Care Home: Aspen House

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What the care home does well One person told us that `the food is very nice`. They `like the staff` The people go on holidays with staff and enjoy this. Some people go to college. One person told us that they have lived at the home for a long time and say `I like it here`. One person said that they would tell the staff if they are not well and `they will call the doctor`. The people like their bedrooms and one person said that they `had a new TV and watched things that they like`. Some staff enjoy working at the home. The staff work very hard to meet the needs of the people. They get training to help them meet the people`s needs. They were seen talking and listening to the people and offering advice in a positive manner. What has improved since the last inspection? New care planning documents are developed so the people will find easy to understand. New easy to understand risk assessments are going to be used for the people. The home has a new manager and they were completing their induction. New Health Action Plans have been introduced. The staff have a better induction programme to help them meet the people`s needs when they start work. What the care home could do better: The person in charge should make sure that all checks are made about staff to find out if they are safe to work with people before they start work. This is to keep the people safe. The people in charge should make sure that they talk to the staff about how they are getting on with their work, and meeting the needs of the people. When the people`s needs change, the staff should write this on the plan to make sure all the staff know about the changes and how to meet their needs. A review of staffing levels needs to be completed to find out if they have enough staff to ensure that the people`s needs are being fully met. The people in charge needs to listen and support staff to help them to do their job properly so they can meet the needs of the people. Key inspection report Care homes for adults (18-65 years) Name: Address: Aspen House 277 Wellingborough Road Rushden Northants NN10 9XN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ansuya Chudasama     Date: 3 0 1 0 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 30 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 30 Information about the care home Name of care home: Address: Aspen House 277 Wellingborough Road Rushden Northants NN10 9XN 01933419345 01933419456 manager.aspen@CommunityCareSolutions.com www.communitycaresolutions.com Community Care Solutions Limited care home 10 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia physical disability Additional conditions: Any service user admitted to the home who falls within category PD or D must also fall within category LD ie. dual disability No person who falls within the category of Mental disorder (MD) may be admitted when four persons who fall within category MD are already accommodated in the home No person who falls within the category of Physical Disability (PD) may be admitted to the home when one person who falls within category PD is already accommodated in the home Date of last inspection Brief description of the care home Aspen House is situated in a residential area of Rushden in Northamptonshire. The home is within walking distance of Rushden Town Centre where community resources include shops, pubs, swimming pool and restaurants. The home is owned by Community Care Solutions Ltd and is registered to provide personal care for ten adults Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 0 10 4 1 0 3 1 1 2 0 0 8 Brief description of the care home with learning disabilities including up to four people with additional mental health problems and one person with additional physical disabilities. Service users with more challenging behaviours are accommodated in the rear unit of the home. The home is divided into two units, the rear unit being known as Aspen Lodge, each area having a kitchen, dining area and lounge. Accommodation to the people within the front unit of the home is provided across two floors; accommodation to people at the rear of the home is all at ground floor level. The home has rear and side gardens accessible by the people and a parking area for the homes vehicles to the front of the house. Fees range from £1082 to £1853 per week according to peoples assessed needs. Care Homes for Adults (18-65 years) Page 5 of 30 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 report refers to we this is because the report is written on behalf of the Quality Care Commission. We last visited this service on the 03/11/08. We looked at concerns and things that have happened in the home, which are reported under notifications and are a legal requirement. We spoke to the manager and some staff. We also spoke to the people and watched how they and staff got along together. We read two peoples care plans to find out how their needs were being met by the home. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The person in charge should make sure that all checks are made about staff to find out if they are safe to work with people before they start work. This is to keep the people safe. The people in charge should make sure that they talk to the staff about how they are getting on with their work, and meeting the needs of the people. When the peoples needs change, the staff should write this on the plan to make sure all the staff know about the changes and how to meet their needs. A review of staffing levels needs to be completed to find out if they have enough staff to ensure that the peoples needs are being fully met. Care Homes for Adults (18-65 years) Page 7 of 30 The people in charge needs to listen and support staff to help them to do their job properly so they can meet the needs of the people. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 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 9 of 30 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. The peoples needs are assesssed prior to admission to ensure that home can meet their needs. Evidence: We looked at the Annual Quality Assurance Assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment tool that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We are told in the AQAA that the home has not had any new people admitted to the home. On the day of the inspection there was one vacancy at the service. The home has a Statement of Purpose and a Service User Guide and we are told that a copy is given to the people and their representatives. The inspection report is kept in the office. The people spoken to told us that they had visited the home with their family. One Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: person said that they visited the home and liked it and wanted to live at the home. It was also said that they have lived at the home for a long time. Staff told us that the home carries out peoples needs assessments and has meetings with the funding authority, and the persons family. This is to make sure that