Care Home: Adepta John Paul House 7-9 Pound Lane

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What the care home does well Care plans are of good standard and person centred, regular reviews are undertaken to ensure peoples interests and needs are still met. The home is making good use of pictures and symbols, which supports and helps people using the service in choosing meals. A varied and healthy diet is provided by the home. Staff demonstrates good understanding of service users complex needs and interact patiently with people using the service. Regular stakeholders` reviews enable people using the service, family and staff to take part in improving the service. Food provided by the home reflects the cultural and ethnic background of people using the service. The increase in daily activities has improved the lives of people living in John Paul House. What has improved since the last inspection? The home has met all four statutory requirement notices issued following our unannounced key inspection in September 2009. The home has informed us that all people using the service are or will be in the process of receiving a full review of their placement and care needs, which will ensure that the service continues to meet their needs. To minimise the risk to people using the service when contractors visit a risk assessment procedure has been implemented ensuring people using the service are safe. The home hasdiscussed with the staff team how peoples dignity and privacy can be upheld if contractors or visitors visit the home. Staffing ratios have been reviewed and a protocol has been implemented enabling staff to deal with sickness. People using the have been accessing the community more frequently. The home had 15 outstanding requirements, 14 of these requirements have been met, one of the requirements has not been met, but the timescale has yet not expired. The home has updated all fire risk assessments on 18/12/2009, which minimizes the fire risk to people using the service. Staffing numbers have been reviewed adequate staffing enable people using the service to have more opportunities such as accessing the community and taking part in planned activities. The statement of purpose and service users guide has been reviewed and changed were required, ensuring prospective people using the service are provided with current information about the home. The home is offering a wider range of activities and people using the service are encouraged to take part in stimulating opportunities. Staff have undertaken medication training, which ensures people using the service can be confident in staff administering medicines. Staff have undertaken adult abuse training and demonstrated good understanding of referral processes. Effort has been made to minimise the strong smell of urine, by replacing carpets and purchasing new beds. Cleaning materials are stored safely in a lockable cupboard. The registeredmanager has undertaken management training and has achieved her Registered Managers Award. What the care home could do better: We have made six new requirements during this unannounced key inspection. The manager must audit peoples health records regularly to ensure any changes in peoples conditions can be acted upon swiftly. Information on peoples health care needs must be up to date to ensure peoples needs can be fully met. Medication no longer used, but still recorded on the Medication Administration Sheet (MARS); the records must be updated to reflect peoples actual medication. Documentation around best interest decisions made on behalf on people using the service must be available at all times to ensure staff are aware of these and support people using the service appropriately. The broken toilet seat on the upstairs toilet and missing light cord switch in the downstairs bathroom must be repaired. The manager must ensure that weekly fire alarm test and emergency light tests are carried out to ensure people using the service are protected. Key inspection report Care homes for adults (18-65 years) Name: Address: Adepta John Paul House 7-9 Pound Lane 7-9 Pound Lane John Paul House Willesden London NW10 2HS The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Andreas Schwarz Date: 0 8 0 2 2 0 1 0 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 31 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 © (2010) 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 31 Information about the care home Name of care home: Address: Adepta John Paul House 7-9 Pound Lane 7-9 Pound Lane John Paul House Willesden London NW10 2HS 02084516843 02083438876 dorretta.mcgregor@adepta.org.uk www.pentahact.org.uk Dimensions (ADP) Limited care home 8 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 8 0 learning disability Additional conditions: Date of last inspection A bit about the care home John Paul House is one of a number of care homes formerly managed by Hillstream Care Limited. The organisation merged with Pentahact in September 2004 and with Dimensions in 2009. The home is registered to accommodate 8 adults with learning disabilities. At the time of the inspection there was one vacancy. The weekly contribution by people using the service towards the care ranges from GBP62.35 to GBP 94.45. Further information about Care Homes for Adults (18-65 years) Page 4 of 31 fees can be obtained from the registered manager or Dimensions Head Office. The property is situated on Pound Lane and there are good links with public transport. There are a number of shops close by. The property is detached and has a large driveway for off street parking. There is a large garden at the rear. The property consists of two floors and on the ground floor there are two bedrooms, a shared toilet and bathroom. There is an office, laundry room, lounge and large kitchen/diner. On the first floor are 6 further bedrooms for residents, bathroom with toilet, another toilet, a storeroom and a staff bedroom. Residents attend local day services and are supported to use community facilities such as leisure centres, parks etc. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 31 How we did our inspection: This is what the inspector did when they were at the care home This unannounced key inspection took place in February 2010 and lasted six hours. The lead inspector Andreas Schwarz was accompanied by Chris Carter. Chris Carter was taking part in the inspection as an observer. We spoke to the registered manager, three members of staff and two people using the service during this inspection. We sampled care plan folders, staffing records and other relevant documentation. A compliance visit was undertaken by Fay Bennett on 23/12/2009 to assess if the home has met the Statutory Requirement Notices (SRNs) following our key inspection on 30/09/2009. It was noted in Ms Bennetts report that all issued SRNs have been complied with. We would like to thank people using the service, staff and management for all their hard work and support provided during this key inspection. