Care Home: Ashdene House

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What the care home does well Each person has an assessment that is done before they come to live at the home. These contain good information to form the basis of the individuals support plan. This means that people thinking about coming to live at the home will know that the service should be able to provide the support that they need. Everyone has a care plan that tells the staff how support them in a way that suits them best. Risk assessments are enabling and not restricting .This allows people to live an interesting and active life while being as safe as possible. People have the opportunity to take part in a range of activities which they choose and enjoy. Relationships are supported and encouraged so people can keep in touch with family and friends. Service users rights are respected and people are listened to. Any complaints or concerns are taken seriously and acted on. A service user told us who he would talk to the registered manager if he had any worries. The staff have received the necessary training to give them the skills, competencies and knowledge to meet the needs of all the people in their care. Training is on going and up-dated. What has improved since the last inspection? Ashdene House has the necessary information available for prospective service user`s and their families/representatives to help them make an informed decision as to whether or not the home is a suitable place for them to live in. This is in a format that is `service user` friendly. Peoples` life style support plans are now in a format that people can understand and be involved with. People develop their own support plans and reviews. Staff help them to do this. They have a say in the support and care they receive. People have a choice about the meals they eat and are supported to choose by the use of pictures and by talking with staff. Staffing numbers have increased and staff now receive more training to make sure they do their jobs properly and are able to support the service users in the way that suits them best. The home now has a registered manager. This will make sure the service users have someone in charge who is responsible for making sure the service provided by the company is run in their best interests. The fire safety assessments have been updated to make sure people are as safe as possible. What the care home could do better: The service needs to make sure that the staff have all the information they need about peoples health conditions so they know if they are deteriorating and can take the necessary action. All information about peoples changing health needs must be recorded. This will make sure that people are being monitored and staff will know whats going on and take the appropriate action if someone is unwell. The staff need to keep accurate records for the reasons they are giving `when required` medication to service users and record the outcome. This will make sure that people are benefiting from the medication and that it is working as it should. People need to be supported to take their medication on their own. This will promote independence and autonomy. The service needs to provide accurate dates on its maintenance and renewal programme to make sure that the works needed will be done in a timely manner. They need to continue improving the environment to ensure it is maintained to a good standard and suitable for the people who live there. The people who live at the home need to be protected from all kinds of abuse. This means that the home needs to make sure their finances are appropriately managed and they are protected by the safety check for people who work with the service users. Because of the shortfalls we found in this area we reported our concerns to the safe guarding vulnerable adults team. This means that concerns about the home will be looked at by the local social services `safe guarding adults` team. For more information please contact the Provider. The registered manager of the service needs to make sure that the home is safely managed on a day- to- day basis. She needs to ensure that the service users are fully protected and that independence is promoted. The quality audit systems in place should make sure that any shortfalls within the service are identified and addressed. The AQAA we received from the registered manager was not adequately completed. This means the service did not give us the information we asked for about what was happening at the home and how they are planning to improve the service for the benefit of the people who live there. There is guidance on how to complete an AQAA on the CQC professional site. We have made 4 requirements in this report. This means the service have to take action to deal with the shortfalls that we have identified. We may return to the home to make sure there is compliance within the timescales. We will ask the home for an improvement plan. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ashdene House 50 St Mildreds Road Ramsgate Kent CT11 8EF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mary Cochrane     Date: 0 5 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 36 Information about the care home Name of care home: Address: Ashdene House 50 St Mildreds Road Ramsgate Kent CT11 8EF 01843592045 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : ashdenehouse@aol.com Ashdene House Ltd care home 18 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 18 The maximum number of service users to be accommodated is 18. The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Date of last inspection Brief description of the care home Ashdene House (the Service) is registered to provide accommodation and personal care for 18 younger adults who have a learning disability. Some of them may also have a physical disability. Most of the people who live in the home have special communication needs. The main premises