from stains. There was a lack of homely affects in the corridors for example framed pictures on walls, or any signage throughout the home and limited homely ornaments which would reflect more of a homely atmosphere. It has been required that all parts of the home are kept reasonably decorated, that suitable lighting is provided and areas of the home including carpets are kept in a good state of repair. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: The upstairs bath was noted to be secured to the wall which did not enable staff to access both sides of the bath and the stairway leading to the first floor was noted to be steep. These observations were brought to the service representatives attention in view of the future changing needs of the residents within their home. It has been recommended that due to the future changing needs of the residents that the upstairs bathing facility and use of stairs be considered by Welmede in order to ensure that the residents individual needs can continue to be met within their home and any adaptations are considered to maintain residents independence and safety. The enclosed garden was well maintained and accessible for residents to use if they choose. It was observed that the side gate of the garden was not secure as the bolt had not been secured which was viewed as a potential hazard for residents who may leave the home unescorted and a requirement has been made that a risk assessment be completed regarding the security of the home in order to ensure the safety and protection of residents at all times. Care Homes for Adults (18-65 years) Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment practises have been maintained. Staff in the home are not currently fully trained to support people who use the service. Evidence: The homes staff of 10 are currently supporting 6 residents. The service representatives advised that there is currently a shortage of 2 full time care staff and Welmede have been undertaking a recruitment drive to secure the full quota of staff for the service. The remaining staff team have been stable and this has had a benefit to the residents in providing a consistent and predictable approach to their support and care. The service representatives advised that when a full staff team are established the deployment of staff will be reviewed to further benefit the residents so staff will be available at specific times of the day in order to support residents either in or outside of the home with meaningful activities. It was observed that the level of staffing was appropriate on the day of the inspection to meet the needs of the residents yet additional staff would have been of further benefit. As previously documented the homes staff were observed as skilled in supporting residents in their care and were knowledgeable regarding the specific needs of residents to ensure their safety, well being and offer reassurance. Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: Written comments received from staff regarding the home stated I feel the home could do more than they already do yet the clients are happy and that is the main thing,find more staff who are experienced and motivated, Staffing levels could be better, we feel that residents are often denied one to one outings due to only 2 staff being on duty at times it seems the same staff take residents out and this is not equally shared with staff colleagues, Since recent changes the residents have more choices, are more relaxed and happier than they were, staff moral is higher and we have more input with care plans, health action plans and the residents are accessing the community more.At the moment every thing is being done to maintain good team work and a happy environment for the residents, The home is running more effectively, the residents are now given more choices with outings when possible. Staff are going on courses and discuss events and happenings with staff and residents and are more involved in residents care and needs. Moral is now higher and residents a lot happier. The home has a recruitment and selection policy, which incorporates equal opportunities. The inspector did not sample any staff recruitment files as the service representatives confirmed that no staff had been employed since the previous inspection in October 2007. The staff mandatory and induction training records were sampled and evidenced several shortfalls which included lack of staff training in moving and handling, food hygiene, and fire training. The shortfalls were discussed with the service representatives and whilst the home have identified the shortfalls in staff training a requirement has been made that all staff must undertake training in order to ensure that they have the skills and abilities to support the needs of the residents in their care. The AQAA identifies that 4 of the homes staff have achieved their National Vocational Qualification in Care Level two or above. Care Homes for Adults (18-65 years) Page 25 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home needs to be strengthened. The home continues to be run in the best interests of the residents and their views and opinions and those of others associated with the home are sought. Residents welfare is promoted yet needs to be further strengthened through the robust monitoring of health and safety in the home. Evidence: As documented within the report it was evident through observation that the pace of the home continues to be designed to meet the needs of the residents and the care staff present during the inspection demonstrated a good knowledge of the residents to ensure the residents safety and well being. The management of the home is currently under review and the commission continue to be kept informed of the homes day to day management arrangements. The management arrangements need to be strengthened to ensure the home is consistently managed for the benefit and welfare of residents and staff. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: Welmede have introduced a new filing system within the service and it was observed that the management of files and related documents was orderly. Some accident and incident records were sampled within residents files. The commission have confirmed following the inspection that the home continues to give notice to the commission without delay regarding any event, which affects the safety and welfare of the residents. The home has some areas which provide hand washing facilities yet these were not consistent throughout the home. It was noted that staff were not observing procedures for the handling of soiled laundry and did not wear protective clothing for example disposable aprons, consistently when supporting residents with personal care. It has been required that the control the spread of infection in the home be further managed to ensure that welfare and wellbeing and prevent the spread of infection in the home. Records indicated that servicing of fire equipment had taken place and health and safety checks had been undertaken and recorded. A current insurance indemnity and certificate of registration of the home was displayed. Confirmation was seen that the home continues to seek residents and their representatives views and opinions about the service through the Quality Assurance procedures and Welmede tenants group and residents meetings about the running of their home and issues affecting their daily lives. Regulation 26 records of unannounced visits by the organisations area manager or other registered managers noted that the record was thorough in assessing the quality of the service and any issues identified would be noted by Welmede in order that appropriate action would be taken to rectify any shortfalls. The control of substances which are hazardous were observed to not be consistently stored in compliance with the control of substances hazardous to health COSHH legislation as the cupboard under the sink in the kitchen was left unlocked and contained a variety of chemicals. All cleaning fluids and materials must be stored and kept securely in compliance with the control of substances hazardous to health COSHH guidance in order to ensure the health and safety of residents. As recorded throughout the report a number of aspects of the homes management are potentially putting the health, safety and welfare of residents and staff at risk. This includes the lack of up to date information about the home in order that prospective residents or their representatives can make an informed choice about moving to the Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: home, lack of robust management of risk assessments and some medication procedures, lack of some staff training including safeguarding adults training, shortfalls in providing a homely and well decorated environment for residents, lack of robust procedures regarding the control of infection in the home and the storage of chemicals hazardous to health. It has been required that the home must forward an improvement plan to the commission detailing how the home intends to improve the services provided in the home to ensure the safety and well being of residents in their home. These requirements have a bearing on the safety of, and outcomes for, the residents who live at the home and the failure to comply with the regulations is an offence. Care Homes for Adults (18-65 years) Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 Arrangements must be 30/11/2009 made that the Statement of Purpose and Service User Guide must detail the information in respect of the Care Homes Regulations 2001. Both documents must be kept under review and the commission and service users notified of any revision within 28 days. In order to ensure that prospective residents and their representatives have up to date information about the home. 2 9 13 Arrangements must be 31/12/2009 made that any activities in which a resident participates and any unnecessary risks to the health and welfare of residents must be identified and documented and so far as possible eliminated. Care Homes for Adults (18-65 years) Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action In order to ensure the safety of residents at all times. 3 20 13 Arrangements must be made that medicine procedures in the home must be strengthened. In order to promote the safety and well being of residents receiving medicines. 4 23 13 The home must make arrangements, by training staff or by other measures to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. In order to promote residents rights to protection from harm or abuse. 5 24 23 Arrangements must be made that all parts of the home are kept reasonably decorated, that suitable lighting is provided and areas of the home including carpets are kept in a good state of repair. In order that the residents home is safe and comfortable. 26/02/2010 31/12/2009 31/12/2009 Care Homes for Adults (18-65 years) Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 6 35 18 Arrangements must be made that all staff must undertake all mandatory training. In order to ensure that they have the skills and abilities to support the needs of the residents in their care. 31/12/2009 7 37 9 The management arrangements of the home need to be strenghthened. To ensure the home is consistently managed for the benefit and welfare of residents and staff. Arrangements must be made that all cleaning fluids/materials must be stored and kept securely in compliance with the control of substances hazardous to health (COSHH) guidance. In order to ensure the health and safety of residents. 31/12/2009 8 42 13 30/11/2009 9 42 16 Arrangements must be made that the control the spread of infection in the home be further managed. In order to ensure that welfare and wellbeing and prevent the spread of infection in the home. 30/11/2009 Care Homes for Adults (18-65 years) Page 32 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 10 42 24A Arrangements must be 29/01/2010 made that the home forward an improvement plan to the commission detailing how the home intends to improve the services provided in the home. In order to ensure the safety and welfare of residents and staff in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 30 It has been recommended that due to the future changing needs of the residents that the upstairs bathing facility and use of stairs be considered by Welmede in order to ensure that the residents individual needs can continue to be met within their home and any adaptations are considered to maintain residents independence and safety. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!