Care Home: Beech Tree Care Home

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What the care home does well Admissions and settling in time are well managed and arranged in a planned way so that a person`s needs are fully assessed, whilst ensuring that the service is suitable for them. Care plan records show that people are involved and that they are often consulted about their care and aspirations in life. The service works closely with other health and social care professionals to ensure that people`s health, well-being and independence is promoted. Care and support needs are monitored closely to ensure that people stay as well as possible. People are treated with respect and dignity that promotes their individuality and values their rights. The service supports people to follow their chosen lifestyle and to access appropriate educational, leisure and occupational facilities. Staffing is flexible and organised to meet people`s individual needs and preferences. During our visit, the one person using the service gave complimentary feedback about the home. They said, "I like it here, the staff are nice, better than other places I`ve stayed in." Beech Tree is a spacious house that offers homely and comfortable surroundings. The decor, furniture and fittings are of a very high standard and people can personalise their rooms as they so choose. The management team have a very positive approach to developing this new service and show commitment and enthusiasm to run it in the best interests of the people who use it. The new manager is knowledgeable, experienced and provides good support and leadership. What has improved since the last inspection? We carried out a random inspection in August 2008 when the service was dormant and made some requirements around health and safety checks. In response to our requiements, an electrical safety check has been carried out and an external company completed various checks on the fire equipment and alarm system. Two requirements concerning fire safety remain outstanding which we have discussed in the next section. What the care home could do better: Overall, this service shows more strengths than weaknesses and we have judged it to provide good outcomes for the people who use it. Two requirements remain outstanding from our last inspection. However, as there were no people using the service up until the 12th April 2010, we have taken a proportionate approach and extended the completion date for a final time. Three fire doors, including the kitchen one were propped open with rubber wedges. This practice could compromise people`s safety in the event of a fire and doors must be kept closed. As the kitchen door needs to be kept open at regular times throughout the day, a suitable door closure device that links to the fire alarm system is needed. Until the work is completed a risk assessment must be put in place. Secondly, there was no up to date fire report from the LFEPA. The provider must arrange a visit to ensure that the premises comply with fire regulations. The main areas for improvement centre around staff training and recruitment. All staff must attend training on safeguarding so that they are up to date with procedures and necessary guidance to keep people safe. The local authority procedure must be available to guide staff on how to report safeguarding allegations. Records must show that staff have the knowledge and skills to meets the needs of people who use the service. This also applies to training in key health and safety issues and the safe handling of medication. This will ensure that procedures are correctly followed and staff are familiar with current legislation that they can apply in their practice. A suitable induction programme is also needed to ensure that staff are adequately prepared for their jobs and the way the service is run. Staff recruitment practices need to be more thorough, to ensure that people are kept safe from possible harm or poor practice. Full employment histories must be explored and recorded for all current and future employees. Furthermore, two references must be obtained and include the applicant`s most recent employer. This will ensure that all staff working in the home are safe to do so. A bedroom window on the first floor did not have a restrictor fitted. This may compromise a person`s safety and needs to be risk assessed. We have also made some good practice recommendations for the service to consider. Key inspection report Care homes for adults (18-65 years) Name: Address: Beech Tree Care Home 38 Plough Lane Purley Surrey CR8 3QA     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: Claire Taylor     Date: 1 4 0 5 2 0 1 0 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 32 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Beech Tree Care Home 38 Plough Lane Purley Surrey CR8 3QA 02084075199 02084071728 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Tessa Penelope Carter,Dr Neil John Carter Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 9 The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admision to the home are within the following categories: Mental Disorder, (excluding learning disability or dementia) - Code MD Date of last inspection Brief description of the care home Beech Tree Care Home was first registered as a service for people with learning disabilities in August 2007. No people used the service in its first year and the provider made a successful application to change the registration service category to mental disorder. The service remained dormant up until April 2010 when one person moved in. Situated in a residential area of Purley, the home is well placed to access local Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 9 Brief description of the care