are a large detached property to which a ground floor extension has been added at the rear. In the main house, the accommodation is provided on the ground and the first floor. There is no passenger lift or stair lift to the first floor. This means that people who have a physical disability do not have the option of having a room upstairs. Care Homes for Adults (18-65 years) Page 4 of 36 Brief description of the care home On the same site as the main house, there is a self contained smaller house. This can accommodate three people. Again there is no lift to the first floor where all of the bedrooms are located. All of the people have their own bedroom. Each bedroom has a private wash hand basin. The property is located in a quiet residential area that is within walking distance of Ramsgate town centre. There is plenty of off-street car parking. Ramsgate has a mainline railway station. There is a bus service that passes near to the Service. The Registered Provider is a private limited company. It runs a number of similar residential care services in the region. The range of fees charged currently for each person is living at Ashdene House is from £766.00 to £2005.87 per week. The fees cover the cost of accommodation, personal care, meals at home, laundry, in-house entertainment and use of the Services vehicle. They do not cover extras such as personal toiletries and meals out. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The last inspection on this service was completed on 13th May 2008. The visit to the service was an unannounced Key Inspection which took place over one day. This means we visited the home without telling anyone we were coming so that we could get an idea of what the usual day is like for people living in the home. We were in the home for just over 6 hours. We spent some time with the registered manager and deputy manager. We were Care Homes for Adults (18-65 years) Page 6 of 36 introduced to and spoke to the people living in the home and the staff. We walked round parts of the home and had a look around. The people living at the home and the staff on duty were helpful and co-operative. They old us things about the home and about the support and care they receive and give. General observations were made during the day of how people are supported. We observed how staff supported service users during social activities and when offering care. We looked at and discussed service users individual support plans and their risk assessments and saw some policies. We also looked at staff training records and the homes quality assurance. An annual service quality assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information received from the home since the last inspection was used in the report. We also took into account the things that have happened in the service, these are called notifications and are a legal requirement. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 36 The service needs to make sure that the staff have all the information they need about peoples health conditions so they know if they are deteriorating and can take the necessary action. All information about peoples changing health needs must be recorded. This will make sure that people are being monitored and staff will know whats going on and take the appropriate action if someone is unwell. The staff need to keep accurate records for the reasons they are giving when required medication to service users and record the outcome. This will make sure that people are benefiting from the medication and that it is working as it should. People need to be supported to take their medication on their own. This will promote independence and autonomy. The service needs to provide accurate dates on its maintenance and renewal programme to make sure that the works needed will be done in a timely manner. They need to continue improving the environment to ensure it is maintained to a good standard and suitable for the people who live there. The people who live at the home need to be protected from all kinds of abuse. This means that the home needs to make sure their finances are appropriately managed and they are protected by the safety check for people who work with the service users. Because of the shortfalls we found in this area we reported our concerns to the safe guarding vulnerable adults team. This means that concerns about the home will be looked at by the local social services safe guarding adults team. For more information please contact the Provider. The registered manager of the service needs to make sure that the home is safely managed on a day- to- day basis. She needs to ensure that the service users are fully protected and that independence is promoted. The quality audit systems in place should make sure that any shortfalls within the service are identified and addressed. The AQAA we received from the registered manager was not adequately completed. This means the service did not give us the information we asked for about what was happening at the home and how they are planning to improve the service for the benefit of the people who live there. There is guidance on how to complete an AQAA on the CQC professional site. We have made 4 requirements in this report. This means the service have to take action to deal with the shortfalls that we have identified. We may return to the home to make sure there is compliance within the timescales. We will ask the home for an improvement plan. If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 9 of 36 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 36 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 11 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need in a format they can understand to help them make a decision about this home. People know that their needs and future goals will be assessed to make sure the home can support them properly. They know what they are paying for and their places at the home are