Care Home: Beacongate

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What the care home does well People are satisfied with the care and support they receive. When asked what the home does well comments were `take me to Southview day centre and carriage driving + help me choose my clothes`. Feedback from relatives was positive. Comments included `X is very happy there and when we visit all the other service users seem happy. X can be difficult and stubborn but they coax gently. Its a very well run home`. `We are very happy. The staff are marvellous`. Feedback from staff was positive. One commented `the residents at Beacongate are very well cared for and all appear to be content with their lives here`. When staff were asked what the home does well their comments included `creating a home environment, individuality with service users own rooms, supporting services users with their choices, assessing risk to service users and staff, keeping contact with relatives, varied menus, providing equipment with services users needs and seeking advice from professionals`. `paperwork is kept up to date + information communicated to a good level`. `Staff are dedicated and try to support and provide the residents with a good standard of care even when staffing is low`. Admissions to the home are well planned to ensure people settle in. The atmosphere in the home on the day of the visit was relaxed and calm. People have a pleasant home in which to live with individual rooms and a pleasant garden. Some paperwork is in a user friendly format. What has improved since the last inspection? There were no requirements or recommendation made at the last inspection. What the care home could do better: Recruitment records held at the home should reflect a robust recruitment process is followed to protect people. Other areas for improvement can be found in the main body of the report. Key inspection report Care homes for adults (18-65 years) Name: Address: Beacongate Beacon Road Crowborough East Sussex TN6 1AZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sally Gill     Date: 0 5 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 28 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 28 Information about the care home Name of care home: Address: Beacongate Beacon Road Crowborough East Sussex TN6 1AZ 01892669579 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.eastsussex.gov.uk/socialcare East Sussex County Council care home 5 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 5. 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 Beacongate is registered to provide accommodation for up to five adults with a learning disability and admits people with medium to high dependencies. The home is part of services provided by East Sussex County Council (ESCC). There is a manager who has day-to-day control of the home but not registered with the Commission. The premise is a large bungalow situated on a main road. There are four bedrooms all with a wash hand basin on the ground floor and another with ensuite facilities in the attic. People have access to an assisted bathroom and also a walk in shower and a spacious lounge/diner. There is also a laundry and kitchen accessed with staff support. The home is non-smoking. To the rear there is a well maintained sloping garden with established shrubs and tress, table and chairs and raised flower bed and tubs. The Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 5 Brief description of the care home home is suitable for wheelchair access. There is limited parking to the front of the home. The home is situated approximately 5 minutes walk from the centre of Crowborough and its town centre amenities. The nearest bus stop is outside of the home, which could take you into Uckfield or Tonbridge. The staff compliment consists of the team leader (manager), senior care officers and care officers. Care staff work a rota 8am - 9pm with a minimum of two staff on duty. One member of staff sleeps on the premise at night. Fees are based on a financial assessment and people make a contribution although this does not reflect the cost of care. Details of the unit cost per person are available from the manager. Previous inspection reports are available from the home or can be viewed and downloaded from www.cqc.org.uk Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The previous inspection took place on 21st November 2007. This key inspection was carried out over a period of time and concluded with an unannounced visit to the home between 09.30am and 4.25pm. The manager and staff assisted during the visit. People that live in the home and staff were spoken with. Observations were made throughout the day. Five people were living at the home on the day of the visit. Surveys were sent to the home for the manager to distribute to people that live there, staff and health and social care professionals. Four were returned from services users all of which were completed with the help of staff. Three were received from staff. All surveys were positive about the care and support received. As people that live in the home have communications difficulties telephone calls were Care Homes for Adults (18-65 years) Page 6 of 28 made to two relatives to gain feedback about the home. The care of two people was tracked to help gain evidence as to what its like to live at Beacongate. Various records were viewed during the inspection and a part tour of the home undertaken. The home sent their annual quality assurance assessment (AQAA) to the Commission just outside the required timescale. The AQAA is a self-assessment picture of how the manager thinks they are doing against the national minimum standards. Care Homes for Adults (18-65 years) Page 7 of 28 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 28 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 