home transport links, community facilities and shops. Shared space includes a kitchen with dining area, a good sized lounge, office area and laundry room on the ground floor. There is a large rear garden with both a lawn and patio area. Accommodation consists of nine single bedrooms over three floors, all with en suite facilities. There are two ground floor bedrooms, five on the first floor and a single bedroom on the second floor. There is also an additonal staff sleep in room on the second floor. Weekly fees ranged from £550.00 to £650.00 and were correct on the day of our inspection. The Statement of Purpose includes the following information, At Beech Tree the staff and management aim to provide a high standard of care for those with mental health problems. The age range of service users is 18-65 years old. Further details about the services provided can be obtained directly from the home. Care Homes for Adults (18-65 years) Page 5 of 32 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: We as it appears throughout this inspection report refers to the Care Quality Commission. Beech Tree has been dormant since it first registered in 2007 which means that there were no people using the the service. In April of this year we were notified that the home had begun providing a service to one person. Before making our visit we reviewed all the information we have about the service including the Annual Quality Assurance Assessment (AQAA). This is a self assessment that is used to tell us about the services provided, how well outcomes are being met for people using the service and any planned developments.The AQAA was returned when we asked for it but had not been completed as the service was not operating at that time. Our inspection lasted six hours and we met with the person using the service, one staff member and both the new and former home manager. We case tracked the one persons records of care. Case tracking means we looked in detail at the care people receive. We also looked at various records in relation to the staff and the way the home was being run. We also looked around the building and viewed the bedrooms to Care Homes for Adults (18-65 years) Page 6 of 32 check that the premises were safe. All this information helps us to develop a picture of how the service is managed and understand what it is like to receive support and care at Beech Tree. We would like to thank all those who took part in this inspection for their time, assistance and hospitality. The reader should also note that a new system of registration and assessment for social care will come into force during 2010. Providers of adult social care and independent healthcare must be registered with us under the new system from 1 October 2010(registration under the Care Standards Act 2000 will continue until then). Further details can be found at our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Overall, this service shows more strengths than weaknesses and we have judged it to provide good outcomes for the people who use it. Two requirements remain outstanding from our last inspection. However, as there were no people using the service up until the 12th April 2010, we have taken a proportionate approach and extended the completion date for a final time. Three fire doors, including the kitchen one were propped open with rubber wedges. This practice could compromise peoples safety in the event of a fire and doors must be kept closed. As the kitchen door needs to be kept open at regular times throughout the day, a suitable door closure device that links to the fire alarm system is needed. Until the work is completed a risk assessment must be put in place. Secondly, there was no up to date fire report from the LFEPA. The provider must arrange a visit to ensure that the premises comply with fire regulations. The main areas for improvement centre around staff training and recruitment. All staff must attend training on safeguarding so that they are up to date with procedures and necessary guidance to keep people safe. The local authority procedure must be available to guide staff on how to report safeguarding allegations. Records must show that staff have the knowledge and skills to meets the needs of people who use the service. This also applies to training in key health and safety issues and the safe handling of medication. This will ensure that procedures are correctly followed and staff are familiar with current legislation that they can apply in their practice. A suitable Care Homes for Adults (18-65 years) Page 8 of 32 induction programme is also needed to ensure that staff are adequately prepared for their jobs and the way the service is run. Staff recruitment practices need to be more thorough, to ensure that people are kept safe from possible harm or poor practice. Full employment histories must be explored and recorded for all current and future employees. Furthermore, two references must be obtained and include the applicants most recent employer. This will ensure that all staff working in the home are safe to do so. A bedroom window on the first floor did not have a restrictor fitted. This may compromise a persons safety and needs to be risk assessed. We have also made some good practice recommendations for the service to consider. 