Care Home: Beech View

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Beech View 14 The Plies London Road Fairford Gloucestershire GL7 4AJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kathryn Silvey     Date: 1 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 32 Information about the care home Name of care home: Address: Beech View 14 The Plies London Road Fairford Gloucestershire GL7 4AJ 01285712437 01285712437 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Brandon Trust Name of registered manager (if applicable) Miss Cedria Ruth Clifton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 6 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Beech View is a registered care home and is able to accommodate six adults who have a learning disability. The home is situated close to the centre of Fairford and is about ten miles from Cirencester. It is an adapted house, which was originally a pair of semidetached houses. The accommodation is on the ground and first floors, comprising of single bedrooms. There are bathrooms and toilets on each floor and a large shower room on the ground floor. Currently there is a lounge on both floors and a kitchen with a small dining area on the ground floor. There is a level accessible garden to the side and rear. Care Homes for Adults (18-65 years) Page 4 of 32 care home 6 Over 65 0 6 Brief description of the care home The Brandon Trust runs the home, having taken over from the previous service provider in April 2006. A Statement of Purpose and Service Users Guide are available to prospective service users. Up to date information about fee levels was not obtained during this visit. 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: The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. We, the Commission completed this surprise key inspection in one day. We spoke to all six people living in the home and watched the care staff talking to them. We also spoke to the manager, and two of the care staff. We spoke to both a carer and relative on the telephone. A number of records were looked at including care plans, risk assessments, health and medication records. The care records of two people were looked at in detail, and we Care Homes for Adults (18-65 years) Page 6 of 32 spoke to the manager about the care of the other four people living in the home. The home was looked at, and staff were watched helping people living in the home. The manager had completed the Commissions Annual Quality Assurance Assessment, AQAA this is information sent to CSCI each year. One staff survey was returned to us. 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 Care Homes for Adults (18-65 years) Page 8 of 32 following this report, you can contact them using the details set out 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Service User Guide had not been updated since 2007, however the Statement of Purpose had been reviewed and updated, it was not in an easy read format for people with a learning disability. The admission procedure and records were complete, however, there could have been more social history to help identify behaviour patterns. Evidence: The manager had reviewed and updated the Statement of Purpose, which was well done and had included a reference to the Mental Capacity Act, and the use of Best Interests guidance when determining peoples capacity to consent. The Service User Guide is still in the process of being updated and the manager told us that it should be completed by the end of March 2009, this should have been completed in 2007. We looked at the admission procedure, which had been reviewed since the last key inspection, and the pre-admission assessment for one person. The form was filled in Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: during a visit to the persons home, there were comprehensive areas to address, however not all areas were complete, however, there was sufficient detail to help ensure the home can meet the persons needs. There was, however, little social history although the persons relative was there during the assessment. We also looked at the care plan provided by the social services that funded the placement, which included maintaining social networks, support with diabetes, and no reference to any challenging behaviours. The manager told us that before admission the occupational therapist was contacted and the person visited the home several times before they moved in. As this person was assessed as being at risk in their own home the manager felt that a decision was made more quickly than usual, and she thought it would have been better to complete the admission process more slowly. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans seen had a lot of detail, however, a care plan was not recorded for all identified needs. The outcomes for people, however, were mostly good as the experienced staff knew them well. There were regular reviews of the daily records, which helps continuity of care. People are helped to make decisions through best interests guidance with healthcare professionals when necessary. Risk assessments had been completed where required. Evidence: We looked at two care plans in detail and spoke to the manager about all six people living in the home. We found out what they liked to do and how their needs were met. One individual record had a detailed care plan with clear well written goals. The plan included what the person liked and didnt like with regard to daily routines and social activities, the person dislikes change so there was a detailed morning and lunchtime routine. The plan also included communication, personal hygiene, finance, what Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: happens outside the home, night time care, nutrition, healthcare and medication. Risk taking is recorded for some activities to help ensure safety and minimise restriction to peoples lives, an example seen was for riding in the mini bus. Risk assessments were reviewed every six months. One care record we looked at had detailed information about managing behaviours, which was excellent, however, there was not enough information to ensure that all needs had a care plan. This person had been living in the they had been reviewed monthly, which included healthcare. The reviews were well written and we spoke to the staff and they knew exactly what the persons needs were and the outcomes were generally good. The shortage of staff over the last year has had an impact on the completion of records and access to