Care Home: Arnold House

What the care home does well A resident stated in a survey questionnaire that `Staff and volunteers are very good. Activities are very good. The home is always clean.` In answer to the question `what the service does well`, people who use the service said: `My room is kept very tidy` `Cooking. (The meal is nice).` Others said `general care.` `Everyone is very friendly.(even the office workers.)` `they solve each problem. I can trust them.` A health professional explained in a survey response `Good communication between all grades of workers in the Unit and with District Nurses.`A social care professional said that a long term resident `expresses a high degree of satisfaction at the care she receives.` Inspection confirms that the home does provide a good standard of care. Care plans are appropriately detailed and the organisation provides people who use the service with good support which includes key workers, mentors, physios, activity coordinators as well as volunteers to support the activity program. Records are well organized. What has improved since the last inspection? The last inspection made six requirements. All but one of these were met at this inspection. The improvements were made to the complaints records, staff training, building certificates and fire risk assessment. What the care home could do better: Two residents said in a survey when asked this question `Nothing.`Another said `Could improve social activities in the community.` One resident said `More visits (organised by the home) i.e. shopping, local parks etc.` `Limited access to some doorways.` A health professional said in a survey response `Can not see any (aspect of home life) that can be improved.` The requirement that has to be repeated in this report is about the recording of actions being taken when weight loss is identified. Other aspects of home life needing action to ensure that residents are protected as well as possible were medication monitoring and ensuring that the cellar store room doors were kept shut. A number of issues were identified which could reduce the effectiveness of person centered planning and could mean that the outcome experienced by residents is less individual than they and the service would wish; these were the timing of the formal assessment of prospective residents, review of care plans, the provision of bedlinen and towels, timing of meals and availability of the homes transport. Two requirements are about the building and could affect the residents perception of the comfort of the home. These are ensuring en suites are available for use and there is an up to date maintenance program. Key inspection report Care homes for adults (18-65 years) Name: Address: Arnold House 66 The Ridgeway Enfield Middlesex EN2 8JA     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: Gail Freeman     Date: 1 2 0 5 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 35 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 35 Information about the care home Name of care home: Address: Arnold House 66 The Ridgeway Enfield Middlesex EN2 8JA 02083631660 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: nooranah.islam@lcdisability.org www.lcdisability.org Leonard Cheshire Disability care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: Four specified service users who are over 65 years of age may remain accommodated in the home. The home must advise the registering authority at such times as any of the specified service users vacates the home. Date of last inspection Brief description of the care home Arnold House is a care home registered to provide care to 21 people who have a physical disability. The care home is owned and managed by the Leonard Cheshire Foundation, which is a voluntary organisation providing care services to people with disabilities. The care home is in a building, which was bequeathed to the Leonard Cheshire Foundation by the Arnold family. There are extensive grounds to the rear of the care home. The organisation is working on plans to demolish the existing building and replace it with a new purpose built service in the existing grounds of the home. Accommodation is provided in single bedrooms on the ground floor and there are a number of communal rooms and a physiotherapy area available for service users also on the ground floor. The homes administrative offices are on the first floor, as well as accommodation for staff. The organisational mission is: To work with Care Homes for Adults (18-65 years) Page 4 of 35 21 Over 65 0 Brief description of the care home disabled people throughout the world, regardless of their colour, race or creed, by providing the environment necessary for each individuals physical, mental and spiritual wellbeing. At the time of the inspection there were twenty service users living in the service. The current range of fees in the home is from £970 - £1100 a week. Care Homes for Adults (18-65 years) Page 5 of 35 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 peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection on this service was completed on 16th April 2007. This unannounced inspection took approximately 9 hours and was undertaken by two Inspectors. The registered manager was not working on the day of inspection and the inspectors were assisted by Ms Pauline Lewin, Care Supervisor. Ms Lewin was present throughout the inspection and was open and helpful. There were twenty people living at the home at the time. The inspection included: meeting with people living at the home and speaking in private to 5 of them. Inspectors were also able to speak to one residents visitor and two visiting Health Professionals. Permission was requested to speak to the relatives of residents but was not granted by the time the report was drafted. The Inspectors also spoke to the Care Supervisor, Training Manager, General Manager, the Regional Mentor and four other staff. Further information was obtained from a tour of the building, Care Homes for Adults (18-65 years) Page 6 of 35 inspection of records kept at the home and consideration of completed returned surveys. These included four from residents, filled out with help from staff or relative, seven from staff and one from a health professional. After the site visit Inspectors had phone and email contact with three community social care professionals. The Inspectors would like to thank everyone at the home for their help and hospitality. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Adults (18-65 years) Page 8 of 35 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 35 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 35 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. The home has up to date information about the services it provides to allow people to make informed decisions about living there. Prospective residents are given the information they need to make an informed choice about where to live. This does include an opportunity to visit and experience the home. The home does not formally assess prospective residents needs in a timely way to assist the decision making process. Evidence: The service has a detailed service user guide and statement of purpose which has been updated recently. It is clear and in an accessible format. A copy is available in the hallway. The person most recently admitted to the home confirmed that her views were sought as part of the admission process, but could not recall whether any literature was received about the home. This persons file was examined. Although it contained an assessment summary and care plan from the placing authority there was no information to demonstrate how the staff team were undertaking their own Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: assessment procedure. The service user had used the service for respite care over a period of many months however there was no evidence to demonstrate how the staff team were reviewing changes in need between respite stays. Residents who completed our surveys confirmed that they were consulted about admission to the home and that they received enough information. The files of other residents were also inspected. Care plans were detailed and relevant but up to date review information was lacking. Signed individual agreements between resident and home were noted on some files. Care Homes for Adults (18-65 years) Page 12 of 35 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 living at the home are involved in care decisions and consulted and are involved in decisions about home life. People are supported to take appropriate risks in their lives. The formal recording of care planning consultations are not always up to date. Evidence: Residents who completed our surveys confirmed that they can always make decisions about what they do each day and that they can always do what they want to do. A social care professional responded that care plans for both customers are appropriate to meet their identified needs. The files of 6 service users were examined. All contained detailed care plans known as personal support plans. These were separated into areas including communication; mobility; continence; nutrition and gender care. The information was clear and specific to the likes and dislikes of each person, providing detailed guidance to staff on how peoples needs were to be met. The plans set out the desired outcome, action plan; timescale and the evaluation for each area. Risk assessments were in place for some aspects of care, specific to the needs of the Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: individual, for example, pressure care management. The General Manager said that they were in the process of looking at how to make the care plan more person centred. The date of review was included on the support plan, but many plans had passed the scheduled review date, with no evidence of the review having taken place. There was no evidence from the files inspected of any restrictions on choice and freedom, relating to the Deprivation of Liberty Safeguards. It was unclear whether the homes internal review process included input from the service user. People who use the service confirmed that their views were sought by staff, although this seemed to relate to day to day choices. Staff were observed to offer choices and to consult residents as the day progressed. A resident spoken to knew who their key worker was. The organisation has a Service User Support Team which is a team of people with a variety of disabilities. We met with one of the Mentors from this Team as he visited the home. He said ...we are seen as neutral and Service Users tend to find us as a trustworthy resource for support. We work very closely with quite a few Service Users from Arnold House and staff on occasions refer Service Users to us for support and guidance. All people who use the organisations services are part of the Service User Network Association. This group has national committee members as well as 2 regional representatives from most services. Arnold House currently have two service representatives who have been active in the region and receive support from the Mentor and another member of that Support Team. Records of reviews by placing authorities were significantly out of date in most files inspected, with most files showing the last statutory review having taken place in 2007. However, the deputy manager confirmed that reviews had taken place in February and March, and that the minutes had not yet been received.Social workers spoken to also confirmed this. Some residents have their own towels and bedlinen, but most do not. The Care Supervisor said that they are starting to enable residents to buy their own linen with their own money. We saw no evidence of how the decision had been made for residents to purchase their own bedlinen. People can have their towels washed separately if they put it in their laundry bag and therefore keep their own towel. Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: There are minuted residents meetings every two months. Topics have included activities, amended menu, new building, H&S training, a coffee morning, issues from residents. People who use the service are involved in the organisations recruitment process. This includes being part of the interview panel. Care Homes for Adults (18-65 years) Page 15 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are supported to have full and active lifestyles although availability of transport detracts from this for some people. People have contact with their relatives and friends. They enjoy healthy and nutritious meals. However, the last meal of the day is too early for some people. Evidence: At the start of the inspection the house was calm and quiet. Bedroom doors where personal care was happening were closed. The atmosphere continued to be calm over time but gradually cheerful interaction between staff and residents, as residents came into shared spaces, altered the quiet. People who use the service were observed to take part in activities in the home during the day, with a lively word game in the morning and bingo in the afternoon. Several people also went out with relatives or advocates, and one persons relative visited for Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: several hours. Some people were seen to use the paved patio area, but none were using the garden, despite the day being warm and sunny. A resident explained in a survey questionnaire that Activities are very good.Another said Could improve social activities in the community. The home has suitable vehicles for people to use. Some people reported that they would like to go out more, but this was not often possible, staff resources being the main problem, either as escorts, or more frequently due to a lack of drivers. Staff have to prioritise meeting the needs of people in the home, leaving limited opportunities to support people to participate in activities in the wider community. This means that service users ability to be part of the local community and to visit local places of interest is limited. All of the people who use the service have profound physical disabilities, and many said that they cannot use services such as Dial-a-Ride or taxis due to the special nature of their wheelchairs. At the time of the last inspection, the access to drivers was of concern and it would appear that no progress has been made in this area. A shop, run by one of the service users, sells toiletries and other sundries. There was no evidence from the files examined that people were being supported to participate in employment or educational activities outside the home, for example, the events provided by the University of the Third Age, which several older residents said that they might be interested in. People living in the home are able to enjoy contact with relatives, and several had visitors on the day of the inspection. One visitor reported that the staff were providing a good service to his wife. The organization has had a Personal Relationship Policy for 2 years. For each service there are two personal relationship facilitators who are trained to provide that support. This policy and process will be reviewed after two years. Two people have been supported to enjoy a personal relationship that has led to an engagement. There is an accessible kitchen area in the dining room space but this was not seen to be used by residents. The main meals are provided by the cook and her assistant but care staff serve the tea. Cooked breakfast is not provided. There was a choice of cereals and bread and butter or toast. The Care Supervisor said that this was something they needed to review.The cook knew which residents needed particular diets, e.g. diabetic, low cholesterol or low fat and said that she provides appropriate meals for those people. She said there was always a green salad and fruit salad with each main meal. The lunch main meal was jacket potatoes, chicken stir fry and black bean sauce with pancakes for pudding. There was a vegetarian quiche as an alternative. Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: Mealtimes were observed to be unhurried events, with staff supporting people on a one to one basis, according to need. A resident said in a survey response that The meal is nice. However, several people reported that the mealtimes were too early with approximately three hours between breakfast and the main meal of the day, followed by tea at approximately 4.30 pm. Some people also said that it was a long time between tea and the breakfast the following day. These issues had been brought up at residents meetings but some people had been told that the tea had to be early to enable staff to prepare residents for bed. The Care Supervisor said that tea should be later and that snacks were available during the evening. At approximately 5.30 pm on the day of the inspection, there were very few residents remaining in the communal areas, and it was unclear if they were being supported to prepare for bed, or if it was their choice to return to their rooms. Care Homes for Adults (18-65 years) Page 18 of 35 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 living in the home receive personal and health care in a manner which reflects their individual needs and choices, by a team of appropriately skilled and knowledgeable staff. The staff team work effectively with community health care professionals to ensure that each persons specialist health care needs will be appropriately met. Evidence: It was apparent from the support plans and from discussion with people who use the service, that considerable attention is given to identifying peoples personal and health care needs, and ensuring that it is delivered in a manner which each person prefers. All of the people who spoke to the inspector confirmed that staff were kind and caring when providing intimate personal care. As previously stated, the support plans provide clear guidance as to how personal care is to be provided. They include the required outcome and action plan and timescale, with separate evaluations for each area, however daily records did not clearly demonstrate how each care plan goal was being met. A range of aids and equipment is available to meet the diverse and complex needs of the service users. There was evidence on the files that staff were identifying when someone required different equipment, and ensuring that this was provided. Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: There was also evidence of routine maintenance of wheelchairs, including charging batteries. Residents weight was recorded on a monthly basis, with everyone weighed on the same day. Specialist scales are available, with a facility to subtract the weight of the wheelchair. The main area of concern was that there was no evidence of action taken when weight loss or gain was identified, either to determine whether the scales were accurate, or whether there was a need to refer the individual to the GP or dietitian. This was a requirement of the last key inspection which appears not to have been met. Two district nurses visited during the inspection. One was able to provide brief feedback, stating that the staff team were very quick to identify health care problems, and that they followed instructions and advice given by doctors and district nurses. Although one person was being treated for pressure sores, these had not been acquired since the person was admitted, and the district nurse said that she could not remember the last time that someone acquired pressures sores in the home home. This is to be commended, bearing in mind the complex needs of the people who use the service. The morning medication administration was observed and was found to be satisfactory.Team Leaders are responsible for the administration of medication and are trained to carry out this task. Examination of the controlled drugs register found that there was an error between the number of recorded tablets and the number in stock.The error was eventually identified, and advice was given on a more robust and regular monitoring procedure. Personal support plans provided very little information as to how the ethnic and religious needs of residents was to be met. Two files identified the service users as being of the Jewish faith, but there was no evidence as to whether or not their faith was important to them, and if so, how their needs were to be met. One person said that she could only attend church if a volunteer driver from the church was available to collect and return her. The Care Supervisor said that staffing resources meant that it was not always possible to meet a persons spiritual needs. Physiotherapy staff and space was available in the home. Care plans include an end of life plan. Care Homes for Adults (18-65 years) Page 20 of 35 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. Residents are protected from harm by the organisations policies and procedures. People who use the service can be confident that their views and concerns will be listened to and any issues acted upon. Evidence: The service user guide and complaints procedure has been updated recently and has correct names of senior staff therein. There are three-monthly minuted residents meetings that includes space for resident input. The organisation has a service user group which is managed by a Regional Mentor. He accepts referrals from residents, staff or anyone else and provides signposting and support for service users re personal issues. He will also support people to complain if necessary. All of the residents who contributed to the inspection said that they knew who they would speak to if they were dissatisfied or concerned. Most said that this would be their key worker, one of the senior staff or a relative. None of the people spoken to said that they had needed to make a complaint, and that general issues were discussed in team meetings. One visitor had a great deal of dissatisfactions, but these related to the process of admission by the social services department of that resident of their relative. The senior members of staff were clearly well-informed about the issues. Residents in surveys said about staff: They solve each problem. I can trust them. Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: The organisation is active in making sure staff have mandatory training including safeguarding. All staff spoken with said that they had had safeguarding training and that they felt able to raise any issues with line management. All staff understood the line management structure. The complaints file is well organised and the section for 2008 had two complaints both of which were completed; 2009 had one complaint which was also completed with actions taken recorded. The file also has a section for concerns but there were no instances recorded. Care Homes for Adults (18-65 years) Page 22 of 35 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. The homes premises are suitable to meet the needs of the people who live at Arnold House, with efforts made to personalize each residents personal space and to maintain the building to an adequate standard whilst plans are developed to re-build the property. Evidence: The house is clean with no unpleasant smells. There are homely touches such as pictures in communal areas.The general impression on arrival was of a quiet, peaceful and unhurried start to the day. The building was fit for purpose, shabby, but homelike in individual rooms that were visited. A number of bedrooms were visited, with the service user. All were found to be personal to their interests and preferences, with specialist equipment according to their needs. People with limited mobility had equipment available to summon help, and we were informed that staff were responsive to the alarm call. Odour control throughout the building was very good.A resident explained in a survey questionnaire that The home is always clean. (My room is kept very tidy) We noted that en suite facilities were often used for storage and in one case the lavatory had no toilet seat. Even if the service user is unable to use the facilities, the impression created is poor. Hoists and platform scales are stored in the corridors but these did not pose a safety hazard. The plans for a new home in the grounds of Arnold House has been approved by the local council. Work has not yet Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: started but when the project is completed residents will transfer into the new house. The Care Supervisor confirmed that the homes maintenance program was being continued in spite of the plans for the new house. She said that the fire doors have recently been replaced, there have been new carpets and work to the plumbing to ensure it meets legionella requirements. There is an annual organisational health and safety inspection and active follow up. The inspection report states that the emergency evacuation plan needs to be up dated to take new residents into account by 15/05/09. All required health and safety checks of equipment and systems are undertaken and up to date with appropriate recording. The laundry is relatively clean and tidy but is very cluttered with two cleaning trolleys parked there. The equipment is adequate. The stone floor is porous. Laundry is managed via a laundry bag system. Soiled laundry is washed in a sealed bag to ensure infection control. The housekeeper confirmed that she had had infection control and manual handling training. Kitchen is shabby but overall with work surfaces and fridges and freezers clean and tidy. The wall tiles and