Care Home: Auckland House

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What the care home does well The home has a clear assessment process for any potential service user. People are involved in the planning of the weekly menu and enjoy meals in the home. People have support to access a wide range of health and social care professionals. People are aware of the complaints procedure and feel their complaints will be dealt with. What has improved since the last inspection? Each person now has a financial risk assessment. There has been some improvements in medication practices in the home, but there is still room for further improvements in this area. The environment of the home has been improved and was clean and safe. What the care home could do better: Assessments need to be reviewed on a regular basis, to ensure they reflect the current needs of a person. Care plans and associated risk assessments need to demonstrate how staff should support the current needs of people and how risks can be minimised. Both need to be reviewed on a regular basis. Clear plans need to be available to demonstrate what range of activities people are involved with. The Medication procedure needs to be followed as current practices could put people at risk Staff need to receive regular training, which they need, to be able to carry out their role efficiency. Staff need regular and formal support. Key inspection report Care homes for adults (18-65 years) Name: Address: Auckland House 55 St Ronans Road Southsea Hampshire PO4 0PP     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: Michelle Presdee     Date: 0 2 1 2 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: Auckland House 55 St Ronans Road Southsea Hampshire PO4 0PP 02392739600 02392739600 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Auckland Care Ltd care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 10. 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 Auckland House is registered to provide care and support to ten residents with learning disabilities and is one of two homes run by Auckland Care Ltd. It is a large Victorian terrace house is situated in a residential area of Southsea, close to local facilities and the seafront. Accommodation is organised over three floors, with eight single bedrooms and one double. At present there are only nine service users as the double room is not used as a double. The home has ample living space including a basement activity room and separate sensory room, and a small enclosed rear garden. There are a number of quiet areas and a communal lounge. The home aims to run a person centred planning system with residents, based on their Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 10 3 0 0 1 2 0 0 9 Brief description of the care home individually assessed needs and wishes. Residents are encouraged and supported to use their local community for work, education and leisure activities 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 unannounced inspection took place on the 2nd December 2009 between 10:50am and 17:05pm. The Commission (we) were assisted by the person who is currently managing the home. This person is not registered with the Commission but in this report will be referred to as the manger. We were advised this person is going to apply to become registered with the Commission. Two members of staff were on duty and were part of the inspection. Seven people currently live in the home and on the day six residents were met and were part of the inspection. Surveys prior to the inspection were sent to some people living in the home, health, social care professionals and staff members. At the time of writing this report six surveys had been received from people living in the home, all with support. Seven staff members and one social, health care professionals had returned surveys. In parts of the surveys people are asked to tick boxes with judgements ranging form always, usually, sometimes and never. These are referred to in this report. Care Homes for Adults (18-65 years) Page 6 of 30 The home sent us their Annual Quality Assurance Assessment (AQAA) back on time, which, detailed information on the home. The home has sent us notifications appropriately regarding the welfare of people. Paperwork including assessments, care plans, menus, staffing records and safety checks were seen. A tour of the home including all communal areas, the kitchen and five bedrooms was undertaken. All this information has helped form judgements in this report. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New residents can be confident the home will carry out an assessment of their needs, but they can not be confident their assessment will be kept under review to reflect their current needs. Information on the home is available, which will be presented in a more service user friendly manner. Evidence: The manager showed up an up date copy of a service user guide and statement of purpose. These reflected the recent changes in the home regarding the staffing and management arrangements. The manager stated she was now going to produce these documents in a format more friendly to those who may use it. We were informed by the manager there had been no new admissions since the last inspection. The manager discussed the admission process she would use when the home had an enquiry about a vacancy. This involved meeting the person, gaining as much information from the person and those who are currently involved in their care and slowly introducing them to the home to meet the current people living in the home. The manager confirmed the opinion of those living in the home would be taken Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: into consideration. Whilst looking in files containing assessments and care plans, it was noted some parts the of assessment had been reviewed at multi disciplinary meetings but there was not an overall assessment detailing a persons current needs. From discussions with staff, residents and from notifications received it was clear the home had recently been challenged by some of the behaviour of the residents. This had resulted in one resident being given notice and another residents placement is under review. One staff member wrote, There is not always enough staff on shift and we do not always know what to do with residents with aggressive behaviour. From training records it was evident staff had only recently been given training on challenging behaviour. The manager explained she had seen this as a priority for staff. 