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their representatives have the written information needed to ensure they are choosing the right service. People can be sure their needs based on their assessment will be met. Evidence: People have the full information they need to make an informed choice about whether this home is right for them. A copy of the statement of purpose/service user guide was obtained. The document is produced in a user friendly format using photographs, symbols and words. It was last reviewed in August 2009. People surveyed indicated they received enough information about the home before moving in. Peoples needs are assessed prior to using the service. People surveyed indicated they were asked if they wanted to move into this home. All referrals to the service are via their local social services who undertake a full assessment of their needs. The manager told us that the home obtains a copy of this assessment before the individual moves in and it is usually held on file. For the last person to move in one was not held on file. The manager also told us as the individual had come from another ESCC group Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: home a copy of the existing care plan would have been obtained. People have the opportunity to visit and test drive the home. A staff member discussed the planned admission of the last individual to move in. This involved several visits to the home to look round, have a meal, meet staff and generally spend time in the home. In addition a member of staff from the individuals previous home spent a week at Beacongate working alongside staff to ensure the settling in period went as smoothly as possible. This is commendable. People are protected by contracts of terms and conditions which have been agreed with the home. New user friendly contracts (licence agreements) are in place. Two files were examined and had a contract present. One contract was signed by the key worker who stated they had been shown and explained the document to the individual. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples individual needs are recorded in their care plans. People could be more involved in decisions and choices regarding their day to day lives. Evidence: Peoples needs and routines are reflected in their care plans. Two care plans were examined. Care plans have been drawn up by key workers who have knowledge of the individuals needs and over a period of time have built a picture of their likes and dislikes. Care plans contain good detail in relation to peoples routines, what skills individuals have and what assistance is needed by staff in most support areas. Daily notes evidenced one individual had been recently diagnosed a health condition but this had not been followed through into the care plan. Daily notes could better reflect care needs in the care plan are met. Staff surveyed indicated that they are usually or always given up to date information about the needs of people for example in the care plan. A review is held every six months. The manager advised there is some slippage on Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: dates at present. Some review paperwork is in a user friendly format using symbols and words. These would be completed with key workers to help focus the review to achive what the individual wishes. At the reviews individual goal planning is discussed and agreed. Some goals or at least the way they are recorded are really support people should receive as a given not goals which reflect peoples aspirations or development, others its is difficult to ascertain what the goal actually is. For example to weigh monthly and outings. The monitoring of goals is not good. To find a new activity has taken more than seven months and others have not been achieved to date. The manager is aware of all of the above and is taking action to address this area. People could have more choice and involvement in day to day decisions. There is some evidence that people are asked about what to eat and what to do. A discussion with a staff member showed a reluctance to introduce methods such as picture book communicate with individuals to enhance decision making in some areas. Resident meetings are held monthly. During the last meeting it is pleasing to see people were asked about complaints, menus and activities. One to one meetings are also held and recorded. Records are poor as they do not show peoples opinions, ideas that have been discussed or comments. Good practise would be to record peoples decisions and how they are able to have a say. Discussions with the manager confirmed they are aware that individuals could be more involved in decision making and are taking steps to achieve this. Most people surveyed indicated they can usually make decisions about what to do each day. Relatives felt people are able to live the life they chose. Any limitations in place are in line with the homes duty of care and are recorded in the care plan. People are generally supported to take appropriate risks. Risk assessments for two people were examined. Most risk assessments had been reviewed in line with good practise timescales of six months. Care should be taken when reviewing documents as one risk assessment had been reviewed and was clearly no longer accurate. Actions to minimise any risks are recorded in risk assessments. However in two instances these were not all in place. For example all staff are trained in Strategies for Crisis Intervention and Prevention (SCIP) and a second hand rail fitted to the stairs leading to the first floor bedroom. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle but this could be developed further as perhaps could their life skills. Introducing a better variety of suitable social, educational and recreational activities could enhance outcomes for people using the service. Evidence: People have access to a range of activities. One individual attends a day centre three times a week. Outside activities and accessing the wider community are evident. One person regularly enjoys a carriage driving club and proudly displays their rosettes on their bedroom wall. Another individual is about to join a rambling group. Records confirmed other outings although limited in number have taken place in the last six weeks including going out for coffee, visiting a garden centre, lunch or pub visit and visiting Seaford. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: Discussions with staff and the manager highlighted that a past incident out in the community with an individual has seemed to curtail activities in the community. The manager now intends to address anxieties staff may have to ensure individuals have greater opportunities for activities out in the community. This should include improved planning of outings to take into account individuals needs out in the community. Staff talked about in house activities which include building bricks, music and sensory equipment, exercises, television, drawing and colouring, puzzles and spending time in the garden. A musician visits the home every two weeks. People surveyed indicated they can do what they want during the day, evening and weekend. Observations confirmed people are able to spend time alone as they wish. Discussions confirmed people are able and encouraged to have contact and visits from family. One individual has recently been supported to visit friends they knew where they lived previously. Relatives felt the home is very good at keeping them in touch. One felt one of the homes strengths is that they ensure X visits their family and is enabled to be included in family occasions. People have limited involvement with daily household chores as skills allow. Discussions with staff confirmed that only two people are able to participate in housework type chores and this is either dusting or bringing clothes down for laundry. Staff were mixed about whether individuals were involved or had the skills to be involved in meal preparation. Staff were observed to interact with people during the visit. The manager advised that currently no-one holds a key to their bedroom. People are offered varied meals. Staff advised menus are drawn up with individuals likes and dislikes taken into account. There is evidence that individuals do also at times choose a dish to put on the menu. This is something that should be developed. In the homes own quality survey two people indicated they get to choose when and what they eat. Staff and records advised breakfast is cereals, toast, eggs, yogurt and fruit juice. Lunch is a light meal. The main meal (except Sundays) is in the evening. According to care plans two people should be on special diets however there is little evidence in the record of food and menus that this is in place. Care Homes for Adults (18-65 years) Page 15 of 28 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 health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put in practise. Evidence: People receive support in a way that they prefer. A key worker system is in place. During the visit people were treated with respect and their rights to privacy upheld. Equipment is in place to aid independence and meet peoples complex needs such as a assisted bath and shower, over head tracking in bedrooms and the bathroom, mobile hoist and adjustable beds. Peoples wishes are recorded in their care plans regarding their preferred morning and evening routines. Relatives were happy with the care and support received. People have a health care plan, which has been supported by their GP. The health action plan examined lacked any dates of last appointments or checks up. There is no current tracking system to ensure what should happen in relation to regular check ups actually does a part from daily notes made by staff. This could mean essential check ups get missed. Records and discussions confirmed that people do have access to a regular chiropodist, district nurse, visit their GP and attend hospital appointments. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: One relative felt a recent health concern of their family member should have been spotted sooner but said once it was it was dealt with well. The homes own quality survey indicated people felt they are supported to go to the GP when unwell. One member of staff felt some people saw the dentist and some visited the optician. Reports were evident on file from psychologists and their recommendations had been followed through into the care plan. Staff also support individuals to do exercises as recommended by a health professional. The home should ensure people are encouraged to have the type of diet that is recommended by health professionals as currently this does not appear to be the case. People are protected by safe medication systems. The home has a medication policy in place. Storage for medication is safe and secure. Medication Administration Records (MAR) charts were examined and had appropriate use of signatures and codes. There are specific instruction for medications given as required. Staff that administer medication have received training. Since the last visit there have been incidents reported of medication errors. Management have taken action. A new trolley has been purchased, reminders of non blister pack medications have been developed, each shift a staff member is allocated responsibility for medication administration and this is indicated on the staff rota and some staff have undertaken further training and competency checks. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have opportunities to express their concerns, and have access to a complaints procedure, and are protected from abuse. Evidence: People have opportunities to express concerns. The AQAA stated no complaints have been received by the home. It is acknowledge that people would require assistance to make a complaint. People surveyed indicated they know who to speak to if they are not happy but were mixed about whether they knew how to make a complaint. The home has a user friendly complaints procedure. Staff have also recently spent time with individuals explaining the process. Relatives were mixed about whether they knew how to make a complaint. One said they had been sent a copy of the complaints procedure. One said they had raised concerns with the management and these were addressed. Currently people can attend residents meetings and also have one to one time with their key worker. Records are maintained of both. The manager acknowledges that both these facilities need improvement to ensure individuals that live in the home are really able to contribute. Work has already started to make changes. For example the home plans to bring in an experienced communicator/facilitator for the residents meetings and has introduced a new type of record chart for one to one to ensure peoples opinions, comments and concerns are recorded which at present they are not. People surveyed indicated that staff and managers always or usually listen and act on what they say. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: People are protected from abuse but further staff training could enhance this. The AQAA states that polices and procedures are in place to safeguard people. There have been a number of referrals and safeguarding investigations all of which have been managed appropriately. Records indicated that most staff has received up to date safeguarding training. Good practise would be to train all staff. Staff spoken with showed a good knowledge of routes to report any abuse both within the home and outside. The manager acknowledges that some work needs to be done with the staff team in relation to handling and dealing with aggressive outbursts by individuals. For a period of time it would appear activities have been curtailed due to a past incident within the community. Risk assessments also state staff will be trained in SCIP but they are not and action needs to be taken to put in a safe system of work. Detailed behavioural guidelines which include known triggers are included in the care plans Care Homes for Adults (18-65 years) Page 19 of 28 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 home, which is comfortable, clean and homely. Evidence: People live in a home that is clean, well equipped and well maintained. A part tour of the home was undertaken with the manager. Generally the home is well maintained although some minor areas were noted which should be addressed. These included damaged plasterwork, peeling paint and blackening to an area in the shower room. People have pleasant bedrooms that reflect them individually. One person confirmed they are happy with their room. The home own quality survey indicated people are happy with their rooms. Staff advised that some individuals like to spend their time in their rooms. Rooms are decorated individually and reflect personal interests or hobbies. One bedroom has had a new carpet since the last inspection which the individual confirmed they had chosen themselves. One risk assessment states a second hand rail will be fitted to the stairs leading to the upstairs bedroom but this is not in place and would be good practise to ensure safety. People have access to a lounge/diner which is comfortable and homely and has patio doors leading to the garden. Equipment storage is an issue in here and the manager advised that one option to address this is being looked into. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: The garden is well maintained with established trees and shrubs, flower beds and pots and a water feature. The manager advised that since the last visit contractors have taken over maintenance of the garden. The garden is on a slope and although accessible for those with mobility problems in one part this is quite steep. A hand rail is provided. The home has one assisted bathroom and another walk in shower room. The manager advised new toilet seats are on order for both rooms. People have specialist equipment they require to maximise their independence. The bathroom and two bedrooms have overhead tracking. There are specialist wheelchairs, adjustable beds, bathing/shower chairs and the home has a mobile hoist in case of emergencies. Another hand rail has been fitted to the hallway. The home was generally clean and tidy throughout. People surveyed indicated the home is always clean and fresh. Relatives said when visiting the home is clean and tidy. Liquid soap and paper towels are supplied as necessary to avoid infections. It would be good practise to have a pedal type bin for clinical waste. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are generally trained and skilled. Further training, numbers qualified and a review of staffing levels may improve the support people receive and the smooth running of the home. Recruitment records held at the home do not evidence a robust recruitment process is in place. Evidence: People may benefit from further numbers of staff who are qualified. The manager told us five staff have obtained a National Vocational Qualification (NVQ) level 2 or above. This is just under the recommended 50 for good practise. People surveyed indicated that both staff and managers always or usually treat them well. There is a team of eleven permanent staff in the home. The team is male and female. Staff advised that a minimum of three staff are on duty in the mornings although this is usually four and can rise to five. There are a minimum of two staff in the afternoons and this can rise to three. One member of staff sleeps in at the home during the night. The home also