high surfaces need cleaning. The cook said that the six month deep clean was due in July 09. The oven is mainly clean and free from food spillage but it will need a deep clean as planned. Freezer and fridge temperatures are monitored appropriately. All bins in the house have lids. The doors of storerooms in the cellar were open during the inspection. There was a member of the maintenance team in the cellar at the time but doors must be closed except when the store room is being used. The cellar and attic were mainly free of combustible materials. Care Homes for Adults (18-65 years) Page 24 of 35 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 who live in the home are supported by staff who are knowledgeable, competent and who are committed to providing a service which respects the individual service user. Evidence: Observation and talking to staff confirmed that staff had a good understanding of the needs of people who use the service, were very well informed and were caring. Staff reported that recruitment was thorough and included CRB checks. Inspection of staff records confirmed this. Staff files were organised appropriately and up to date. Staff sign to confirm they have received the staff handbook, and policies. These include GSCC Code of Practice. A resident explained in a survey questionnaire that Staff and volunteers are very good.A health professional explained in a survey response Good communication between all grades of workers in the Unit and with District Nurses. Staff confirmed that they have one-to-one supervision with their line manager. Records confirmed this but also showed that at least in one case the supervision session did not happen at the required two monthly intervals. All staff spoken to said that they talked to their line manager regularly about day to day issues. The General Manager said that the organisation use the line management grand parenting scheme to monitor and support the staff supervision process. The General Manager looks at Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: the managers supervision program and offers advice and support as necessary; the manager does likewise with regard to the care supervisors supervision responsibilities. All staff surveys but one confirmed that staff felt they were always given up to date information about the people they support. One person said that usually they were. All staff surveys confirmed that they were checked before starting work and that their induction covered everything they needed. Staff surveys also confirmed that staff felt adequately supported by management and that there were enough staff. There are regular staff meetings. Minutes are are professionally presented and the agendas are appropriate. Staff reported that they had had mandatory training and records confirmed this. Interview with the Training Manager confirmed that training staff plan and monitor staff training. Staff talked to confirmed this.They let you know when you have to do training and dont let it go. Training recently has included understanding pressure area care and dementia and equalities and diversity. The Training manager explained all but six out of the 29 staff at the home,(including bank staff),have completed NVQ. The six staff are relatively new and will need to complete induction and mandatory training before they start NVQ. Staff are encouraged to progress beyond the required NVQ level for their job. The manager has achieved NVQ level 4 in care and is enrolling on a Leadership in Management in Care Services Course. The care supervisor has achieved NVQ level 3 and is enrolled for NVQ level 4. All training officers have at least NVQ level 3 in Learning and Development. The training manager explained that up date training for health and safety and infection control was managed within the line management system but no records were seen of this process. Volunteers are used in provision of activities but not for provision of personal care. The volunteers include young people from Japan who come to the service via an agency for six months or so. The arrangement is monitored and subject to service levels agreement by the organisation. The service manager explained that all volunteers have CRB checks. They are supervised day to day by the activities coordinator and monitored and supported by the volunteer coordinator. Care Homes for Adults (18-65 years) Page 26 of 35 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. People who live in the home benefit from a generally well-managed service. However,it is important that there is a clear sense of direction and leadership, with operational systems which are sufficiently embedded so that the home continues to operate efficiently and in relation to continuous improvement, even in the absence of the registered manager. Evidence: The line management structure at the home is clear and understood by staff. People at the home and staff know who to go to if they wish to discuss an issue and say they feel comfortable to do so. Quality assurance monthly visits by the organization management team happen and the General Manager and Training Manager are part of that Team. Each visit has a different emphasis and always includes contact with people who use the service. The organization also carries out a Health and Safety audit and records confirm that actions needed identified by both audits are actively followed up. An up to date employers insurance certificate for the home is prominently displayed. Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: As described earlier in this report residents and staff have their own regular meetings. Staff recruitment includes service user involvement.The training team provides training about this for residents who want it to assist the process. The service user involvement includes being part of the interview panel. All staff surveys but one confirmed that staff felt they were always given up to date information about the people they support. One person said that usually they were. All staff surveys confirmed that they were checked before starting work and that their induction covered everything they needed. Staff surveys also confirmed that staff felt adequately supported by management and that there were enough staff. External checks and servicing arrangements for the building and equipment are arranged by the organization and are up to date. Records are kept at the home. The organizations fire risk inspection identified action needed. The records of this work was not immediately available at inspection. The organization is clear that staff are not to be responsible for the handling of residents money but does provide individual safes for residents. Not all residents can use the safe independently due to the nature of their disability. The home does assist residents in ensuring the banks provide residents with appropriate access to the money when needed. Monitoring of residents money is through the local authority care management and review process. Records seen were not clear that resident capacity to manage their money had been considered or about risk assessment. The organization is in the process of up-dating the resident finance policy. The Manager of the home is about to go on to Maternity Leave. The general manager is in the process of arranging for the post to be covered in her absence. Care Homes for Adults (18-65 years) Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes R 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 19 13(1) The registered person must 31/05/2007 ensure that effective action is taken to determine the cause of an identified person?s recorded weight loss and ensure that where possible action is taken to address this to maximise their well being. The registered person must 31/05/2007 ensure that the complaints record includes a record of the outcome of a complaint and the timescale for the issue to be resolved so that the home has a full record of how the complaint was dealt with (previous timescale of 31/10/06 not met) The registered person must 31/08/2007 provide staff training on pressure care and supporting people who have depression or alcohol abuse to ensure that staff have the necessary skills in these areas (previous timescale of 30/1/06 not met). 2 22 22, Sch.4 3 35 18(1) 4 35 18(1) The registered person must ensure that staff undertake 31/08/2007 Care Homes for Adults (18-65 years) Page 29 of 35 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 refresher training at regular intervals in health and safety and in infection control to ensure that staff?s core skills are kept up to date. 5 42 13(4) The registered person must 31/05/2007 send a copy of a current electrical installation certificate for the home to the Commission, to evidence that the health and safety of all people in the home is being safeguarded. The registered person must 31/05/2007 ensure that the home reviews its fire precaution arrangements and produces an updated fire risk assessment and an updated fire plan to evidence compliance with the new fire regulations. The home must consult with the fire officer as part of this process. 6 42 23(4) Care Homes for Adults (18-65 years) Page 30 of 35 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 1 6 15 Care plans must be updated regularly with the resident. This must be completed so that resident and staff can be sure that the care provided is appropriate. 20/08/2009 2 7 12 Bedlinen and towels must be 22/10/2009 provided by the home. The provision must include enabling resident choice. This must be completed to ensure residents have appropriate choice in their daily lives. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 13 A copy of the records of completed fire safety work must be forwarded to CQC. This is to provide evidence that the work was carried out to the required standard. 24/07/2009 2 2 14 Prospective residents individual aspirations and needs must be formally assessed by the home. 22/07/2009 Care Homes for Adults (18-65 years) Page 31 of 35 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 prior to admission and readmission This must be carried out so that the resident and staff can be sure that the home can meet the persons needs. 3 12 16 Work must continue to enable residents to have transport available for social and educational activities. This is to ensure that residents do not have their choice limited by transport. 4 17 16 Lunch and tea times must be reviewed to ensure meal times are appropriately spaced and take account of resident choices. This is to ensure that all residents enjoy their meals. 5 19 12 The cause of an identified persons recorded weight loss or weight gain must be identified wherever possible and action to address this weight loss or gain must be taken and all actions recorded. This must be done to ensure persons well being is maximized. 31/07/2009 24/07/2009 24/07/2009 Care Homes for Adults (18-65 years) Page 32 of 35 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 20 13 Medication monitoring must be reviewed to ensure that stock reconciles with administration records. This must be completed to ensure that medication administration is safe. 24/07/2009 7 24 14 The cellar store room doors must be kept closed except when the store room is being used. This must be done to ensure the buildings fire safety arrangements are not compromised. 25/06/2009 8 27 16 All en suite facilities must be 25/09/2009 made fit for use. This must be done so that residents space is homely and appropriate. 9 35 18 Health and safety and infection control up date training must be recorded and those records must be available for inspection. This must be done to ensure records are up up to date. 25/07/2009 10 36 18 One-to-one supervision sessions for staff must happen at least at two monthly intervals. 25/09/2009 Care Homes for Adults (18-65 years) Page 33 of 35 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 This must be done to ensure that staff have appropriate support. 11 42 13 The Resident Finance policy must include the issue of capacity, risk assessment and protection. This must be completed to ensure residents interests are protected. 12 43 8 The person who takes on the 25/09/2009 role of manager to cover maternity leave of the manager must apply to CQC to become registered as manager. This must be done to ensure there is regulatory compliance. 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 23/10/2009 1 24 The homes maintenance and cleaning program should be kept under review until the home closes to ensure it does reflect all work needed. The laundry floor should be sealed to provide a more hygienic surface. 2 30 Care Homes for Adults (18-65 years) Page 34 of 35 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. 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