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. People can not be sure they will have a care plan, which is up to date and reflects their current needs and risks, to ensure staff can meet their needs and minimise risks. Peoples finances are protected but staff must follow the homes procedure to ensure people are not put financially at risk. Evidence: The manager explained she has worked on half of the files belonging to people containing their assessments and care plans. Requirements from the previous report were made concerning care plans and risk assessments being kept under review. One of the new files was looked at in detail. This file contained a very clear picture of the persons needs and a very clear picture of how staff should support them. Information had been written from the view point of the person and included information on the way the person had communicated their agreement, as they were unable to sign the care plan. Each part of the care plan had a photograph of the person and had been split into looking at the area of need and the care and support required. The care plan looked at many areas and it was noted this had been reviewed on a monthly basis Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: until September 2009. Associated risk assessments had also been completed in each area where a risk had been identified. It was noted these were clear and detailed what action was to be taken to minimise the risk. It was noted again some of the reviews had not taken place when it had been recorded they should have. This meant some of the information was out of date, so some of the monitoring detailed as needed by staff was no longer necessary as the person had improved. The files which had not been updated were viewed; one was looked at in more detail. The information in this file was not up to date and did not reflect the current situation. The care plan had information which was recorded at the end of 2007. It was not possible to establish how this was being monitored or the risks being minimised. The manager agreed the information was out of date and reported she thought all care plans were more up to date than this. She stated she was working on them but was finding it hard to priorities the time to bring them all up to date and to a standard she would be happy with. Both care plans looked at, gave clear information on how the person managed their finances. A requirement was made at the last inspection regarding financial assessments for people, it was noted people now had a financial risk assessment. Whilst for one person the information recorded was a few years old we were advised the plan had not changed. The home manages the allowance for all service users who also all have their own bank account. The home keeps a certain amount of cash for each person in a safe place and records all money in and out. Receipts are also maintained. The manger advised us she checks all finances on a monthly basis. The finances of two people were viewed. It was noted the money held, matched the records held. It was noted from two receipts, a member of staff had used their own debit card to pay for a service users goods and then been paid back from cash. This was not clear from the audit trail in the financial records. The manager stated she was aware of this and had had advised the member of staff it was not in line with the homes policy. We were advised this member of staff no longer works in the home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is difficult to establish that people engage in a wide variety of social and community activities. People are supported to have links with family members and enjoy and choose the meals in the home. Evidence: In the AQAA October 2009 we were advised Our staff team ensures that our service users are able to take part in age, peer and culturally appropriate activities. Staff will support service users to continue their education or training and to take part in meaningful activities. We support our service users along with social services to develop and maintain links with further opportunities as they arise. On the day we were advised at the current time none of the service users have a job. One resident told us he had recently stopped working due to health problems but that they had really enjoyed working. We were advised three people attend college two Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: and a half days a week. Two people are able to go out as they wish as they are able to make their own arrangements. From peoples care plans and from other recorded information in the home it was difficult to establish how people spent their time. In discussion with one person they stated, they went to bed on their days off. They did state they would like more to do and would like to join in with more sports. It was noted in one persons care plan they had recorded they would like more one to one time with staff. In one survey received a staff member had written when asked, What the home could do better? Would like service users to have more activities outside. In discussion with residents it seemed they enjoyed shopping but when asked if they went out for meals, to the theatre, cinema, pub or bowling they all said no but would like to do these things. Staff reported the home had a mini bus and would take people out in this. One person attends church on a weekly basis. Two residents have regular contact with their family and go and stay with them on a regular basis. We were advised people can call and visit when they want and the resident will always be asked if they want to see the person. People are asked to sign in and out so staff are aware of who is in the home. One relative wrote, Staff are very friendly and make me feel welcome. One resident explained how he was going to miss one of the residents who had just moved to independent living, the manager stated they had been told they could visit the home and these arrangements would be made. We were advised the home has a weekly planning meeting with all residents to discuss the next weeks menus. Each resident has a choice of their favourite meal on one day a week. On the day ham and salad sandwiches were served for lunch and for tea residents had cheeseburgers and chips. A written weekly menu plan was available, this had not been presented in a picture format. Residents enjoyed the meal times and helped as much as possible. There was much merriment in the kitchen as a life sized singing father Christmas had been purchased which the residents loved. In one of the new care plans seen, it has established for a period of time there was concern over how much weight a service user was loosing and steps had been taken to monitor and review this. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive support with health and personal care in a manner which respects their privacy and dignity. Medication procedures in the home do not always ensure the safety of people in the home. Evidence: It was clear form evidence in care plans residents have access to a wide range of health and social care professionals. Although there was not always a comprehensive care plan it was possible to see professionals had been called in appropriately to assess, monitor and review peoples specific needs. It was noted in one care plan the person needed a blood test but had declined this, but it was unsure if the person had capacity to make this decision. Appropriate steps and referrals had been taken to assess if the person had capacity or not. People spoken to felt the routines in the homes were flexible to meet their needs. Staff explained the routines of the home are arranged around the choices and needs of residents. We were advised one person is out for the majority of each day but staff explained they work around this. From observations on the day it appeared peoples privacy and dignity is respected. Residents showed us around the home and their own Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: bedrooms, each locking their own bedroom