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 9 of 32 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 10 of 32 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. Beech Tree provides good information about the services offered and introduction opportunities so that people can decide whether it can meet their support and accommodation needs. Prospective users of the service are protected by a good admission process that ensures their individual strengths, needs and expectations are fully assessed prior to any move. Evidence: We looked at the Statement of Purpose which provides people with clear information about Beech Tree, the type of needs accommodated and the services they can expect to receive. We recommend that the document is updated for clarity to reflect the changed management arrangements. Beech tree had just begun operating at the time of our inspection and one person had moved in during April this year. The acting manager confirmed that trial periods, including overnight stays are always offered, and that the transition process is led by the choice and individual needs of the person. We spoke with the one person using the service who confirmed that they had settled in and that the placement was working well for them. Records confirmed that management carry out a pre-admission assessment for all prospective users of the Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: service. This would include gathering information relating to their background, needs and aspirations, likes and dislikes. The information is gathered from all those involved in supporting the prospective person such as other relevant professionals, family members, previous carers and the individual themselves.This process helps ensure that admissions only take place once the service is confident it can meet a persons needs. The person using the service had a recent Enhanced Care Programme Approach (CPA) which outlined their needs and presenting risk factors as well as other reports from professionals involved in their care. The CPA provided by the placing authority was up to date and the homes care plan was based upon the desired outcomes from the needs assessment. We saw a basic needs assessment that the home intends to use when considering prospective users. It was a tick box type analysis however and lacked detail about a persons specific needs. We suggest that this tool is reviewed and amended to reflect the needs of people who have mental illness. The person using the service had signed a contract about their placement. It reflected the terms and conditions for staying at Beech Tree and specified the fees and costs for services. Care Homes for Adults (18-65 years) Page 12 of 32 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 needs are well met through good practices that are supported by informative care plan records. People are supported to make decisions about their lives and to take risks as part of an independent lifestyle. Evidence: We looked at the one persons care records which included their recent CPA undertaken in February this year. The care objectives provided staff with clear direction about the most appropriate ways to give the required support and help the person to achieve their goals in life. The manager explained that care plans would be developed for each person following the trial period of six weeks and a planned review meeting to decide if the placement is suitable for them. We looked at daily reports which gave a good overview of a persons daily experiences, activities, health and well being and any other significant issues. House meetings for people using the service had not started as only one person had moved into Beech Tree. Records told us however that people can make their own decisions and staff respect their views. There was no evidence of restrictions on individual choice or freedom except where an Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: assessed risk had been identified and documented. An example of this was recorded in respect of locking the front door at night for security. The person had signed their risk plan in agreement. Any risks to people through general health,needs or activities are assessed and clear action to reduce any risks had been recorded within the CPA assessment. We think that additional contingency or crisis plans should be developed for people using the service. These should guide staff on what action to take if a person experiences a relapse in their mental health and ensure that they get the support they may need. Care Homes for Adults (18-65 years) Page 14 of 32 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 and are supported to be part of the local community. Visitors are welcome and people are supported to keep in touch with their families and friends. Evidence: As a new service, the manager has plans to provide a wider range of social and leisure activities once more people have moved in. Preferred interests, hobbies and likes are identified as part of the personal care planning process. Care records included information about the persons aims and ambitions, and how staff are to support them with their social interests and occupation. The person staying at Beech Tree had planned their own timetable of activities which included going bowling, playing football and fishing. They went out bowling with one staff during our inspection. The service supports people to visit family and friends and to keep contact with those that are close to them. Care records included details about the persons social needs and who Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: is important in their lives. At the persons request, the manager was in the process of helping them to trace a relative. One staff we spoke to was clear about their role to promote core values for people in areas such as privacy, dignity, respect and choice. The person using the service told us I like it here, the staff are nice, better than other places Ive stayed in. There were no specific menus due to there only being one person staying at Beech Tree. Records showed that people can plan and prepare their meals as they choose. Care Homes for Adults (18-65 years) Page 16 of 32 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. Health