protected. Evidence: We saw a statement of purpose and service user guide giving details and information about what the home has to offer. The service user guide is in large easy to read print and has colour pictures and photos of staff, events and activities. This gives people the information they need in a format they can understand to help them decide about moving in. The service users do not have easy access to the guide so do not always have the information available. The manager said that this issue would be addressed. We found that one person has moved into the home since the last inspection. We looked how the assessment was carried out. Before coming to live at Ashdene House the prospective service user was visited in their previous home by the manager and Care Homes for Adults (18-65 years) Page 12 of 36 Evidence: area manager of Ashdene House. A thorough and comprehensive assessment was completed which looked at all the aspects of support and care the person would need. The assessment we saw contained the detailed information needed to assist in making a decision as to whether or not the home would be able to look after the person. The assessments contained the information that was needed to start developing an individual support plan. All the service users have contracts and terms and conditions of residency on file. These are stored separately. There is information about the fees charged what they cover when they must be paid and by whom. The manager told us she is going to bring all the information together so it easy for the service users to access and understand. Care Homes for Adults (18-65 years) Page 13 of 36 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 at the home can be sure most needs are planned for. For most people goals and aspirations have been identified and worked towards. People are supported to take reasonable risks. Evidence: We found that each person living at the home has a support plan which is used by the staff and a separate lifestyle plan. The lifestyle plan is in a format that is suitable for the people living at the home. People are supported to develop their own lifestyle plans and usually do this with their key-worker. These contained information about the persons life what they liked to do and how they liked to have things done. They are individual and contained pictures and symbols. This means that they have a say about the support they want and need. The plans are kept in the office but we were told that service users do access them Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: and they are updated regularly. The support plans are in large files the files are bulky and therefore difficult to use on a day to day basis. Staff told us that they do not use them daily as they know the service users well and know what needs to be done to support them. The plans explained in detail information on how people like to be support with their personal care. They also contain why some people are not allowed to do certain things. There are also plans on, eating and drinking needs, medical and specialist needs, and individual behavioural needs. The also included information on cultural support and relationships. Staff told us that there is a consistent approach when dealing with behaviours and incidences. Incident report supported this. The home arranges reviews with peoples care managers and families a minimum of yearly but these are often done more regularly. People are very involved with their reviews and help to organise and decide what is discussed. Each person with support does a review booklet which contains information about what they have been doing at the home. We saw pictures of people having a good time on holiday, we saw examples of what activities people are doing. We also saw that people identified what they wanted to do in the future and how they are going to do this. One person had said that he would like to do a work placement and on the day of the visit there was a phone call to say placement had been found. Other people had said they would like to use the computer more, so a computer room had been developed. Not all the people had clear identified goals and aspirations. This means that there are no plans in place to support the achievement of individual goals for everyone and people with more complex needs are missing out. The manager told us she would make sure everyone had the opportunity to work towards goals. Daily records are kept separately to the care plans and we found that the information in them did not always relate to the care plans. This means that sometimes there is not a information to evidence that person had all there needs met during the day. We did find that sometimes care plans had not been updated when a persons care needs changed. (This will discussed later the report in the section of Personal and Health Care Support). We discussed this with the manager and she said she would review the procedure to make sure key workers were responsible for updating the plans of the people they were supporting. The staff we spoke to were able to explain about risks and how to minimise them. We saw guidelines to tell staff what to do if a person did not return to the home at a certain time and had not contacted them. We also risk assessments for behaviours. We did find that there no risk assessments in place for service users who manage their Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: own monies this means that there may be a chance that people are more vulnerable and at risk than they need to be because how to reduce the risk has not been considered and thought through. The manager told us this would be addressed and since the inspection she has told us how she is going to do this. The service is looking at different ways on supporting people to communicate effectively and more freely. They have pictures of different meals so people can choose what they would like to eat. A service user told