when they had finished. One resident stated they had chosen the colour their bedroom was decorated in and had a range of make up in their room. The home has a medication procedure and we were advised staff have received training in the administration of medication. We were advised no resident is on controlled medication or manage their own medication. Cocerns over medication practices were made at the last inspection and requirements were issued in this area. We looked at the medication storage unit and noted this does not meet the required standard. Each service user has their own records with a picture of the service user and listed their medication. Each person had their own protocol for as required medication. This detailed what the medication was used for what may happen if the medication was not administered. The medication administration records (mar) were checked against the medication held. It was noted the home was on the first day of the new 28 day blister packs. All the morning medication had been dispensed and signed for. The medication records of the last month were viewed. The manager stated she was aware all residents had taken their medication as no medication had been recorded as needing to go back to the pharmacist. When checking residents records it was noted for one person on one day at tea time five of their medications had been administered but not signed for. For another resident it was noted they had left the home for a few days. The medical administration records reflected this but no record had been made of the medication which left the home and accompanied the resident. The manager stated she was aware a record should have been made of the medication leaving the home. After checking the medication cupboard it was noted the manager left the key in the drugs cupboard for two about one hour whilst residents were showing us around the house. The manager reported this was due to the stress of the situation. 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. People are aware of how they can complain and the complaints procedure is followed. People are protected by the home following the adult protection policy, with some safeguarding referrals remaining open. Evidence: In the AQAA we were advised The complaints procedure has now been up-dated, it includes the stages and time scales for the process and that service users are supported and encouraged to understand how and to whom they can make a complaint to. We were shown a copy of the complaints procedure which detailed all the correct information. The manager showed us a file which detailed two written complaints, which she had dealt with in the last seven months. These demonstrated all had been dealt within the timescales and the complaint had been happy with the outcome. Residents indicated in surveys they would all know how to complain. Details of the complaints they have made on a day to day basis were recorded and it was possible to see how these had been dealt with. The home has a procedure on safeguarding and it was noticed this was detailed in brief in the office, detailing the steps to take if abuse is suspected. Both members of staff on duty were asked what they would do, if an allegation of abuse was made to them. One member of staff had a clear idea the other was unsure. The home has been Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: working closely with social services as many safeguarding referrals have been made appropriately. The manager advised the majority of these will now be closed with the movement from the home of one of the service users. A safeguarding from the previous year regarding service users money has still not been concluded and concerns were expressed at this inspection regarding staff still not following the homes procedure. 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 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 homely, clean and comfortable environment. Evidence: In the AQAA we were advised we provide a lovely big house which has been adapted to meet the needs of our service users in a comfortable and homely way. We have replaced the flooring in the dining room as it was looking very old, tired and worn, the dining room itself is as we speak being completely redecorated and will have small furnishing and fittings replaced to up-date it. The hall, stairs and landing has had the carpet replaced again this being very old tired and worn. All communal areas of the home were seen and five residents showed us their bedrooms. Residents stated they were happy with their rooms and they had been involved in choosing the colour their room was decorated in. Each bedroom reflected their own personality, some people had rooms which were full of their possessions whilst others were bare in comparison. One bedroom had a large patch on the ceiling and the wall paper in this area was beginning to peel. The person stated the person in the above room had had a leak in their sink and it had created this damage. The manager explained it had already been painted once but would ask the homes maintenance man to look at it. It was also noted the light in the porch area outside two bedrooms was not working, making it difficult for these two people to see to put Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: their keys into their door. We were advised this had already been reported and they were waiting for the maintenance person. People on the day congregated in the homes dining room and seemed very comfortable. Two residents later went to one of their bedrooms and discussed what was on television later. All areas of the home were clean and people spoken to stated they were involved with the cleaning of the home and their rooms. In surreys received from residents all stated they felt the home was always clean and fresh. On this visit due to the weather conditions a tour of the garden was not undertaken but from a window it appeared staff are no longer leaving their cigarette ends in the garden. The manager confirmed this was not happening and would not be acceptable. 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. People can be confident the home has carried out checks on staff to ensure their safety. People can not be confident there will always be enough well trained staff on duty to meet their needs. Evidence: The AQAA states we now have a qualified, dedicated and committed staff team. The continuity of a staff team is of the most high importence so now we have got this staff team it is paramount that we keep them to maintain some very long overdue stability here. I ensure the staff receive the support they need to carry out their duties in a professional way and manner. The manager explained since she had started in the home some staff had left and some had started and she was just recruiting more staff. The manager explained she felt she was now recruiting more experienced staff who would be able to meet the needs of those living in the home. The home currently has eight permanent staff members and some bank staff. We were advised well over 50 of these staff have achieved a National Vocational Qualification Level 2. The manager explained the home has not had to use agency staff since she joined the home. The manager stated the staffing levels were reviewed and