and welfare is closely monitored to ensure that peoples physical and emotional needs are met. Medication practices are generally well organised although some improvements will ensure better safety and consistent treatment for each person. Evidence: Records confirmed that the person is fully supported to access relevant mental health services and that management maintains effective communication links with other relevant professionals. We saw that information was recorded in the personal file about how the person was affected by mental illness and the impact this may have on their day to day routines. Routine appointments with agreed outcomes were documented clearly. This shows that the staff team monitors health care needs closely and works positively with other health care professionals to offer a responsive and supportive approach in assisting people to maintain good health. We checked the way the service manages its medication practices and discussed the process with the manager. Records were not available to show that staff had completed training on medication. The manager told us that she plans to arrange a course through the supplying Boots pharmacy. The one person using the service manages their own medication and had chosen to store their medicines in the locked Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: cabinet in the main office. A risk assessment should be agreed with the person however to show that they are safe and capable to do so. We acknowledge that this is a new service and that only one person was prescribed regular medication. Systems need to be put in place however to ensure the safe and effective management of medication. Care Homes for Adults (18-65 years) Page 18 of 32 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. Arrangements for dealing with concerns and complaints ensure that people who use the service feel listened to and their views are acted upon. Safeguarding procedures and practices need some improvement to ensure that people who use the service are fully protected. Evidence: Since Beech Tree first registered in 2007, no complaints or safeguarding concerns about the service have been raised with us or to the provider. There was information in the service user guide about the complaints procedure including how to make a complaint and the process for dealing with complaints. We saw a policy on abuse but there was no local authority guidelines for safeguarding vulnerable adults. The homes policy must reflect local authority procedures so that staff are aware of the correct guidance and know how to refer concerns of this nature to the local social services department. There were no records to show that staff have received training on safeguarding. The manager advised that she recently attended a course on the Mental Capacity Act and DoLS (Deprivation of Liberty Safeguards) which was run by the Croydon local authority. We suggest that such training is extended to all staff so that they are up to date with relevant legislation and understand how to apply it in their practice. Care Homes for Adults (18-65 years) Page 19 of 32 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 are provided with comfortable and homely surroundings that are kept clean, hygienic and in a good state of repair. Some improvements concerning fire precautions are now outstanding and must be prioritised to ensure that people live in a safe environment. Bedrooms are designed and furnished to meet peoples individual needs, personal preferences and interests. Evidence: Beech Tree is well furnished, homely and decorated to a very high standard. There are nine en suite bedrooms which similarly, were all well furnished and decorated. There is a good sized lounge with comfortable furniture, modern decor and a large wide screen television with DVD player. People have access to a well maintained garden which has a spacious lawn area and patio with outdoor furniture. The kitchen and adjoining dining area is domestic in nature and people can freely use the facilities to prepare their drinks and meals. We looked around the building to check that it was safe. When we last visited the home in August 2008 we made two requirements around fire safety. Our report said,The report from the local Fire authority (LFEPA) dated 1st August 2007 stated that some further work was needed to ensure that the premises would be deemed to be satisfactory. A follow up visit is therefore needed to confirm that the premises now meet with fire safety regulations. In addition, several fire doors were propped open with rubber wedges. Although there were no people living in the Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: home at the time of this visit, this practice could compromise peoples safety in the event of a fire. Where fire doors need to be propped open, appropriate closure devices that connect directly to the fire alarm system must be fitted. Advice should be sought from the local fire authority. At this inspection we observed three fire doors, including the kitchen, propped open with rubber wedges. In addition there was no up to date fire report from the LFEPA. These requirements were therefore outstanding. As there were no people using the service up until the end of April 2010, we have taken a proportionate approach and extended them for a final time. This has been discussed further on in the report under management and administration standards. In one of the vacant bedrooms on the second floor we checked the window which opened wide enough for someone to climb out if they so wished. It is acknowledged that the room was not in use at the time of our visit but the manager is required carry out risk assessments on all its windows and to fit those with