the home is able to meet the persons needs. The people in the home have contracts so they know about their rights and responsibilities of staying at the home. The information in the AQAA says what we could do better is to ensure that the home has the past history of individual Service Users before they are admitted and to continue to ensure that families and carers are involved from the start regarding information sharing. Care Homes for Adults (18-65 years) Page 11 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans do not always reflect changes so there fore staff will not have all the information needed to meet the peoples needs. Evidence: We looked at two peoples care plans in detail and discussed their care needs with staff on duty. The plans had information about the peoples health, personal and social care needs. The staff showed that they had good understanding of the care needs of the people. Evidence showed that these plans were being reviewed by putting a line through the care plan date and then writing a new review date. However the plans were then not up dated with information recorded in the daily notes. the home has had a high turn over of staff, which may impact negatively on the consistency of care provided to the people. This was also noted by a care manager from a funding authority and the safe guarding team of social services team when they inspected a persons care plan at the home. We also had concerns raised about the home with regards to care plans are not being Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: followed and different carers caring for service users in different ways. Information on restrictions that the people have was not recorded in all the peoples files. The plans seen did not indicate involvement of the people or their representative. A range of risk assessments are in place that enable the people to take risks as part of an independent lifestyle. However, the information needed expanding and made easier for the people to understand. This was discussed with management at the home and it was agreed by them that care plans and risk assessments needed updating. We were told that the organisation had developed new care planning format and a blank document was seen and this was in widget format and covered a lot of information. Risk assessments were also being replaced by a new format. The information in the AQAA says that our plan for improvement in the next 12 months is to ensure that the Care Plans and risk assessments are more detailed and robust. The peoples information was kept secure in the office. Care Homes for Adults (18-65 years) Page 13 of 30 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. Activities and independence is promoted to enable people to meet their social needs. Evidence: The people tell us that they enjoy living at the home. One person had a new TV in their room and watched things that they enjoyed. Another person told us that they had made friends in the home. We were told by one person that they went on holiday with staff and enjoyed this. We observed the people in the home getting on well together. People spoken to told us that they went to snoozelan, college, and to the corner club. Some people helped with washing up, drying up, and tidying their rooms. The kitchen door in the house unit was being locked by a key pad due to identified risk. The people spoken to said that they were not happy having the kitchen door Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: locked because they like going in the kitchen to make drinks. It was also said that they did not like the office door being kept locked all the time. This was discussed with the manager and we were told that they have an open door policy, and the people can talk to them any time when they are in the office. We are told that the meals are chosen by the people by using pictures. The people we asked did not know what was for dinner. We did not see a menu displayed for each day or on a weekly basis in picture format. The manager said that they would get the menu for each day displayed in picture format in each unit. It was also said that they will try and get more people involved in meal preparation. We were told by the people spoken to that they would like more takeaways because this only happens some times. We were told that the food budget had been reduced. It was said this was because the home used to be get £40.00 for milk and they also had a separate budget for food. It was said that the milk money was taken away and this now has to come out from the food budget. So therefore there was not much money left for take away food. The finances of two people were inspected. The money checked was correct. However we were told that the peoples statements go to head office and they take a photocopy and send the original copy to the home. The people do not keep their own bank books in the home; these are kept at head office. It was said if a person wants to buy something, they have to ask head office for the money. This was discussed with the manager and it was said that they will look into this to ensure the people are more involved in managing their finances The people spoken to say that they like the staff and one person said that they get very upset when staff leave, which resulted in self harm. This was also confirmed by talking to staff who said that the people were very apprehensive when lots of new staff start work. Most of the people in the home maintain contact with their families and friends. Care Homes for Adults (18-65 years) Page 15 of 30 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. The peoples health care needs are being met by the home. Evidence: We observed staff interaction and noticed that they talked to people in a respectful manner and were careful to preserve their dignity. The people we spoke to informed us that the staff knocked on their doors before going into their room. One person said that the staff helped them with personal care when they needed help. Staff spoken to also explained how they provided personal care to some people. Evidence in the care records showed that people are offered support for their physical and emotional health needs. There were records of district nurses, general practitioner, and hospital appointments, and people have access to the opticians, dentists, and other health care professionals. The people told us that if they did not feel well, they would tell the staff. It was also said that staff accompany those people who needed this help. The home had health action plans and these were completed in picture format and had information about peoples health needs. We were told that the staff who gave out medication had received the accredited training. We observed staff giving out medication and this was done by talking to the Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: people. There were medication profiles for each person. The medication records looked at showed that there were no gaps in the record. The records and medication checked was satisfactory. Care Homes for Adults (18-65 years) Page 17 of 30 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. Safe guarding procedures are not always followed properly so there fore do not protect the people from potential harm Evidence: The home has a complaints policy and a copy is recorded in the service user guide. The AQAA states that the number of complaints received was 3 and states 5 complaints were upheld. It also says number of complaints waiting for an outcome on the day this form is filled was 5. At the inspection we were told that the home had received two complaints. One was from a neighbor and another complaint was still on going from one of the peoples family. The home had made 8 referrals to the safe guarding team of social services. The outcome of one referral was that it was felt that the home had not acted appropriately in the following areas. A failure to comply with safeguarding procedures and by not reporting the assault to the police, and failing to maintain good communication with the persons family. Concerns were raised from a care manager regarding a person that they fund. It was said that the persons family were not being informed of when the person had bruising on them. It was also said the family were no longer reporting bruises the person had when they visited them because they did not always get a response from the home when they made a complaint. Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: Some people spoken to were capable of informing staff if they had any concerns. They told us that they would tell the staff if they were unhappy. The staff spoken to informed us that they had completed the safe guarding of vulnerable adults procedures training. They had good understanding of this and understood the peoples behaviours to know if they were unhappy or not feeling well. The home has a new revised safe guarding procedure and we were told that all the staff were going to read and sign the document. This was to state that they understood the homes safe guarding procedures. The AQAA says to continue with the rigorous recruitment procedure to protect service users and ensure staff are SOVA trained. To ensure complaints are dealt with swiftly by using the correct procedures are followed. Care Homes for Adults (18-65 years) Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The enviroment meets the needs of the people but some areas in the home needs improving to ensure all the peoples needs are being met. Evidence: A tour of the home showed that the home is in two units. One unit is called the Lodge and has people with challenging behaviours and the other unit is called the house where the people do not have challenging behaviours. The office was situated in the middle of the two units of the home. The office is small and is kept locked by using a key pad from both sides of the unit. We also observed staff and the people walking through the office to get to the units. The house side of the unit has a dining room, and a lounge. The manager said that the lounge was going to have some cushions and pictures of the people to make it more homely. The entrance hall area was also being looked at to make it pleasant. The kitchen was clean and domestic in character and this was kept locked by using a key pad. The laundry room is very small and did not have a sink. This room is kept locked. There is one bedroom with en suite down stairs. There are no toilets down stairs. The staff, visitors and the people who have no toilets in their room have to use the toilet on the first floor. The first floor has one bathroom with a toilet and another bathroom Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: with no toilet. Both rooms needed decorating and the manager said that they have a new maintenance man and they would be coming once a week to do the decorating. There are two bedrooms on the first floor and two on the second floor. The lodge side of the unit has a shower room, a small laundry room with a small sink and this room was very hot and untidy but the room is kept locked. There is a kitchen with dining area and domestic in appearance. The toilet was damp and we were told by the manager that it was being refurbished. The lounge area has a small TV in a wooden box. We were told and evidence showed that people sitting at the sides of the room could not see the TV. We were told that the people would like a bigger TV so they can see the picture better. There was a conservatory, which was used as an activity room. The bedrooms seen were individualised to the people and those spoken to tell us that they like their rooms. The AQAA says that the home is in need of re-decoration. What they could do better is to to improve the time taken to ensure that areas of the home are attended to promptly, particularly when it concerns re-decoration and to ensure that maintenance issues are recorded and documented Care Homes for Adults (18-65 years) Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing inconsistency and staffing levels does not always meet the peoples needs. Evidence: The staff recruitment files are not kept at the home. These are kept at the head office. A home manager staff record with information of the person and checks completed by the human resources department is sent to the home. We looked at the details of a new staff. The information held in the home and discussion with staff and management identified a potential breach in the regulations in relation to staff recruitment. Following on from the inspection, management provided us with statements which indicate that they had followed correct recruitment processes and staff had made an error in the information they supported us with. The staffs second reference was not received until after the 14/10/09. All the information in the staff record was not completed. The information on the staff record had the old address and telephone of the organisation. The induction programme for staff had also not been completed properly. Staff spoken to said that they received an induction at the home when they started work. We were told that all staff had completed all the statutory training. Also training was on going and they were waiting to do the deprivation of liberty training. Discussion with the manager and evidence in the AQAA showed that the home has had Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: many staff leave this year. We were told that they had 8 new staff and a new manager and area manager start work at the home. We were informed by staff that new staff come and go and this was disheartening for the old staff. This was because they spend time training new staff and then they leave because they are not happy the way the home is managed. The staff say that they work hard to look after the peoples needs well. We were told that staff morale was low because their shifts were being changed without their knowledge and having to work late shift and most weekends. It was also said that changes in staffing was not having a good effect on the people. We were told that more staff were needed on the Lodge unit. This was because