has access to flexi-bank staff and two were on duty on the day of the visit. The afternoon staff levels of two do seem low particular given that two individuals need two staff for assistance with their care. Staff surveyed indicated they feel their is usually or sometimes enough staff to meet the individual needs of people who use the service. One staff surveyed said too much paperwork on Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: occasion not enough quality time spent with service users, there is a pressure to meet targets (paperwork). It is also unsettling that all staff must re-apply for their own jobs during the restructuring of services. Recruitment records do not evidence a robust process is followed to protect people. Staff surveyed indicated that the employer did carry out checks before they started work. Original recruitment documents are held at County Hall. The manager has started to review recruitment information using the Annex 4 forms as required by regulation to be held at the home. Forms must be completed by the manager who is verifying that the documents/information is in place not by a staff member. No forms viewed were not completed fully. A requirement is made for recruitment information to be available at the home. Peoples needs are generally met by appropriately trained staff. Further training could enhance the staff team. Staff undertake induction training which is to Skills for Care specification. Staff surveyed indicated their induction mostly covered everything they needed to know to do the job. A copy of the training matrix was obtained. Mandatory training such as fire, first aid, food hygiene, infection control, moving and handling, medication and safeguarding adults is in place and regularly updated. There are some shortfalls at present. The manager advised that moving and handling training was booked for the following week. Staff surveyed indicated that they receive training relevant to their role and to meet the needs of people living at the home. Risk assessment state staff should be trained in SCIP techniques and this needs to be addressed or risk assessments revised to ensure people are safe. People benefit from a staff team which is supervised. The manager has recently taken over the supervision of staff with half completed. The manager felt staff have received supervision to the recommended timescales although the supervision matrix could not be found. Staff surveyed were mixed about whether the manager gives them enough support and meets with them to discuss their working, staff indicated regularly, often and sometimes. Staff spoken with say they feel supported. Although one felt staff feel unsafe at present due the organisations restructuring. They also felt the management changes in the last eighteen months have not help leaving the home at times without clear leadership. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Stable leadership could enhance the running of the home and outcomes for people living there. Quality assurance systems are in place. Peoples health, safety and welfare is promoted and protected. Evidence: The current manager is committed to the smooth running of the home. The manager has taken on the management of the home in a temporary capacity. They took up post on 02/09/09 and the position is being reviewed on a monthly basis. This is not ideal and unsettling for both people that live in the home and staff. The home has lacked a registered manager since April 2008. Since then staff have either acted up to the position of manager or a manager has been in post who has not registered with the Commission. One staff surveyed said a lot of changes in the management and uncertain of future with this service. Two surveys said the home could be better structured. The current manager has considerable experience in working with learning disabilities. They have acquired NVQ level 4 in care and a Registered Managers Award (RMA). Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: People have opportunities to express their views on the home. People are asked to complete an annual questionnaire have a nice day to gain feedback on the home. The last survey was completed in May 2009 and feedback was positive about the care and support received. People do have resident meetings although the manager is looking at how these are facilitated in relation to the communication needs of people living at the home to ensure they do benefit from them. One to one talk time is also in place but records do not reflect people have been asked their opinion of the support they receive and any concerns they may have about the home. Regulation 26 visits required by legislation take place to check the quality of care provided and a report is produced. Information in the AQAA was comprehensive and gave a picture of the home. Some minor data information was missing. The AQAA indicated that health and safety checks and maintenance is carried appropriately. On the day of the visit the fire alarm system was serviced and an environmental check of the home undertaken. Fire extinguishers were seen to be service within required timescales. There is evidence that water, food, fridges and freezer temperatures are all checked regularly. Care Homes for Adults (18-65 years) Page 25 of 28 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 28 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 34 17 The registered person shall maintain in the care home the records specified in Schedule 4 In particular recruitment records Regulation 17 (2) of the Care Homes Regulations 2001 require the registered provider shall maintain in the care home the records specified in Schedule 4 05/12/2009 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 27 of 28 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). 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