restrictors where deemed necessary. This is to protect the people who use the service from avoidable harm. Care Homes for Adults (18-65 years) Page 21 of 32 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. Recruitment practices aim to safeguard people from unsuitable staff although some additional checks are needed to ensure that people using the service are fully protected from possible poor practice or harm. Staff training and development needs to improve as it does not give full assurance that staff have the competencies and skills to meet peoples needs. Evidence: Before Beech Tree opened we were told that the registered provider recruited a number of staff in preparation during the summer of 2009. We looked at the recruitment process for four staff and found that some pre employment checks were incomplete. Although each employee had an up to date CRB and POVA check, there were some gaps in their employment history (no explanation)and limited references available. In addition there were no application forms or evidence of training and qualifications. The acting manager was aware of the missing records and had started to reorganise the staff files. We have therefore made requirements concerning the recruitment process. All recruitment records must include two verified references, one of which must be the applicants most recent employer. Any gaps in employment history must be explored and recorded to confirm the employee is suitable to carry out work with vulnerable people. There were no certificates for any training which had previously taken place or any Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: details about planned training. There were no records of induction to the home and a suitable process must be followed. An induction prepares staff for their caring role and should be based upon the Skills for Care standards. Staff must also possess specialist training to meet the specific needs of the people who use the service. Records must therefore be kept in the home to show that staff are suitably trained. As the service had only just started, recorded supervision and appraisal for staff had not begun. The manager discussed various systems that she intends to use for supporting staff and monitoring their performance and practice. The manager told us that she had also sought advice from an external company concerning employment issues. We will look at staff supervision in more detail at the next inspection. Care Homes for Adults (18-65 years) Page 23 of 32 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. There is a new manager who has a good leadership approach to run the service in the best interests of the people who use it. Overall health and safety practices are managed well to ensure that the environment is safe for people and staff. Outstanding concerns related to some fire safety precautions must be addressed however. Evidence: Since the home first registered with us in 2007, there has been several changes of manager due to the service being dormant for over two years and the change of registration category to mental health. Mary Andrews was appointed as the new manager in April this year and confirmed that she has made an application to register with us. The previous manager Ken Watts still works at Beech Tree and will also have management responsibility. As the management arrangements are job shared, the service should ensure that clear lines of accountability are recorded and that each managers role is defined. Mrs Andrews has an RMN qualification and significant experience of working with people who have enduring mental health problems. Previous work has included ward management in a mental health hospital and a care home for older people. She advised that she also has a Diploma in management Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: studies. Discussion with both managers confirmed that they are knowledgeable about person centered outcomes for people and the regulations for running a care home. Records showed that the manager is keen to develop the service and run the home in the best interests of the people using it. As the service is still in its first months of operation, the overall effectiveness of the quality assurance systems could not be fully assessed. The manager has plans to ensure that the quality of the service is monitored through questionnaires and audit checks for example. When we walked around the building, we saw that several fire doors were propped open with rubber wedges. Before the home opened, we made a requirement concerning fire doors as this practice could compromise peoples safety in the event of a fire. Where fire doors need to be propped open, appropriate closure devices that connect directly to the fire alarm system must be fitted. This requirement therefore remains outstanding from our last two reports and now that people are using the service, the provider must address the matter without delay. We have extended this requirement for a final time and may consider enforcement action if there is another failure to comply. Aside from this issue, there are some systems in place that aim to promote the health, safety and welfare of the people using the service, staff and visitors. During our inspection the managers met with an external company for advice on Health and safety matters and to implement a suitable system. Records and certificates showed that regular checks had been carried out on all fire equipment and alarms and an electrical safety test completed in April of this year. As there were no staff training records available, it was difficult to confirm if they were up to date with key health and safety issues. One staff we spoke to told us that they had attended recent updates at their second place of work. We suggest that the manager develops a training planner for all staff to show what courses they have done and when they are due to refresh. This will help ensure that staff are up to date with their training. The provider is reminded that staff should have mandatory training in fire safety,moving and handling, first aid, basic food hygiene, health and safety and infection control. Care Homes for Adults (18-65 years) Page 25 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 24 23(4) The home arranges for a visit 25/07/2009 from the local fire brigade (LFEPA) To ensure that the premises comply with current fire regulations and are safe. This requirement has been extended as the service has been dormant and there were no people using the service. 