the people had high needs and needed more support. We were told that one person in the home used to do activities in the community and in the home but this was not happening now. It was said that this was due to not having enough staff on duty. On the day of the inspection we were told that 4 staff were on holiday, the home had no drivers. The staff rota showed that on the 17th of October a member of staff worked with two people. The care plan read for one of the people said that they were to have a one to one with staff all the time. This resulted in staff having to meet the needs of the other residents to being short staffed. The staff working rota did not have all the names of the people working in the home. It was also at times difficult to understand. The staff say that they do not have regular staff meetings and asked for more meetings. Staff spoken to informed us that they were not getting regular supervision with management. The AQAA says that the number of permanent care staff with NVQ level 2 or above in Care or Health and Social Care was none. However for what we could do better, the AQAA says is to improve on the numbers of staff with NVQ qualifications and increase our own bank staff list to reduce the need for agency staff and to decrease the use of agency input. Care Homes for Adults (18-65 years) Page 23 of 30 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. Unstable management has not provided continuity of care and leadership to staff. Evidence: The registered manager of the home left in April 08 to undertake another position within the organisation. We were told that management in the home has not been stable for a long time. We were told that the home had conflicting directions from management and this was confusing for them. It was also said that this did not help staff to do their job properly. Concerns were also raised by the peoples families because of the turn over of managers and the impact this was having on the delivery of care since last year. The home has now appointed a new manager and they started employment in October 09. They were completing their induction at the time of the inspection. The new area manager of the home was supporting the manager with the induction programme. We are told that the manager of the home will carry out management administrative duties three times a week and work two days on the working rota. The manager said that their induction was very good. They had worked with people Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: with learning disabilities and have completed NVQ level 3 in care. We are told that they are on a three month probation period. They will apply after their probation to become the registered manager of the home. We were told that they have an open door policy where staff and the people can discuss any concerns with them. A discussion with the manager and the area manager showed that they are both aware of the changes needed in the home to meet the needs of the staff. The staff recruitment procedures lacked detailed information and there fore may not protect the people from potential harm. The accident and incident records show that these were being recorded appropriately. The AQAA says what we do well is by having quality assurance questionnaires issued annually to service users, their relatives, staff, and commissioning. We were given information about a survey carried out by the home to find out the views of the people living at the home. However some of the questions asked were difficult to understand and there fore the people would not understand what this meant. This was discussed with management and agreed by them that the people would not understand some of the questions. The home did not have staff, the peoples family, and commissioning peoples surveys as stated in the AQAA. The fire alarm system was being tested on a weekly basis. The emergency lighting was done on a monthly basis. We were told that fire drill practice was also happening on a regular basis and the people were involved in this process. We were told by staff that they had received fire training and food hygiene training. Care Homes for Adults (18-65 years) Page 25 of 30 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 26 of 30 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 6 15 Changes in peoples needs must be updated in the care plans. This is to ensure staff have the information needed to meet the peoples needs. 15/01/2010 2 16 16 The registered person must 17/12/2009 seek advice from deprivation of Liberty safe guards agency regarding locking of the kitchen door. This is to ensure that the people are not deprived of their rights to access the kitchen. 3 22 22 All complaints must be dealt with appropriately using the homes complaints procedure. This is to ensure the peoples concerns are listened to and resolved appropriately to meet the needs of the people. 16/12/2009 Care Homes for Adults (18-65 years) Page 27 of 30 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 4 23 12 The home must ensure that the safe guarding procedures are followed. This is to ensure that the people are kept safe. 16/12/2009 5 33 17 Staff working rota must 16/11/2009 have all the names of the people working at the home. This is to show what staff have worked at the home each day. 6 33 18 Staffing levels must be calculated on the assessed dependency levels of the people living in the home and be regularly reviewed. This is to ensure there are adequate number of staff on duty to meet all the peoples needs. 16/12/2009 7 34 7 The home must ensure that 30/11/2009 all information stated in schedule 2 of the Care Homes Regulations is obtained prior to a staff member starting work at the home. This is to ensure the people are protected from any potential harm. 8 42 13 Management must ensure 30/11/2009 that there are robust monitoring systems in place. Care Homes for Adults (18-65 years) Page 28 of 30 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 To safe guard people from any harm. 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 1 6 Display the inspection report and the service user guide where the people and their representatives can view this. Ensure the people and their representative are involved in their care plans. This is so they are aware of how their needs are being met. Provide the care plan and the risk assessments in a format the people can understand to meet their need. Display the meals in picture formation so the people know what meals they are having on the day Ensure the information on how many complaints are received by the home is recorded accurately. This is so the records are up to date so we know how the complaints are being resolved by the home. Ensure the communal toilets and bathrooms are redecorated to meet the peoples needs. Provide staff with regular supervision and access to staff meetings. This is to provide positive outcomes for the people and staff in the home. 3 4 5 6 17 22 6 7 24 36 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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