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well What has got better from the last inspection The home has met all four statutory requirement notices issued following our unannounced key inspection in September 2009. The home has informed us that all people using the service are or will be in the process of receiving a full review of their placement and care needs, which will ensure that the service continues to meet their needs. To minimise the risk to people using the service when contractors visit a risk assessment procedure has been implemented ensuring people using the service are safe. The home has Care Homes for Adults (18-65 years) Page 8 of 31 discussed with the staff team how peoples dignity and privacy can be upheld if contractors or visitors visit the home. Staffing ratios have been reviewed and a protocol has been implemented enabling staff to deal with sickness. People using the have been accessing the community more frequently. The home had 15 outstanding requirements, 14 of these requirements have been met, one of the requirements has not been met, but the timescale has yet not expired. The home has updated all fire risk assessments on 18/12/2009, which minimizes the fire risk to people using the service. Staffing numbers have been reviewed adequate staffing enable people using the service to have more opportunities such as accessing the community and taking part in planned activities. The statement of purpose and service users guide has been reviewed and changed were required, ensuring prospective people using the service are provided with current information about the home. The home is offering a wider range of activities and people using the service are encouraged to take part in stimulating opportunities. Staff have undertaken medication training, which ensures people using the service can be confident in staff administering medicines. Staff have undertaken adult abuse training and demonstrated good understanding of referral processes. Effort has been made to minimise the strong smell of urine, by replacing carpets and purchasing new beds. Cleaning materials are stored safely in a lockable cupboard. The registered Care Homes for Adults (18-65 years) Page 9 of 31 manager has undertaken management training and has achieved her Registered Managers Award. What the care home could do better We have made six new requirements during this unannounced key inspection. The manager must audit peoples health records regularly to ensure any changes in peoples conditions can be acted upon swiftly. Information on peoples health care needs must be up to date to ensure peoples needs can be fully met. Medication no longer used, but still recorded on the Medication Administration Sheet (MARS); the records must be updated to reflect peoples actual medication. Documentation around best interest decisions made on behalf on people using the service must be available at all times to ensure staff are aware of these and support people using the service appropriately. The broken toilet seat on the upstairs toilet and missing light cord switch in the downstairs bathroom must be repaired. The manager must ensure that weekly fire alarm test and emergency light tests are carried out to ensure people using the service are protected. Care Homes for Adults (18-65 years) Page 10 of 31 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Andreas Schwarz 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 02072390330 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 set out 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 11 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective people using the service are provided with up to date information about the home and comprehensive assessments ensure that the home is able to meet prospective people using the service needs. Evidence: The home has updated the service users guide and statement of purpose, which now reflects the organisational and regulatory changes. Both documents are judged as being detailed and the service users guide is available in a user friendly format using pictures and symbols making the documents more accessible for prospective and current people using the service. The home has currently one vacancy and has not received any new referrals since the last key inspection. We viewed assessment records during our previous two inspections and judged them as comprehensive. Care Homes for Adults (18-65 years) Page 13 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are encouraged in contributing to the care planning process and person centred principles enable peoples participation. Risks to people using the service are minimised through robust risk assessment processes, which ensures peoples safety. Evidence: We assessed one care plan, which have been of good standard and the plan viewed has been up dated on 25/10/2009. People using the service told us in previous inspections that they are involved in the care planning process. The home is following the person centred principle and we noted that an up to date person centred plan is in place, which is enhanced by pictorial prompts to make it easier for people using the service to take part in their person centred plan and in review processes. We viewed minutes of the most recent person centred planning meeting and noted that changes in the persons needs have been recorded and new goals have been set. Since the last key inspection the home has changed their care planning system and files have been updated and historical information has been archived. As part of the new system the registered manager informed us that she will be auditing care plans on a monthly basis. Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: During our previous key inspection in September 2009 we noted that people using the service have been referred to an advocate, but the waiting list of the advocacy service makes it difficult for people using the service to be allocated to an appropriate advocate. The home is using pictures for people to make choices about the food they want to eat. People using the service can access the kitchen at any time, which was observed throughout this inspection and we have seen people helping themselves to drinks and snacks. People with communication difficulties are referred to Speech and Language Therapy for assessment and appropriate communication aids are used and investigated. Staff support people using the service to receive the correct benefit and the manager told us that she is currently in the process of asking the Department for Work and Pensions (DWP) to reassess a person for higher benefits. We did not assess financial records of people using the service during this inspection. However during our previous key inspection we assessed financial records of three people, which were all found of good standard. We noted during our key inspection in September 2009, that staff is checking peoples individual money pouches during each handover and close it with a seal each time. We observed staff taking out money for activities and a record is made for each transaction. Risk assessments are of good standard and are reviewed as part of the care planning review process or if risks to people are changing. During our previous inspection in September 2009 we noted that people using the service are put at risks by contractors visiting the home and a statutory requirement notice has been issued in regards to this. The home was visited by Fay Bennett Regional Enforcement Team on 23/12/2009 who stated in her report that the home has complied with this enforcement notice and has put processes in place to minimise the risk to people using the service when contractors visit the home. All contractors have to do a risk assessment together with the homes manager prior to work is being carried out. Care Homes for Adults (18-65 years) Page 15 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is providing various opportunities for people using the service to take part in activities. Holidays are addressed during care plan reviews, supporting people to choose appropriate holidays. Meals are varied, healthy and cultural options are provided. Evidence: Five of the people living at John Paul House access local day centers. The day center provides them with learning opportunities and activities suitable to their needs. None of the people living at the home are in paid or unpaid employment or access colleges. We spoke to one person during our previous key inspection and asked him if he would like to go to college and he told us that he is happy going to Willesden Resource Centre (WRC). During the day of this key inspection four people using the service were at the day center and one person was getting ready to go to the day center. We noted during our key inspection on 30 September 2009, that due to lack of adequate staffing people using the service are offered limited opportunities to access the community. Staffing ratio has been reviewed and extra staff is provided if people using Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: the service choose to go out. Staff spoken to confirmed that more community based activities are offered. We viewed activity records of two people using the service and noted that people visit other services run by Dimensions for dinner, go to the local park for walks, visit the library, go for outings and have lunch in the local community. During the day of this key inspection staff supported people using the service to purchase toiletries and have lunch. An entertainer is visiting the home every fortnight for Karaoke and an aromatherapist is visiting the home for regular therapy sessions. The manager told us that the home has good relationships with their neighbours. The home returned an action plan following our last key inspection, which stated that the home is arranging monthly cultural parties such as Afro Caribbean night, Chinese evening, St. Patricks Day, etc. The manager told us that people using the service have been on day trips during the summer. People using the service have not been on an annual holiday during 2009. We noted in care plans viewed that holidays have been discussed during recent reviews and one staff member told us that she has started looking into various holidays which would be available for people using the service. The manager informed us that staff is currently looking into holidays abroad for one of the people living in John Paul House. The home has resumed community based activities for people using the service and regular family visits have been recorded in daily records viewed during this inspection. One person informed us that he has recently been to the Gateway Club in the evening, which he enjoyed. Five people living at John Paul House access WRC to maintain relationships. One person told us, I can see my friends at the day center. One person told us that the home is helping him to make contact with family members, which has proved to be very difficult. People who have family are encouraged to maintain contact and regular visits are encouraged. We observed people using the service accessing all parts of the home, access is only limited to the laundry room, which is clearly stated in a risk assessment. One person told us that he can go to his room and relax on his own if he chooses to do so; we observed this during this inspection. We observed people using the service helping staff to prepare the evening meal and one person told us that she likes helping in the kitchen. Daily records of one person confirmed that she regularly is involved in household chores. The home is using a pictorial menu, which allows people using the service to choose what they like to eat. Alternatives are offered if people dont like the meal or want to have potatoes instead of rice. Staff informed us that the menu is done weekly and is based on people likes and dislikes. Meal options are recorded on the menu. We noted that regular cultural dishes is offered by the home. Two of the people using the service have Type 2 Diabetes, staff is aware of this and sweeteners as well as low sugar options are provided. Staff told us that two people using the service are slightly overweight and support people reducing the weight by providing fresh fruit, fresh vegetable and low fat desserts. Staff told us that they explored opportunities for people to manage their weight, but Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: unfortunately classes available in a local sports center are not suitable for people living at John Paul House. Care Homes for Adults (18-65 years) Page 18 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are assisted by staff to maintain their personal hygiene and are supported around their personal care. The home is supporting people in accessing health care professionals, but the manager is not always aware if peoples conditions have changed. People using the service are