Care Home: Albert House

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What the care home does well The service achieves a calm, relaxed and homely environment and the service users are at the forefront of care delivery. Staff know the needs of service users well and are adept at meeting needs of people who have limited verbal communication. Despite the challenges that they face staff continue to work hard and in a flexible way, often covering shifts at short notice and working to meet the needs of people who use the service. Staff have a good rapport with each other and the manager and communicate well as a team. The service offers a variety of activities both in and out of the home. What has improved since the last inspection? Albert House DS0000065423.V378609.R01.S.doc Version 5.3 The previous requirement for care plans to contain more detailed information, specifically with regard to health needs has been met. The manager is undergoing the registration process and if successful will meet a previously made requirement. The manager has successfully achieved everything that they outlined at the previous inspection. The home has benefited from some redecoration: New bedroom and all carpets have been fitted. The hall has had a new floor fitted and the front door has been replaced. At the previous inspection the TV picture was fuzzy and a new television and Freeview satellite service have been purchased. The previously acting manager has been employed permanently and they have reviewed and updated documentation. Care plans are clear and concise and evidence is in place of how health needs are monitored, managed and met. Documentary evidence is in place of staff being trained in testing blood sugars and the Aromatherapist has a Criminal Record Bureau check. Fire risk assessments and plans have been completed in line with local fire service recommendations. What the care home could do better: Staff cover does not meet the comprehensive assessed needs of people who use the service. Staffing levels on each shift have been reduced in light of a service user vacancy. However, service users have complex needs and several people require 2 staff to assist them and a high level of supervision to ensure that their needs are met. Reduced staff levels have impacted upon people’s leisure activities and they are going out less frequently. People are also collected from college earlier as pick up times are dictated by staffing levels. Staff levels are sometimes below the minimum level of meeting people’s needs and we identified a member of agency staff working over a month without a day off. The service would benefit greatly from a computer as this would enable staff to access up to date information and enable the manager to run the service more effectively. They currently have to get paperwork typed, printed and distributed by head office in Hertfordshire. Key inspection report CARE HOME ADULTS 18-65 Albert House 167 High Street Clapham Bedfordshire MK41 6AH Lead Inspector Angela Dalton Key Unannounced Inspection 1st December 2009 12:00p Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 1 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. 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 home adults 18-65 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. Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 2 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 Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Albert House Address 167 High Street Clapham Bedfordshire MK41 6AH 01707 652053 01707 662719 karen.cox@caretech-uk.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) CareTech Community Services (No.2) Ltd Manager Post Vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning Disability - Code LD The maximum number of service users who can be accommodated is: 8 13th February 2009 Date of last inspection Brief Description of the Service: Albert House is located in the village of Clapham, a short car or bus ride away from Bedford, which has shops, leisure facilities and links with national bus and rail services. The home has been converted from its original purpose as a domestic dwelling. The building is an extended bungalow which provides single room accommodation for 8 younger people with learning disabilities and who may also have physical disabilities. A communal lounge/diner and a room that is used for activities are located to the rear of the property. A shared drive at the front of the property leads to a parking area for several vehicles. To the rear of the property is a large garden that leads directly to the river Ouse. The fees for this home are in the region of £1500.00 per week, depending on the assessed need of the person. Additional charges are made for hairdressing, aromatherapy, chiropody, toiletries, community based activities, holidays and transport other than for attendance at health appointments. Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. One inspector conducted this unannounced site visit on 1st December 2009 between 12.00pm and 4.45pm. The manager was previously the deputy manager and is currently undergoing the registration process with the Care Quality Commission. Two people were case tracked: the inspector followed the care of people who use the service to ensure the care they receive is reflected in the care plan and meets their individual requirements. The case tracking process crossreferences all the information gathered to confirm that what we are being told is actually happening and reflects the Statement of Purpose, which contains the aims and objectives for the service. We met with service users, staff and the manager to discover what it was like to live and work in the home. People who use the service are well cared for and staff focus upon individual needs and ensure that people develop their skills and independence. However, staffing levels have been reduced as there is currently a service user vacancy and some leisure and college activities have been curtailed. What the service does well: What has improved since the last inspection? Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 6 The previous requirement for care plans to contain more detailed information, specifically with regard to health needs has been met. The manager is undergoing the registration process and if successful will meet a previously made requirement. The manager has successfully achieved everything that they outlined at the previous inspection. The home has benefited from some redecoration: New bedroom and all carpets have been fitted. The hall has had a new floor fitted and the front door has been replaced. At the previous inspection the TV picture was fuzzy and a new television and Freeview satellite service have been purchased. The previously acting manager has been employed permanently and they have reviewed and updated documentation. Care plans are clear and concise and evidence is in place of how health needs are monitored, managed and met. Documentary evidence is in place of staff being trained in testing blood sugars and the Aromatherapist has a Criminal Record Bureau check. Fire risk assessments and plans have been completed in line with local fire service recommendations. What they could do better: If you want to know what action the person responsible for this care home is Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 7 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. Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,5 People using the 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 and current service users have the information needed to make an informed choice about the home. EVIDENCE: There have been no new admissions since the previous inspection in February 2009. Sadly, due to the death of a service user there is one vacancy. The Annual Quality Assurance Questionnaire told us that CareTech have introduced a new admissions process resulting in the Manager being fully involved in the process. The new method consists of a detailed and comprehensive pre-admission assessment where all relevant information is collated for all people involved in the care of the person; the manager carries out a personal visit to meet with the potential service user. If the manager has any doubts or concerns that the potential service user’s needs can’t be meet by he staff at the service an informal meeting will be held with senior managers to discuss and seek a resolution. The manager would ensure that the needs of the current people were a priority before any future admissions were made and that they were compatible. The Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 10 service users’ guide has both words in large print text and pictures to ensure it is user friendly. The manager has reviewed the statement of purpose to ensure it is in a similar easy read format. We reviewed contracts at the previous inspection and as there have not been any new admissions we are satisfied that this standard has been met. Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are the focus of the service and individual choices are actively encouraged and implemented. EVIDENCE: We looked at care plans for two people who live at the home. Care plans have been reviewed since the previous inspection. The manager has separated information into three files and staff told us that this worked well. Health information is kept in one folder and contains the Health Action Plan in an easy read format. The other folders contain the current care plan and historic information and a person centred plan. Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 12 The Annual Quality Assurance Assessment told us that a new way of recording the support information held on each person living at the service. This is called My Plan. It is more’ person centred’ and each plan is written using the preferred way of the service user. My Plan is very informative and reflects the people’s plans for the future and their current achievements. There were lots of photographs to reflect what activities people had participated in from household chores to holidays and leisure activities. The current care plan has been revised and is in a written and pictorial format. The content is comprehensive and provides clear information to enable staff to meet service users’ needs. Where a person does not use verbal communication this is recorded and a record has been made when staff explained the content of a care plan. Family involvement is reflected, specifically where family have liaised with staff regarding end of life wishes. There was evidence that staff had been continuing to develop ways of meeting people’s needs: more information is available on how individuals’ communicate and staff have recorded the Makaton signs that are used or alternative ways of communicating. At the previous inspection the manager told us they planned to expand care plans to ensure that there is more information about how people use their emotions and behaviour to convey their wishes e.g. if someone is tired and wants to go to their bedroom. ‘My Plan’ conveys this information and reflects person centred care. Risk assessments were in place to determine how identified risks were managed. Again, the manager planned to add some additional detail that will enhance information such as sling sizes in the moving and handling assessments and this has occurred. The Annual Quality Assurance Questionnaire told us the risk assessments are an integral part of the support plan and enable the service user to carry out an activity safely. Where a specific risk has been identified an individual detailed risk assessment will be developed, staff will monitor the activity and associated risk to ensure the information is current and the risk assessment appropriate. Most people who use the service have contact with their families and one receives regular visits from their advocate. Other service users have received support from an advocacy service in the past and there are plans to reintroduce this where necessary. This will ensure that if needed all service users could be supported by an advocacy service to ensure that individuals’ views were sought. Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 13 The people living at Albert House are encouraged to take part in ‘house meetings’ and meet with staff who act as keyworker to ensure that their views are known Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12,13,15,16,17 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Daily living activities are tailored to the individual requirements of people who use the service but a limited range is available due to staff constraints. EVIDENCE: On the day of the inspection some of the people who use the service were at home and others returned from daycare later in the day. The service achieves a homely atmosphere: there is no regimented approach and the staff team and manager have successfully achieved a sense of belonging for people who use the service. Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 15 Following our findings at the previous inspection where crockery was chipped or of specialist appearance the manager has replaced it to reflect more ‘ordinary living’ principles. The manager told us that staff ate with people who use the service at breakfast but this did not occur with all other meals. One factor which had impacted upon mealtimes was the budget and the review of the food budget has discouraged staff from eating with service users. The manager will revisit this with the area manager. Staff eating their meal with service users would ensure a more homely experience and to enable staff to know that they are assisting people at the correct pace and to monitor the temperature of food. People have a weekly plan outlining their activities. Previously, no records were kept if people did something different from their plan or remained at home but this was reflected in ‘My Plan.’ Unfortunately, limits placed on staffing levels have impacted upon people’s leisure activities and daycare attendance. Staff have had to collect people from daycare earlier than scheduled to fit in with lower staff numbers and outings and activities have been curtailed. This is due to a service user vacancy and a directive to reduce staff numbers accordingly. The house had recently been decorated for Christmas and a Christmas party was taking place at the weekend for service users’ friends and family. There is an annexe at the rear of the building that is used for arts and crafts. There are photographs of people on holiday and enjoying days out in the summer. The sensory equipment is mobile and can be used in other parts of the home. Some service users visit a local resource centre’s Snoezelen (sensory room) facility and take turns as the home is allocated two spaces. A range of activities is available incorporating attendance at a day centre and college. One person attends horse riding and everyone gets the opportunity to develop daily living skills with staff. All of the people who use the service have one to one time with staff and are able to pursue activities that they enjoy. Staff support five people to attend church on a regular basis and the local vicar has good links with the home. The television in the lounge was on as one service user enjoys watching DVDs. A new television with a satellite facility was purchased which replaced the ‘fuzzy’ signal noted at the previous inspection. One service user is particularly enjoying the music channel. We spoke to staff about activities. One bank member of staff classed the television being on and service users sitting to watch it as an activity. With the exception of lunch this is how they had spent a proportion of their day. There was evidence that other staff are more proactive and ensure a variety of stimulating and relaxing activities are offered. A visit to the butterfly park in Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 16 the summer had resulted in a photo display and associated activities such as a butterfly collage being made. Service users had been on holiday to Oxford and are discussing plans for a seaside holiday. People generally go on holiday in pairs with staff support. Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health records reflect the high standard of care delivered but increased staffing levels would better meet personal preferences. EVIDENCE: The manager has successfully expanded care plan information to reflect how individual health needs are met. None of the service users is currently receiving support from the district nurse team but receive support from multi disciplinary professionals. Staff have received training since the previous inspection on pressure care, moving and handling and measuring blood sugars. This meets the requirement that was made at the last inspection. Care plans have been improved to reflect how individual needs are met and how staff monitor and record any improvement or deterioration. Each service Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 18 user has a ‘Keeping Healthy’ file which ensures all health information and appointments are kept together. This is a vast improvement on the previous daily