us The staff listen to me and care for me. They help me when I need it. Care Homes for Adults (18-65 years) Page 16 of 36 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 have the opportunity to take part in a range of activities including furthering their education. Relationships are supported. The service users have a choice of healthy, varied and nutritious meals. Evidence: We found that the majority of people have the support they need to access a range of activities. The home has recently employed an activities person who concentrates solely on doing different things with people. The service has a building in the back garden which is used for activities. The service users use this throughout the week to do arts and crafts and other activities. We saw that peoples work was displayed through out the home, both inside and out. People say they enjoy going to local colleges, clubs and shops. We found that people are Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: given a choice about what to do like going out for a drive, a walk or to a visit to the local town. The home has a new company vehicle which is wheel chair accessible so more people can get out and about in the wider community. On the day of our visit a group of people were going to do the London sights another person was going to visit his family. Someone else had gone to college and another person was busy on the computer. People had plenty of things to do. There are also walking and music for health groups which people regularly go to. We saw that some people prefer to spend time in their rooms or on their own and this choice was respected. People are busy and active and doing what they like and want. Service users told us that they have contact with their families and people are encouraged and supported to visit relatives. Visitors are welcome at the home. Relationships and friendships outside the home are encouraged and supported. People go and visit their friends. We saw that people have a holiday if they want one and can choose where they go. Three of the people living at the service live in a cottage just outside the main home. These people have a more independent life style and are moving towards more independent living. We found that people are supported to be involved in planning and preparing meals. We found that there are choices of meals and the cook is developing a picture menu to help people make more choices. Some people assist with the cooking and everyone can access the kitchen most of the time. The manager did tell us that the cook does lock the door when she has hot things on the stove and has to leave the main kitchen area. People get their own breakfast when they want to. There are snacks and drinks available throughout the day. People told us they like the food and they had plenty to eat when they liked. They have just started have themed nights. And recently people had a Chinese evening. The next themed night is an Italian one. Peoples cultural food preferences are considered and included in the menu. The home employs a full time cook. When the cook is not at work an extra member of the care staff team is brought in to do the cooking. A record is kept of the food that people eat. This means that any eating problems can be identified quickly and the appropriate action taken. Care Homes for Adults (18-65 years) Page 18 of 36 Care Homes for Adults (18-65 years) Page 19 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users cannot be sure that all their healthcare needs will be monitored and met. People are provided with the personal support they need. People have not been proactively supported to take their own medication Evidence: We found that each person has a personal care needs recorded in their Service User plan. This means that staff know how people prefer to be supported. Where there is risk staff know what to do to make things safe. There was guidance and direction in place so staff know how to move people safely. Staff have got to know each person well and have found out how they like to be supported with their personal care. Routines have been established for them and guidelines have been written for the staff so that everyone is doing the same thing. We saw that care staff gave the people the support and assistance they need while allowing them to do a much as possible for themselves. Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: Each person living at the home has a key worker. The key worker makes sure that all the individual needs are met and are responsible for updating care plans when things change. When we looked at peoples care plans we found that staff work closely with health professionals to make sure that peoples health needs are monitored, reviewed and supported in the best possible way. We saw that people had been able to get appointments and visits from specialist so they could be supported and treated to maintain a good health both mentally and physically. People who have diabetes are well monitored by the local district nurses. Regular counselling sessions are provided for some service users this means they have one to one time to discuss any issues or concerns they may have with a professional person who is from outside the home. We did find that there is not enough individual information for staff in the care plans to identify when people are experiencing symptoms of their illness. This means that service users symptoms may go unrecognised by staff. For example we saw that there was no individual information available to tell staff how to recognise if someone had too high or too low blood sugars because of diabetes. Staff also did not have the information to detect when someones mental health might be deteriorating and the signs to look for. Each service user is registered with a local doctor and any area of concern related to health is referred to them. Medication is stored safely at the home, The staff who administer medication have