due to one residents behaviour the staffing levels had been increased, but since this person had left they had been reduced. On the day Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: of the visit one staff member took and stayed with two service users at college, which left one member of care staff with four residents and the manager. As already stated in this report people and staff in the home have indicated they would like more activities and more one to one with staff, which indicates staffing levels need to increase at some times. In surveys received from staff in equal numbers had said there was usually enough staff and sometimes enough staff to meet individual needs. The staffing records of three members of staff were viewed. It was found these were in good order with all the necessary checks and references undertaken. The manager is currently recruiting more staff and stated she was awaiting checks before someone could start in the home. In surveys all staff stated their employer had carried out checks before they started in the home. From records seen it was not possible to establish the home had a thought out training programme for individual members of staff. Evidence was seen all staff complete the homes own induction programme but this is not in line with Skills for Care Common Induction Standards, which the manager indicated she may start to use. Training that has been carried out was only established by looking at certificates seen on staff files. It was possible to establish staff had received training in equality and diversity, bi polar depression, health and safety, medication, epilepsy, fire safety, first aid and recently challenging behaviour. Evidence on training in moving and handling, infection control and basic food hygiene could not be found. One staff member on duty had only recently joined the home and reported she had just completed training in first aid and challenging behaviour. Another member of staff who had worked in the home over a year reported they had recently undertaken training in challenging behaviour and could remember training in health and safety and first aid, but could not remember any other training they had undertaken. From staff files it was clear staff had received at least one supervision session from the manager, but the manager reported she knew she was behind with formal supervision. She reported she was finding it hard to find the time to offer formal supervision but was offering informal support to staff on an on-going basis. 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. The manager is having a positive effect on the running of the home. Residents views help make decisions on how the home improves but the views of others who visit should also be sought. Health and safety procedures are followed for the protection of residents but staff need training in some key areas to ensure they have the knowledge to follow policies. Evidence: In the AQAA we were informed, As the manager I operate and run the service on a day to day basis, I have 15 years experience. I am qualified to level 4 in Care/ Management and I hold my Registered Managers Award. I also hold my D33/34 Assessor Award. With my qualifications and experience I ensure that the service meets its stated purpose, aims and objectives. The home has been without a registered manger for over a year, but the manager confirmed she is going to apply to the Commission to become the registered manager of the home. Residents spoken to on the day demonstrated they were happy with the new manager. Comments from staff included, Has improved since the new manager Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: has taken over. I have never worked with such a supportive and caring manger. One relative wrote, Since the manager took over in March the home has improved 100 . The manager throughout the inspection demonstrated an awareness of things which she felt were not correct but stated she lacked the time to be able to put everything right. In the AQAA we were advised, We operate a quality monitoring system which is currently being up-dated this is based on the views of service users; this is going to be extended to family, friends, GPs, healthcare workers and any other relevant people who come into contact with our service users. The manager advised the views of residents are sought on a regular basis. This is done on an individual basis with key workers or at regular residents team meetings. At the current time the manager confirmed the views of others who visit the home are not currently sought but advised there is a plan to seek the views of others. In the AQAA we were advised, We keep all relevant records required by regulation for the protection of service users and ensure that they are maintained up to date and accurate for the effective and efficient running of Auckland House. From records it was possible to establish staff had up to date training in some areas but in others including moving and handling, basic food hygiene and infection control it was not possible. Whilst walking around the building it was noted first floor windows were fitted with window restrictors. The cupboard with substances considered harmful to health were kept locked away. Staff were seen wearing protective gloves and aprons appropriately. The kitchen was clean and food in the fridge was labelled and dated. Fridge and freezer temperatures were maintained. All fire exits seen on the day were kept clear. 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 2 14 Assessments must be kept under review and reflect the current needs of each person. It is not possible to establish a persons current needs if their assessment is not kept current. 24/12/2010 2 6 15 All care plans and associated 22/01/2010 risk assessments must give an up to date clear account of how a person is to be supported and risks minimised. Without a current picture of how the person wishes to be supported it is not possible for staff to know how best to support the person. If risk assessments do not reflect the current risk it is not possible for staff to know the risks for people and know to to minimise these risks to keep people 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 safe. 3 20 13 Medication policy and procedures must demonstrate the safe recording, handling, safekeeping, safe administration and disposal of medicines received into the home. It is not possible to establish what medication has been taken if accurate records are not maintained. A clear audit trial of all medication must be available. The storage of medication must be stored in a cupboard which meets required standards. 4 33 18 Staffing levels must be reviewed to ensure the needs of residents can be met at all times. Staffing levels must reflect the social needs and choices of people living in the home are being met. 22/01/2010 22/01/2010 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 5 35 18 Staff must receive training in the core areas to ensure they can meet the needs of people. Staff need training to ensure they are meeting the needs of people in the correct manner. 22/01/2010 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 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. 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