Care Home: Autumn Vale

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What the care home does well The routines of the home are flexible and informal and residents are able to go out when they choose, spend time in the home or in their room, and privacy is respected. A resident told us “I can come and go as I like”. Residents we spoke with told us the food in the home is very good. One resident also told us: “I have lived here for a long time and would not change a thing”.Autumn ValeDS0000062949.V376869.R01.S.docVersion 5.2 What has improved since the last inspection? The service has developed person centred care planning and a key worker system to ensure that individual care and support plans are regularly reviewed in consultation with the residents. Risk assessments have been reviewed and updated with guidance for care staff on how risks are to be managed. Medication policies and procedures have been reviewed and updated in line with current good practice guidance and the home is able to demonstrate that there are safe arrangements for the handling and administration of residents’ medicines. Residents have been supported to manage their own monies and open their own bank accounts, where possible. Staff recruitment procedures have improved to ensure that residents are protected and new staff are suitable to work in the home. The service is in the process of developing quality assurance systems to monitor and evaluate how well the service is providing good outcomes for the residents and meeting regulatory requirements. What the care home could do better: The registered manager must demonstrate that specialist training in mental health care is provided for care staff. This will demonstrate that staff in the home have the skills, knowledge and competencies to meet the care needs of the residents. The home has a copy of the code of practice for the Mental Capacity Act and also has some information leaflets on Deprivation of Liberty safeguards. The registered manager must that staff in the home receive specific training in this area of practice, to ensure that staff are aware of how the Mental Capacity Act will potentially affect people living in the care home. The home has made improvements to the practice of the home in the last six months, to meet legal requirements and to ensure that residents are protected. The registered manager must ensure that improvements are sustained and embedded in practice in the home to promote and maintain the health, safety and welfare of the people living in the home. Key inspection report CARE HOMES FOR OLDER PEOPLE Autumn Vale The Circle 26 Clarendon Road Southsea Portsmouth Hampshire PO5 2EE Lead Inspector Annie Kentfield Key Unannounced Inspection 8th July 2009 09:45 DS0000062949.V376869.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people 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. Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Autumn Vale Address The Circle 26 Clarendon Road Southsea Portsmouth Hampshire PO5 2EE 023 9282 6034 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) autumn.vale@yahoo.co.uk Lutchmy Care Services Mr Bhimsen Seedeehul Care Home 26 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0) of places Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Mental disorder, excluding learning disability or dementia (MD). The maximum number of service users to be accommodated is 26. Date of last inspection 19th January 2009 Brief Description of the Service: Autumn Vale is a detached period house located in an attractive residential area of Southsea, close to shops and amenities. The home provides accommodation and care for up to 26 male and female service users who have mental health problems. The residents are aged between 40 and 80 years. There are 17 bedrooms; 9 are shared bedrooms and all are arranged over three floors. Bedrooms have a wash-hand basin and there are a number of shared bathrooms and shower rooms. Residents have a communal sitting room and dining room and an additional sitting room and access to a garden with seating areas. The home has a passenger lift that provides internal access between the floors but the main entrance of the building is only accessible for residents who are independently mobile. Information about fees and any additional charges are available from the home. Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means that people who use this service experience adequate quality outcomes. We made an unannounced visit to the home on 8 July 2009, with two inspectors, who were in the home from 9.45 am to 3.15 pm. Eight residents, four members of staff and the registered manager, deputy manager and responsible individual were involved in the inspection. We spoke to some of the residents in the communal areas of the home and also met residents when we looked at other areas of the home. Part of the visit was spent looking at records in the home including care records, medication records, staff training and recruitment records and records relating to health and safety and quality assurance. We received the Annual Quality Assurance Assessment before our previous visit in January 2009. This is a self assessment that gives us information about the service and what the service does well and where improvements are planned. In January 2009 we made regulatory requirements about practice in the home that failed to protect the health, safety and welfare of the residents and did not meet legal requirements. This was because medication procedures were not consistently safe and staff did not have access to current guidance on good practice in the safe administration of residents’ medicines. Individual plans of care and risk assessments were not regularly reviewed and updated in consultation with individual residents. The home had not been carrying out thorough recruitment checks on new staff to make sure that residents are protected. Residents’ monies were looked after in a company bank account and residents did not have individual accounts. We also recommended that the service should develop person centred care planning, as good practice. What the service does well: The routines of the home are flexible and informal and residents are able to go out when they choose, spend time in the home or in their room, and privacy is respected. A resident told us “I can come and go as I like”. Residents we spoke with told us the food in the home is very good. One resident also told us: “I have lived here for a long time and would not change a thing”. Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 6 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. Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 - People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New residents do not move into the home until the registered manager has assessed their care and support needs, to make sure that the home is suitable and able to provide the support needed. The home does not provide intermediate or rehabilitative care. (Standard 6) EVIDENCE: The home does not have any vacancies and no new residents have moved into the home. Therefore, we were not able to look at how the home organises the initial assessment. However, at the last visit to the home we spoke to a resident who told us that they had visited the home before deciding to move in. The responsible individual told us that the home actively encourages prospective residents to visit the home as many times as they wish, to look around and meet the other residents. Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 9 In the last inspection report we recommended that it would be good practice to develop person centred care planning. This supports residents to outline their own needs, wishes and goals and enables people to increase their personal self-determination and independence. The home has taken action to carry out this recommendation and has introduced a person centred approach to care and support for the residents. The registered manager told us the person centred care approach would influence their initial assessment process and they would be using a person centred approach to gather a personal history of prospective new residents. The outcomes of person centred care for people moving into the home will be assessed at future visits to the home. Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 8 and 10 - People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual plans of care and support are now person centred and reflect individual preferences and choices. Residents’ medication is safely stored, dispensed and recorded to show that residents receive their medication are prescribed. The registered manager must demonstrate that improvements are sustained to ensure continual good outcomes for the residents. EVIDENCE: We visited the home in August 2008 and January 2009 and found that complete and accurate records were not being kept of medicines given to residents and staff did not have access to current guidance on good practice in the safe administration of medicines in care homes. We made regulatory requirements for the registered person to ensure that arrangements were made for the safe administration of medicines received into the care home, and for medication procedures to be reviewed in line with good practice guidance. Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 11 The registered person has taken action to review medication procedures in the home and has updated the policies and procedures for care staff. The systems now in place demonstrate that there is a clear audit trail for medicines received, dispensed, or returned to the pharmacy. The daily medication administration records are completed by staff and regularly checked by a senior member of staff and the responsible individual to ensure that records confirm that residents are receiving their medication as prescribed. The registered person has also carried out a previous good practice recommendation that when it is necessary to handwrite on a medication administration record chart in the home, that the member of staff writing the chart signs and dates the chart and that a second person checks the entry for accuracy and then initials the chart. Some of the staff have updated their training in the safe administration of medication and other staff are in the process of updating their training. Since the inspection in January 2009 the home has reviewed individual care plans and developed a person centred approach to care planning. (This was a good practice recommendation) We looked at three care plans and these demonstrate that the care and support needs of residents are more clearly recorded to set out individual needs with guidance for care staff on how care needs are to be met. The new care plans contain more personal information and reflect individual preferences and choices. The registered person has met the previous regulatory requirement to ensure that staff have clear and written guidance on how risks or events are to be managed or minimised. The home has reviewed the key worker system and it is planned for residents and their support worker to review the care and support plans on a monthly basis with overall responsibility delegated to three senior key workers. The responsible individual commented that the new care plans are easier to read and out of date information and hand-written notes have been filed elsewhere. The responsible person confirmed that nutritional assessments and dietary plans are now included in care plans, where required. The home must ensure that improvements to medication practice and procedures are sustained and embedded in practice in the home. Person centred care planning has been introduced and the home must ensure that they continue to develop person centred care planning to support residents to increase personal self-determination and independence. Individual care plans must continue to be regularly reviewed and updated to demonstrate that the changing care needs of the residents are identified and met. Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 - People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers a range of activities and outings to residents. Individual social and cultural needs and expectations are now recorded in the individual plan of care as part of the person centred care planning approach, to demonstrate that personal preferences and choice are always being met. EVIDENCE: Residents told us that are able to be independent and go out when they want to. Staff told us that residents are always asked if they will be back for a meal or they want a meal saved for them if they go out. One resident was playing a game with a member of staff and one resident was in the top floor sitting room, other residents were watching television in the ground floor sitting room. A garden party was being planned for the week that we visited; we were told that this was open to residents and their families and staff and their families, with a barbecue and entertainment planned. Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 13 The home has introduced person centred care planning following our good practice recommendation and activities and choices are individually recorded in care plans so that the social needs of individuals can be monitored and reviewed as part of their individual plan of care. This also supports the keeping of information about people with respect for confidentiality. As part of the person centred care planning we saw evidence of ‘aspirational plans’ – these help residents and their key/support workers identify personal aspirations and goals and how to meet them. The deputy manager told us about the goals and choices for two residents and how residents are being supported to achieve their goals. Individual care plans also contain a structured plan of daily living and social activities that will be reviewed with individual residents and their support worker to ensure that goals and aspirations are met. Comments from residents confirm that meals in the home are good. The menu board in the dining room lists the daily choices for each meal and residents are consulted each morning about meal choices. The menu board has been brightened up and also contains topical tips for residents – on the day that we visited, the board contained information about the weather and a reminder to use sun cream. We spoke to the cook who showed us records of what is cooked and eaten each day. The cook promotes healthy eating and food is prepared and offered with serious consideration for the nutrition and health of the residents. The cook said that fresh fruit is always available and offered regularly to the residents. If residents do not like or want the daily meal choices there are always alternatives available and also salad if residents prefer this. Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 - People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents know how to access the complaints procedure and are protected by the home’s safeguarding procedures and practices. EVIDENCE: We looked at the home’s complaints policy and this contained all of the required information, including timescales for any responses and the address of the Care Quality Commission. The deputy manager told us that the policy is made available to residents and their families on admission and a copy is also available in the front entrance of the building. Residents we spoke with told us that if they had any concerns they would talk to the manager or a member of staff and they told us that they were confident that their complaints would be taken seriously and that they would be resolved in good time. Staff we spoke with were also aware of the complaints policy and procedure and told us that if anyone complained to them they would report it to the manager or deputy and they also told us that they would support residents to make a complaint if they wished to do so. Discussion with staff and the examination of training records showed that all staff had received training in safeguarding issues and were aware of their Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 15 responsibilities to report any concerns about the safety and protection of the residents. Staff told us that if they had any concerns they would report these to a member of the management team and they were also aware that they could contact Social Services or the Care Quality Commission if they had any concerns. The manager was clear about the reporting procedures and how to use them. The home had a copy of Portsmouth City Council Safeguarding Adults/Adult Protection, policy and protocol. At the last inspection we made a regulatory requirement for the home to ensure that any money held for individual residents is only kept in an account in the name of the resident to which the money belongs. This was because money belonging to residents was all held in one corporate account. The registered manager has assisted a number of residents to open their own bank accounts and this means that residents hold responsibility for their own finances. The registered manager told us that some residents have been unable to do this and monies are transferred from the corporate account on an individual basis. Following the inspection the deputy manager told us that the home has drawn up a written agreement so that residents have an agreed timescale for when their monies will be available. The new procedures have identified that some of the residents may need support with learning money management skills. The deputy manager told us that the home will research local resources to provide this support. Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 - People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home environment meets the needs of the residents. The registered persons have a programme for continuous replacement and refurbishment of the building. Attention is paid to maintaining good hygiene and the control of infection. EVIDENCE: The home is clean and tidy and comfortably furnished with homely touches for the benefit of the residents. A new clock/calendar has been purchased for the main entrance; this is large and easy to read to assist those residents who experience some cognitive impairment. The menu board in the dining room has improved with coloured letters to highlight the menu choices and also provides residents with other information; for example the daily weather and a reminder to use sunscreen. Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 17 We were able to look at some of the residents’ bedrooms and these were comfortable and personalised with some of their own possessions. One resident told us they were very happy with their room and told us staff had helped them to purchase a new flat screen television which they enjoyed watching. All shared rooms seen had screening available and fixtures and fittings were in a good state of repair. The home employs a handyman and the deputy manager told us that he carries out routine maintenance and decoration. We spoke to a group of residents in the main lounge who told us that they were happy with their environment. One resident told us “I have lived here for 7 years and I would not change a thing”. The main communal area for residents is on the ground floor with an open plan dining room and sitting room. Residents have another sitting room on the first floor where smoking is permitted. There is also an informal sitting area in the basement and this area is used by the visiting hairdresser. Residents have access to the garden and outside seating areas. There is a keypad entry system to the front door, keeping residents safe. The laundry is situated in the basement of the home and this contains an industrial washing machine and tumble drier. The washing machine uses an integral anti-bacterial cleanser. The deputy manager told us that staff carry out laundry duties and there are individual baskets for each service user where clean laundry was placed before being returned to residents’ rooms. There was protective clothing available for staff and hand gel dispensers were situated around the home to help prevent the spread of infection. Bathrooms and WC’s contained hand washing gel and towels. The home was clean, pleasant and hygienic with no unpleasant odours. The passenger lift is not working and the responsible individual told us that the lift was due to be replaced this month but the company doing the work are not able to complete the replacement until August. Since the last inspection the home has installed a new extractor hood in the kitchen. Residents have access to a telephone on the ground floor in the main entrance to the home. Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are protected by the home’s recruitment practice. Staff receive training in all areas of safe working practice to ensure practice in the home is safe for the residents and staff. However, there is no evidence of specific training in mental health issues that are relevant to the needs of the residents. EVIDENCE: At the last inspection we made a regulatory requirement about staff recruitment because the registered person had not been carrying out thorough pre-employment checks for new staff. This meant that the home could not demonstrate that new staff were suitable to work in the home with the residents. We looked at the recruitment records for three new members of staff and these demonstrated that the registered person has received satisfactory checks for new staff before employment started and has complied with regulatory requirements. Staff training records were not easily available at the last inspection and the home did not have a staff training matrix to demonstrate that all staff had completed required training and updates as required. The home has now produced a training matrix and this shows that training is provided in; first aid, Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 19 food hygiene, moving and handling, fire, infection control, safeguarding, medication, health and safety, COSHH, POVA and challenging behaviour. An induction programme is in place for new staff and this includes an “in house” induction which covers policies and procedures at the home and there is also a more comprehensive induction based on Skills for Care (National Training Organisation for Care) induction standards and new staff complete an induction workbook. Staff spoken to confirmed that they received a thorough induction and that they are provided with appropriate training in safe working practice. The home supports staff to achieve an NVQ (National Vocational Qualification) in care. Out of 17 staff, 6 people have achieved an NVQ in care at level 3 and 3 people have achieved an NVQ in care at level 2. Because the home is registered to provide a specialist care service we would expect to see evidence of specific training in mental health care and other health topics relevant to the needs of the residents. The registered manager told us that he gives staff specific knowledge about mental health issues as and when the need arises. However, these awareness sessions are not planned or recorded. This means that the service may not be providing care staff with the levels of skill and competency they need to work with the residents, or in a format that they find helpful. The registered manager confirmed that the home has a copy of the Mental Capacity Act – Code of Practice, and also information regarding the deprivation of liberty safeguards and there were leaflets concerning these issues available to staff. Currently staff have not received any training in the mental capacity act or deprivation of liberty. This means that staff may not be aware of the new legislation and how it may specifically affect the residents in the home. Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 - People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager has the skills and abilities to manage the home effectively. There is a new quality assurance system in place, however this is not yet fully implemented and outcomes for people living in the home have not been evaluated. Systems are in place for the safekeeping of residents’ personal spending money and staff receive regular supervision. The health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: The registered manager of the home has been managing the home since January 2005 and he has the skills and experience to manage the home. The staff rota showed that between 15 – 28 June 2009 he was at the home on 11 Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 21 of the 14 days. Staff spoken with also confirmed that he was at the home on a regular basis. The home has a deputy manager who has been delegated many of the day to day management tasks. The deputy manager is supervised by the registered manager and also the responsible individual, who is in the home on a regular basis. Staff told us that the manager is very approachable and that there is always someone from the management team around to provide advice and support. Since the last visit to the service the home has purchased a quality management tool from a national organisation and the home is in the process of conducting a full quality audit. We saw that questionnaires had been given to residents and there was also a food quality questionnaire. There were questionnaires available in the entrance hall at the home for any visitors to comment on the service provided. The deputy manager told us that questionnaires have not yet been sent to staff, relatives or health and social care professionals and that the resident questionnaires have not yet been collated. There was a record of resident meetings which are held monthly or earlier if required and the minutes of these meeting provided evidence that residents’ views are taken into consideration. Staff meetings are held every 4 – 6 weeks and minutes of these meetings are also kept. The home has made good progress with the quality assurance systems that are now in place; however we cannot fully assess how this is working until sufficient time has been given to enable the quality assurance system to be fully implemented and evaluated. Previously the home kept residents’ monies in a central client account and not in individual bank accounts in the name of the residents to whom any money belonged. Since the last visit the home has changed the system and has worked with people to open individual bank accounts for residents so that their benefits can be paid directly to them. However there are still some residents (5) who do not have individual bank accounts as the home has been unable to obtain the necessary documents to open accounts for them. For these residents the home has developed a new system. Residents’ benefits are paid into a central account and the home then works out any client contributions that need to be paid and the balance is then paid in cash into the safe at the home and is available for service users to access as and when they wish. We saw a record of transactions and there was a clear audit trail of money received in and paid out. We discussed how this works with the deputy manager, as at present it was not clear how long residents’ money stayed in the central account before it was paid to individuals. The deputy manager said that he would draw up an agreement with the residents concerned to ensure that their money was paid to them within an agreed and reasonable period of time. Following the inspection, the home confirmed that a written procedure is now in place that is agreed and signed by the residents concerned. Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 22 The home looks after small amounts of personal monies. Each resident has an individual record and this shows what money is paid in and people sign for any money as it is paid out. We looked at these records and they provided a clear audit trail, however the balance of money is not kept individually, it is kept together in a cash box and this did not make auditing individual residents’ money kept at the home easy. Individual staff files that we looked at contained evidence that staff receive regular supervision and those staff spoken with confirmed that they receive supervision on a regular basis. The home has employed a company to carry out a full Health and Safety audit of the home and the home is waiting for a report of the audit to be completed, however the deputy manager informed us that verbal feedback did not identify any serious issues or that there was anything identified that required immediate attention. We looked at the fire log book and this showed that all of the required testing had been carried out and there was a record of staff training regarding fire procedures. Each resident had an individual evacuation plan and there was a fire risk assessment for the building. We looked at certificates for gas safety and fixed wiring and these were in date and the home’s public liability insurance was in date and displayed in the entrance hall at the home. The home’s passenger lift was currently out of service and there is a major refurbishment of the lift planned for August 2009. Residents that we spoke with told us that the unavailability of the lift did not present them with any problems at the moment. The service has taken action to comply with all of the regulatory requirements made at the last visit to the service. Person centred care planning has been introduced and the new care plans in place show that individual choices and preferences are recorded and will be reviewed each month with key workers. The process of identifying any risks to residents and providing clear guidance for care staff on how risks will be managed, has improved. The person centred care plans identify individual goals and aspirations and how these will be met. The home must continue to develop person centred care and demonstrate that improvements will be sustained and embedded in practice in the home, for the benefit of residents in the home. The service has reviewed and updated the policies and procedures for the safe administration of residents’ medication. The medication records show a clear audit trail for medicines received, dispensed, or returned. The new procedures ensure that residents receive their medication, as prescribed, at all times. The service must demonstrate that these improvements are sustained and become part of the practice of the home. Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 3 Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Autumn Vale DS0000062949.V376869.R01.S.doc Version 5.2 Page 25 Care Quality Commission Care Quality Commission South East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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