2 42 23(4)(a) Fire doors must not be propped open unless they are secured by a suitable device that activates on the fire alarm sounding. Without adequate fire precautions, the safety of people living and working in the home may be compromised. This requirement has been extended for a final time as the service has been dormant and there were no people using the service. Another failure to comply may result in enforcement action. 25/07/2009 Care Homes for Adults (18-65 years) Page 26 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 18 All staff must attend training 30/11/2010 on the handling of medication To update their skills and knowledge and ensure safe practice. 2 23 13 All staff need training in safeguarding vulnerable adults. So that staff are equipped with the necessary knowledge and skills to respond to safeguarding issues and protect people from harm. 14/11/2010 3 23 13 The home must obtain a 31/08/2010 copy of the local authority(Croydon) procedures on safeguarding vulnerable adults and use it in conjunction with their own safeguarding policy. Care Homes for Adults (18-65 years) Page 27 of 32 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 So that staff are aware of the correct procedures for responding to safeguarding incidents. 4 24 23 The home must arrange a visit from the local fire brigade (LFEPA). To ensure that the premises comply with current fire regulations and people are not put at risk in the event of a fire. This requirement has been extended for a final time as the service has been dormant and there were no people using the service. 5 26 23 The window in bedroom 9 on 31/08/2010 the second floor must be risk assessed and a restrictor fitted. So that people using the service can live safely and are not at risk in their environment. 6 34 19 When recruiting new staff, two appropriate references must be obtained and include the applicants most recent employer. To ensure that people using the service are protected 31/08/2010 31/08/2010 Care Homes for Adults (18-65 years) Page 28 of 32 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 from unsuitable staff and that people who work at the home are safe to do so. 7 34 19 All of the required information and vetting checks must be obtained prior to staff beginning work. This makes sure that all people who work at the home are safe to do so. 8 35 19 A suitable induction training programme needs to be put in place for staff. So that staff are adequately prepared for their jobs and acquainted with the aims and objectives of the home. 9 35 19 Training records must be available for all staff. To show that staff have the skills and experience to meet the needs of the people using the service. 10 42 23 Fire doors must not be propped open unless they are secured by a suitable device that activates on the fire alarm sounding. Without adequate fire precautions, the safety of people living and working in the home may be compromised. 31/08/2010 31/08/2010 31/08/2010 31/08/2010 Care Homes for Adults (18-65 years) Page 29 of 32 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 This requirement has been extended for a final time as the service has been dormant and there were no people using the service. Another failure to comply may result in enforcement action. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 1 3 6 That the statement of purpose is updated to reflect any changes and the new management arrangements. The assessment tool is reviewed and amended to reflect more closely the needs of people who have mental illness. Additional contingency or crisis plans should be developed for people using the service. These should guide staff on what action to take if a person experiences a relapse in their mental health and ensure that they get the support they may need. A risk assessment should be agreed with the person using the service to show that they are safe and capable to manage their own medication. Training on the Mental Capacity Act and DoLS (Deprivation of Liberty Safeguards) is extended to all staff so that they are up to date with relevant legislation and know how to apply it in their practice. The application form should require a full employment history and the reasons for leaving posts, which involved the care of children or vulnerable adults, and an explanation of gaps in employment included. The induction programme for staff is based upon the Skills for Care standards. 4 20 5 23 6 34 7 35 Care Homes for Adults (18-65 years) Page 30 of 32 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 8 37 As the management arrangements are job shared, the service should ensure that clear lines of accountability are recorded and that each managers role is defined. The manager develops a training planner for all staff to show what courses they have done and when they are due to refresh. This will help ensure that staff are up to date with their training. 9 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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