received the necessary training and their competencies are checked. A sample of prescription sheets was seen. All prescriptions sheets had been signed to indicate that service users had received their medication on time. Thorough policies and procedures are in place. The recording of receipt, administration and disposal of drugs is sufficient to allow an audit trail. Some of the people living at the home are prescribed medication (this includes analgesia, topical creams, eye drops) on a when required basis. It is required that medication prescribed when required needs to have written instructions and guidance for staff to make sure that the medication is administered consistently and can be monitored. There was no monitoring system when pain relief was given to people. As the service user group have varying communication difficulties, staff would be expected to observe and record he effect of such medication. The manager said she would address this. Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: There are some people at the home who with support have been identified as being able to take there own medication. This was identified at the last inspection. The home have now installed lockable facilities in some peoples rooms but that is as far as this has got in almost a year. This means that service users are not being supported to be as independent as they could be. Care Homes for Adults (18-65 years) Page 22 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be sure that their complaints will be taken seriously and acted on. They cannot be sure they will be protected from all forms of abuse Evidence: The home has complaints procedure and it is accessible to the service users. The complaints procedure is also written in a picture format to make it easier for people to understand. Some of the service told us how they would make a complaint They indicated they would be listened to and their complaint would be taken seriously. Staff said they would listen to complaints and report them to the manager so she could investigate. The registered manager told us there had been one complaint since the last inspection and we saw that this had been investigated through the homes complaint procedure and an out come had been reach and recorded. There is a policy on whistle blowing and the majority of staff have had training in safeguarding vulnerable adults so they know how to recognise and respond to possible harm and abuse. During the inspection we did find there are some areas of abuse that the staff did not seem to recognise or consider. We looked at service users finances to make sure the home was supporting them to Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: spend their money in the safest way. We looked at 3 of the service users recent trips to town and what they had spent their money on. We found that on one occasion a service user had bought lunch and drinks for 2 care staff who were supporting him. We also found that staff bus fares had been paid for from a service users money and also ice cream. We discussed this with care staff and they indicated that they thought this was what should happen. The registered manager told us this was not the policy of the service and staff expenses should be taken from petty cash. The manager and deputy said they would go through all the accounts and reimburse the service users who this had happened to. The service are also going to plan a meeting and retraining session to make sure care staff understand what they are supposed to do. We also found that a service user had an account that the registered manager knew nothing about. This was stored safely at the home. This account had been used independently on a regular basis by the person but the home had not kept track and had no systems in place to try and make sure the person was safeguarded as much as possible. There was no risk assessment to make sure the safety options had been considered. Since the inspection the manager has reviewed the situation and there are now safeguarding systems in place. We also found that a recent financial audit had recently been done at the home by the companys quality assurance person. None of these issues had been identified. We also contacted the area manager of the service to tell her our concerns. From this conversation we also found out the home are not adhering to the companys policies and procedures with regards service users finances. As a result of what we found at the inspection we have made a referral to the local safe guarding adult team. This means that people from social services will look at what has happened with peoples money and they will decide what the best action is to make sure peoples money is protected. At the last inspection it was identified that only 5 people had individual bank accounts. This situation remains the same. This means that some people do not have the opportunity to use a bank in the normal way. The manager said that she has tried to get bank accounts for people but has been unsuccessful. It is the providers responsibility to make sure that the polices and procedures that are in place to protect people are followed by all levels of staff. Care Homes for Adults (18-65 years) Page 24 of 36 Care Homes for Adults (18-65 years) Page 25 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a generally comfortable setting that promotes their independence. Evidence: The service is split into 2 houses. The main house has 10 people and a small cottage at the back of the garden has 3 people living in it. The small cottage has everything people need to develop their independence. There is also a large building in the garden which is used for activities. Areas of the home have been redecorated since the last inspection and at the time of our visit the bathroom in the cottage was being re-tiled and redecorated. There are new carpets in the lounge and hallways and the stair lift has been be up-graded. The fence