protected by a robust medication procedure. Evidence: We viewed personal care guidance in peoples care plan files during our previous key inspection. We spoke to three staff during this key inspection and it was evident that staff have read the guidelines and demonstrated good understanding in how to support people using the service. During our previous key inspection we noted that one of the people living at John Paul House was dressed inappropriately, staff told us that the home has made improvements in regards to this and the person gets dressed if a certain member of staff is on duty. People using the service appeared to know where bathrooms and toilets are located in the home. During our previous inspection one of the people using the service was using the bathroom while contractors were present. The home has introduced a risk assessment which is agreed with all new contractors. We observed staff being more aware and reminding the person to close the door while using the facilities. We assessed health records of two people using the service.In one of the records assessed we found good information of the person accessing community based health Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: care services such as dentist, Speech and Language, optician, etc. We viewed a letter of a neurologist, who raised concern that staff did not take epilepsy information for the appointment. It was also noted that medication has been reviewed and actioned. We noted in a second record that the person had four seizures over the past three months, his care plan stated that he has one occasional seizure per year. We discussed this with the manager who was not aware of an increase in seizures and has therefore taken no actions. In addition to this the manager told us that the person has no regular seizures, this however does not coincide with the evidence found during this inspection. For example a letter from a hospital in 2008 indicated that seizures were almost weekly, another document found in the persons care plan stated that he has monthly seizures. We assessed medication administration sheets (MAR) of two people. The MAR sheets had no gaps, peoples allergies are recorded and a picture of the person is in place. The home has a signatory list of staff competent in the administration of medication in place. We noted in MAR sheet that rectal Diazepam was still recorded, the registered manager told us that this medication is no longer in use. The dispensing pharmacist is monitoring medication and recommendations made during the most recent visit have been actioned. Liquid medication bottles are signed once opened. The home has an up to date medication policy and procedure in place. The medication cupboard is lockable and a sufficient amount of medication is kept in the home. Senior support workers are responsible for the administration of medication and training is provided by Dimensions. Care Homes for Adults (18-65 years) Page 20 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported to voice their satisfaction and dissatisfaction about the home and can be confident that their concerns will be dealt with. People using the service are protected by robust safeguarding procedures, which minimizes the risk of harm and abuse. Evidence: The home has a complaints procedure, which is also available in pictorial format. The manager told us that the complaints procedure was previously displayed on the notice board in the kitchen, but had to be removed due to a service users request. We spoke to staff who informed us that they know how to record complaints and explained that they would talk to the registered manager. One of the people using the service commented, I would talk to my key worker or the manager. The manager informed us that no complaint was received since the last key inspection. Previous complaints have been investigated and dealt with appropriately. Since the last key inspection all staff have received adult protection training. Deprivation of Liberty Training is ongoing and another training session is scheduled for the day after this key inspection. Staff spoken to demonstrated good understanding and confidence in reporting abuse allegations to the appropriate authorities. The home has assessed peoples mental capacity and deprivation of liberty. We found a list of best interest decisions in one of the files viewed, the manager told us that a similar list has been done for another person using the service, but was not able to produce the list for inspection. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service live in a homely and comfortable environment, on occasions their is a slippage of attending to maintenance issues. The home is clean, fresh and free of any offensive odours. Evidence: Since the last key inspection the home has purchased new sofas for the lounge and has replaced the carpets in communal areas with lino flooring. A new bed has been purchased for one of the people using the service and the manager told us that a chest of draws is on order for this person. Carpets in two of the service users rooms have been replaced. The issue with the ramp leading to the garden is still ongoing. The manager told us that she has contacted the Occupational Therapy department at the beginning of January 2010, but was told that the person is still on the waiting list and will be contacted. During the tour of the building we noticed the following issues. The light cord switch in the ground floor bathroom was missing and must be replaced. The broken toilet seat on the upstairs toilet must be repaired. During the day of this visit the home was clean and free of any offensive odours. The manager told us that the new flooring helps to keep the home clean and fresh. Cleaning materials was locked away as per Control of Hazardous Substances (COSSH) Regulations. Care Homes for Adults (18-65 years) Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported by a skilled, well trained and appropriate staff team, which ensures their complex needs can be met. A satisfied staff team is providing good support to people using the service. Evidence: During our compliance visit on 23/12/2009, Fay Bennett Regulation Inspection from the Regional Enforcement Team (RET) found the following evidence. The manager explained that the sickness procedure had been reviewed and a new contingency plan for staff cover had been implemented. It was now the responsibility of the designated shift leader to follow the contingency plan to gain staff cover should a staff member be unable to attend work. This plan included contacting other staff due on duty, staff from other Dimension services, the manager and external agency workers. We saw that both the sickness procedure and the contingency plan had been discussed in the December team meeting. Two members of staff spoken to who had been in post since July 2009 informed us that they had received a detailed induction. They had also received basic training in health and safety, moving and handling, medication, and the Mental Capacity Act. When asked, both staff members demonstrated they were knowledgeable in the areas they had received training in. We viewed the rotas for the month of December and found that an experienced staff member had been identified on duty for all shifts. Where sickness had been recorded the inspector was satisfied that appropriate cover had been sought. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: We have received an Annual Quality Assurance Assessment prior to our key inspection on 30/09/2009 and were told that six out of eleven staff hold or work towards their National Vocational Qualifications in care. We assessed staff files of three members of staff all required documentation were on file and validated were necessary. We viewed three randomly selected staffing records, certificates of training undertaken was in place. The home forwarded individual training plans to the CQC following our last key inspection, which showed that the range of training is varied and suitable to the needs of people using the service. The registered manager informed us that Dimension has introduced E-learning, which can be used by staff. Staff informed us that they had an induction, at the start of their employment. Records of this have been viewed during this inspection. We spoke to four members of staff who informed us that they have been supervised by the registered manager or in case of senior staff by the operations manager. Supervisions records were found to be up to date. Staff spoke very positively about the changes in team spirit and team work since our last key inspection and are very satisfied with the help and support they have received from the manager and the organisation to overcome the difficult times and problems. Care Homes for Adults (18-65 years) Page 24 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by an experienced manager, who has recently obtained appropriate management qualifications. Annual stakeholders surveys are undertaken ensuring peoples views are taken into consideration. Regular Health and Safety checks are undertaken, which generally ensures people using the service live in a safe place. The lack of regular auditing could adversely affect the health and wellbeing of people using the service. Evidence: The manager has been registered with the CQCs predecessor the Commission for Social Care Inspection since 06/01/2009. The manager holds National Vocational Qualification in Care Level 3. She informed us that she has completed her Registered Managers Award and showed us her certificate, she is currently on the waiting list to do her National Vocational Qualifications In Care Level 4. Staff spoke positive about the support they have received from the registered manager since the last key inspection. One person told us: Doretta is taking her time to listen to our problems. The home has undertaken stakeholders surveys in January 2010. The manager told us that they have been send to the head office for being analysed. We asked the manager to Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: forward the completed report to the CQC. The last residents meeting was held on 26/11/2009, the manager told us that these should happen every month, but due to Christmas and work being carried out in relation to the last key inspection there was a slippage. Staff told us that the last staff meeting was held in December 2009. We viewed the homes fire risk assessments which are of good detail and comprehensive. Individual fire risk assessments for each person are in place, which is good practice. Fire drills are done every three months, the last fire evacuation was done on 21/11/2009. We noted however that weekly fire records such as fire alarm test and emergency light tests were not up to date and informed the manager that this is required. Care Homes for Adults (18-65 years) Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 1 24 23(2)(n) The responsible person must 01/03/2010 pursue the OT referral and provide a ramp leading to the garden. This ensures that all people using the service can access the garden independently if they choose. Care Homes for Adults (18-65 years) Page 27 of 31 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description 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 Description Timescale for action 1 19 13 The registered manager must ensure that up to date information about peoples health is available 15/03/2010 This ensures information on files is not misleading and staff are able to deal with peoples health care needs appropriately. 2 19 12 The registered manager must regularly monitor peoples health care records. 15/03/2010 This ensures changes in peoples health can be dealt with swiftly. 3 20 13 The responsible person must 15/03/2010 ensure that only medication used in the home is recorded on the MAR sheet. This ensures people are Care Homes for Adults (18-65 years) Page 28 of 31 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 Description Timescale for action administered medication safely. 4 23 17 The responsible person must 15/03/2010 ensure that important documentation relating to people using the service is available at all times. This ensures staff, health care professionals and manager can respond quickly if peoples needs are changing. 5 24 23 The responsible person must 15/03/2010 ensure that the broken toilet seat on the upstairs toilet and and missing pull cord on the downstairs bathroom light is repaired. This ensures people can safely use the provided equipement and appliances. 6 42 23 The responsible person must 15/03/2010 ensure that weekly fire alarm and emergency light tests are carried out. This ensures people using the service are protected from the risk of fire by following appropriate procedures. Care Homes for Adults (18-65 years) Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 39 39 The responsible person should send the completed analysis of stakeholders surveys to the Care Quality Commission. It is recommended to hold regular staff and residents meetings. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or 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 © (2010) 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. 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