record sheets which were tick sheets and did not reflect how individual needs were monitored and managed. Epilepsy guidelines have been updated to reflect any changes to the care needed. The manager has organised a review to epilepsy protocol by the learning disability nurse and Consultant which will take place in the near future. We observed that there is always a member of staff with service users as some people have regular seizures. Staffing levels have resulted in people’s needs being met at times when optimum staff are available as opposed to a needs led service. Examples of this are people having a bath when staff are available as opposed to when they prefer one. The manager is confident that personal preferences will be met when the current vacancy is filled and optimum staffing levels are employed but it is not clear when this will occur. People who use the service clearly receive a high level of care. One person was seriously ill a few months ago and they have recovered well from their illness, as staff were able to meet their needs. Sadly another service user died but service users, staff and family attended a memorial service led by the local vicar in the home’s garden. An aromatherapist visits the home each week and a risk assessment has now been introduced to reflect that any potential reactions to treatment had been considered. The manager has obtained a copy of the CRB for the aromatherapist as it was held at head office at the previous inspection. We checked medication records and storage for two service users and found everything to be in good order. This ensures that a safe system for medication administration and recording is in place for the protection of people who use the service. Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Measures are in place to ensure people who use the service are protected from abuse. EVIDENCE: The home’s complaints procedures need has been updated to reflect the current address of the Care Quality Commission’s office for correspondence. The complaints procedure was produced in a format appropriate for people who use the service to understand and access. There have been no complaints since the previous inspection. The manager also keeps a copy of compliments that the home has received. They also plan to devise a system to reflect how concerns have been dealt with to ensure that they do not escalate into complaints. The Annual Quality Assurance Assessment told us that a more comprehensive complaints procedure and protocols have been developed and implemented. All staff have a flow chart and clear guidelines for them to follow should they receive a complaint from a service user, relative or health care professional. The home had a safeguarding vulnerable adult’s policy in place, which included whistle blowing. The manager has responded appropriately to two safeguarding alerts since the last inspection. Most staff have attended abuse awareness training, which included Safeguarding of Vulnerable Adults (SOVA); Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 20 SOVA training was also included and formed part of the homes induction process for staff. Three monthly SOVA questionnaires are completed by staff to ensure that they remain familiar with up to date guidance on how to protect vulnerable people. There are plans for the staff team to complete training regarding the Mental Capacity Act. The management team have completed Deprivation of Liberty training and this will cascade to the rest of the staff team. The homes policies and practices regarding people who use the service, their money, and financial affairs were generally satisfactory and protected people who use this service from abuse. We checked finances of two people who use the service and found them to be in good order. Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides a homely environment, which meets the needs of people who use the service. EVIDENCE: The home was clean, tidy and odour free. Since the last inspection the hallway has had a new floor and carpet fitted. 3 bedrooms have been recarpeted and the front door has been replaced. The annexe has been redecorated and a hand basin has been fitted to aid with arts and crafts. As stated earlier a new television and Freeview have been purchased. This work was planned to be completed at the previous inspection. In memory of the service user who died a lilac tree has been planted and a bench purchased. Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 22 Good infection control measures were in place – protective clothing is available for staff. New hand towel dispensers have been purchased and dissolvable alginate bags are used for soiled laundry. The home reflects the personality of the people who live there and their pictures and belongings are present throughout and not confined to bedrooms. The house had been decorated in preparation for Christmas and service users had been involve in the decoration and purchase of ornaments. There is no computer for service users to use and this would provide an additional ‘in house’ activity for people with sensory needs. Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the home has an effective staff team numbers are insufficient to support service users’ assessed needs. EVIDENCE: Some staff changes have occurred since the previous inspection but we observed a good rapport between staff and people who use the service. The service is currently recruiting 2 full time day staff vacancies and 1 full time night staff vacancy. As discussed earlier in the report there are challenges in meeting some service users’ needs and leisure and college attendance have been curtailed due to staff availability. The Annual Quality Assurance Assessment told us that there are 3 service users who require 2 staff. This results in only 1 person being able to have assistance from 2 staff at any time as there are usually 3 people on shift (and 2 at night). The manager has altered the shift rota in an effort to provide extra Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 24 cover during the day but to little avail. Staff receive regular supervision and this issue is recurrent. The home has access to the company’s agency staff who work regularly and know service users’ needs. Should they wish to transfer to working permanently in the home there are fewer problems as recruitment checks have already been completed. We noted that one member of Agency staff had worked for over a month with no days off. Another member of staff had worked a late shift and then a night shift as no additional agency cover could be found. There were also times when only 2 staff had been working on a shift. Only the ‘in house’ agency is used and this must be examined as it does not appear to meet the needs of people who use the service and they are left vulnerable as are staff. The manager has raised this at a senior level and plans to raise it again. We looked at the records of three staff who had commenced work since the previous inspection. The originals of records are kept at head office and copies and a ‘pro forma’ checklist are kept in the home. All were satisfactory. Several staff are working towards their NVQ and some have neared completion 1 is awaiting the outcome of their Level 4 and another is awaiting their level 3. 3 are due to commence Level 3, 2 are due to commence Level 2 and 1 is due to commence Level 4. All staff complete a 5 day induction and are allocated 12 weeks to achieve a further induction and foundation in line with Learning Disability Qualifications skill sets (formerly Learning Disability Award Framework). 7 have achieved their award whilst 3 are due to commence. The manager plans to enrol for the Registered Managers’ Award in the near future. Staff had completed a comprehensive training programme over the past twelve months including pressure care, first aid, safeguarding, fire, moving and handling and values and principles. The manager and deputy manager have completed a ‘Train the Trainer’ course in Safeguarding to enable staff to be trained ‘in house.’ A training matrix clearly displays when staff are due to attend mandatory courses to ensure that they remain up to date with training such as moving and handling, first aid and food hygiene. Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 People using the 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 running smoothly but the manager must complete the registration process to satisfy the Care Home Regulations. EVIDENCE: The manager was previously deputy manager and has a good insight into the needs of people who use the service. They are soon to attend their registration interview with the Care Quality Commission and if successful will obtain the position of registered manager. Staff stated that they felt supported by the manager and they could raise any concerns that they had. The home appears to be running smoothly and the Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 26 action plan the manager identified at the previous inspection in their capacity as acting manager has been fulfilled. Quality Assurance audits occur annually and questionnaires are issued to people who use the services’ families and any professionals involved in their care. The results are issued in a report; the acting manager is reviewing the report and aims to incorporate results in the annual review of the statement of purpose. The manager completed the Annual Quality Assurance Assessment required by the Care Quality Commission. The home does not have internet access or a computer. Any work is sent to the company head quarters in Potters Bar in Hertfordshire which impedes any changes to documentation. The Area Manager agreed at the previous inspection to provide a computer for staff to use by the end of March, which will greatly assist staff to keep up to date with professional websites and assist in completion of NVQ and additional qualifications. The manager will again raise this issue as the Area Manager is currently on a sabbatical and their post is being covered in a temporary capacity. Regular health and safety checks are conducted. We saw records of hot water checks and fire drills and checks. The manager has completed the local fire services’ risk assessment and fire plan to ensure comprehensive details are made available to staff. Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 3 2 X 3 X X 3 X Version 5.3 Page 28 Albert House DS0000065423.V378609.R01.S.doc Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard YA16 YA18 Regulation 16 (2)(m) 18 12, 18 Requirement People who use the service must be offered a range of meaningful activities. Staff support must flexibly meet people’s needs and enable their preferences to be met. E.g. not having to leave daycare early; having a bath at a preferred time. Sufficient staff must be employed to safely meet the assessed needs of people who use the service. A registered manager must be employed to oversee the running of the home. Partially met Timescale for action 31/01/10 31/01/10 3. YA33 12,13,18 31/01/10 4. YA37 8 31/01/10 Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA17 YA29 Good Practice Recommendations Staff should eat with service users. The service should have a computer to support the sensory needs of people who use the service. Albert House DS0000065423.V378609.R01.S.doc Version 5.3 Page 30 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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