that identified in the last report as in need of painting has been done. We found that the home is clean and generally well maintained. People have their own bedrooms. People can have what they like in their rooms and most people had TVs music systems, pictures and games. People we spoke to said they are happy with their rooms. At the last inspection it was reported that someone did not have a T.V ariel. They do have one now. There is a large lounge with lots of sofas and a large television so people have space to Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: relax. There is a large dining room so people can eat together if they wish to. People have been doing lots of art work these pictures and mosaics are on the walls. Some areas have plants and ornaments. Service users said that they liked living at the home. They said that they had everything they needed. Some people need extra help in the bathroom because they have difficulties with their mobility. Support workers know what assistance they have to provide. There is suitable equipment in place to enable them to do this safely and reliably. This includes hoists and there is a special shower that can be used by people who find it hard to stand. We did see that the downstairs bathroom floor was old and stained especially around the toilet. The bath side was a piece of hard board painted white. The bath lift was old and looked rusty in parts. The manager did tell us that it was still serviceable. The bathroom was bare and clinical. Nothing has been done since the last inspection to improve this. As identified at the last inspection the paint on the windows and walls of the outside of the house are flaking and peeling. Nothing has been done to improve this. The registered manager did tell us it is the next thing on the list. The home has a maintenance plan that identifies the work that needs to be done but it does not have timescales. This means that work is not done in a timely manner and areas of the home are deteriorating. The registered manager told us that the fire safety risk assessment was updated 05.01.09 The last inspection also reported that the companys vehicle was very old. This has now been replaced with a new vehicle which means more of the service users can use as it has easy wheelchair access. The kitchen is clean and well organised. The cook does all the necessary checks to make sure that food is stored properly at the correct temperatures. The laundry is equipped with a washing machine and dryer. People are encouraged to do their own laundry with the assistance of care staff. On the day of the visit the home was clean and fresh. Care Homes for Adults (18-65 years) Page 27 of 36 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. Staff have a good understanding of the people living at the home. Positive relationships have been formed. On-going training is in place to make sure the staff have the competencies and skills to meet all the needs of the residents. Recruitment practices of the staff employed by the home protect the service users. But they may be at risk as safety checks have not been done on people from out-side the company. Evidence: We looked at the staff duty rota and we spoke to service users and staff. We found that there are usually five care staff on duty for the early and late shifts and the activities co-ordinator works from 8.00 a.m to 4.00 p.m and there is a always a team leader on duty. At night there is 2 staff awake and one sleep-in staff on call. We found that there is enough staff to meet the service users needs. The home have now employed enough staff to look after people 24 hours a day. The staff team is stabilising and settling. There is a key worker system and staff support and communicate with service users in Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: a respectful manner. Staff were observed interacting with service users throughout the site visit. There was a relaxed atmosphere with service users being able to express themselves and enjoy what they were doing. The service users responded positively with the staff. Service users told us that everyone gets on well together. One person said staff are kind. We received three surveys back from service users and they were positive about the staff. They told us that the staff treat them well and listen and act to what they say. The home has an NVQ programme. They have reached the 50 target of staff trained to this level. We looked at the training the staff have received to help them look after the service users in the best and safest way. The manager told us and evidence was seen to show all new staff receive a thorough induction into their role and responsibilities in the workplace as well as undertaking the Common Induction Standards. The home have recently employed 5 new staff are they are all in the process of receiving the necessary training One member of staff told us I have received continuous training and support in all areas of the job. I have been impressed with the level of support I have received. We saw records of staff training. Training is well organised and is updated at the required intervals. Any gaps in mandatory training are identified and the necessary training is then accessed as soon as possible. The home provides specialist training to ensure that staff have knowledge and skills to look after people with learning disabilities. The majority of staff have received training in mental health, autism, challenging behaviours, and safe guarding adults. Most staff have received mental capacity training. To make sure the service users are kept safe and are protected the home has recruitment procedures in place. We looked at three of the files of the staff who are employed work at the home as support workers these included 2 of the most recently employed staff to work at the home. The manager completes a number of safety checks on new care workers. These include things such as confirming their identity, taking up references and doing a police check. The safety checks have been done. There are audits in place to make sure all the necessary information has been received and filed. The registered manager does carry audits on the files to make sure everything is in place. We did find that there are other workers who support service users on an individual Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: basis but are not employed through the Allied Care Company. There was no evidence available and the registered manager did not know if these people had received the necessary safety checks. This means that service users maybe at risk because the checks have not been done. The registered manager told us she would address this and take the necessary action before they worked with service users again. A requirement will be made in the report. The service told us that regular staff meetings are held, evidence of this was seen during the inspection. There is an open door policy, issues are usually discussed as they occur. All staff have regular supervisions and appraisals. Care Homes for Adults (18-65 years) Page 30 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are shortfalls in the management and quality auditing systems of the service. Required health and safety checks are undertaken. . Required health and safety checks are undertaken. Evidence: The manager of the service has now successfully registered with the commission. This means that she had to demonstrate that she has the knowledge and skills to manage the service effectively and in the best interest of the people who live there. The registered manager does have has an understanding of the key principles and focus of the service but we did identify shortfalls in the inspection with regards the support and protection of the service users. There were shortfalls identified that the registered Care Homes for Adults (18-65 years) Page 31 of 36 Evidence: manager was not aware of. She is now aware of the shortfalls within the service and told us that these will be addressed. The registered manager said she will be working to improve the service and provide an improvement in the lifes of the service users. The senior management of the company have told us they will be supporting her to do this. We received an AQAA from the home when we asked for it. However the information in it was insufficient to assist us with the main parts of the inspection process. The manager had not taken into account the shortfalls identified at the last inspection and did not tell us in the AQAA how these had been addressed. There was little information on how the service had improved and how the were planning to improve further. We spoke to the manager about this and she told us she make sure the next AQAA contained the information which is needed. The Company has a quality assurance programme in place, the Area Manager carries out Regulation 26 visits and the Quality Assurance Manager visits the home at regular intervals with questionnaires for staff and service users. Regular audits are done to make that standards are maintained and with the aim to identify shortfalls. We were concerned to find that a financial audit had recently been done but the shortfalls identified at the inspection had not been highlighted. The results of the questionnaires had been collated so that the strengths and weaknesses of the service could be identified. The results of the survey had not been published and made available to the service users. The registered Manager said she would address this. The AQAA told us all of the necessary Health and Safety checks have been carried out in the home. The random checks that we did confirmed this. A record is kept of incidences and accidents. All fire assessments and checks are done at the required intervals. Water temperatures are taken and comply with regulations. The home tells about any event or incident that may affect the well being of the people who live at the home. Care Homes for Adults (18-65 years) Page 32 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 There needs to be protocols 31/08/2009 and guidance in place for all medication that is given on a when required basis. Medication given for pain needs to be monitored for effectiveness. People need to be supported to take medication in a way that promotes independence and autonomy. To make sure people receive their medication consistently and that effects are monitored. To make sure independence and automony are promoted and supported. 2 23 13 The registered manager shall make arrangements to make sure peoples finances are fully protected. The services policies and procedures need to be followed. 30/06/2009 Care Homes for Adults (18-65 years) Page 34 of 36 People need their own indvidual accounts. To make sure people are protected from financial abuse. To make sure people receive the support they need to manage their own moneys as independently as possible. 3 34 19 All people who work with 30/05/2009 service users need to have the necessary safety checks. To protect service users. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 6 19 All plans need to be up to date and all peoples goals and aspirations need to be identified and worked towards. Staff need guidance and direction to help identifiy individual symptoms that might mean someones condition is deteriorating and what they have to do. The registered manager of the service needs to make sure that the home is safely managed on a day- to- day basis. She needs to ensure that the service users are fully protected and that independence is promoted. The quality audit systems in place should make sure that any shortfalls within the service are identified and addressed. The AQAA needs to be completed to a good standard. 3 37 4 39 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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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