activities outside the home. The manager told us that some care plan reviews had not been completed. The people living in the home were observed and spoken to during the inspection and without doubt it was their home and staff spoke to them with respect and patience. One person liked to help with cleaning chores and we observed how this was managed. Best Interest meetings were recorded by healthcare professionals to assess peoples capacity to consent. The two completed, one by the dentist and one by the Community Learning disability Team (CLDT) indicated that the people, for whom there were planned medical interventions, did not have the capacity to consent. One person admitted this year had a social services review four months later and it was noted that there was deterioration, which has continued. Other people in the home are overdue for their annual review from social services. The manager has recently asked for a review for someone due to behavioural needs and is also waiting for the report from the psychologist. We spoke to a relative who was concerned that not all needs were being met especially with regard to going out, which the person enjoyed. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can access the community for some activities, however, trips out have been limited due to staff shortages. Annual holidays are enjoyed by some people. The meals provided are what people like and sometimes they help shop for the ingredients, which are mainly fresh. Evidence: All people with the exception of the new person have individual programmes of interests and activities, and they include attending day centres, the local sports centre for swimming, trips out shopping locally in Fairford, Swindon and Cirencester. Sessions provided at home include monthly aromatherapy massage, ball games, watching films on DVD and chatting to staff. The manager told us that activities were limited due to staff shortages and space in the home, and that people were becoming older and less Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: active. The AQAA told us that the shortage of staff had also meant that valuable one to one time with people was not always possible and that they need more individual attention. The three staff we interviewed, one by telephone, agreed that people should have additional activities and be taken out more. A staff survey told us there is never enough staff to cater for peoples individual social needs. The more able residents are taken out more than the less able as only one member of staff is needed. The daily records indicated what people had been doing, they had been to Westonsuper-Mare, two people had enjoyed a weekend away at Centre Parcs and one person had been on holiday to Brean Sands. Various holidays have been provided that included a visit to a specialist, Calvert Trust, activities holiday in Devon, staying at a holiday chalet in Dorset and staying at a Steam museum convention. Some service users choose to go on day trips rather than stay away from home. There are no vocational or work related activities undertaken mainly due to peoples disabilities and understanding. We looked at the four week menu plan and asked about the preparation and shopping for food. People often go to the shops to help buy the food each week with a member of staff. There were fresh vegetables and people are asked what favourite foods they would liked cooked. The staff knew about the texture of food for a person with swallowing problems and diabetes as they had read the letter from the Speech and Language Therapist (SALT), however, there should be a detailed care plan for staff to follow. We observed the staff preparing food correctly to support this person. The staff told us they always listen to what people would like to eat, and they thought that the home provided good food. We observed the staff prepare, serve and help people with their lunch while enjoying their own sitting with them. There is not enough space for everyone to sit at the kitchen table so two lunch sittings are provided. People did not appear to mind waiting until second sitting as they were used to the arrangements. A relative told us the food was alright and that appropriate meals were provided. 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. People receive additional specialist support when required and their healthcare needs are well met. Medication is well managed and regular audits and staff training help ensure that people are protected. Evidence: Each person had a comprehensive record of health to include histories of medical conditions, which the CDLT had helped to provide. The healthcare records completed by the staff were good, we saw a record of visits to ophthalmology and the diabetic clinic, and records from other healthcare professionals that support people in the home. The daily records also contained good healthcare records. The records we looked at told us that people are very well supported by health care professionals and the CLDT. One person had two dementia pathway assessments requiring medication adjustment. Occupational therapy visits were recorded and the doctor called during the inspection to complete a medication review and investigate a continence problem. The manager told us that the doctors have just completed detailed annual health reviews. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: The staff are aware of behavioural needs, and we looked at the records of any challenging behaviours, which are used to help the psychiatrist/psychologist support people with mental health needs and behavioural problems. Two people are wheelchairs users and have a hoist to help manage their physical needs. As previously mentioned care plans should be completed for specific healthcare needs for example incontinence, and eating and drinking where weight loss may be a problem. We looked at a review of the daily records which indicated a weight gain where loss had been a problem. The physiotherapist visited a person during the inspection as their mobility was deteriorating and using the stairs was becoming a problem. Care plans record the ways in which people communicate, which includes individual body language. The staff were observed communicating with people and easily understanding what they wanted. We looked at the medication storage and administration records. All the staff had signed that they had read the medication procedure. People do not self-medicate and the staff do not give homely remedies. All medication is recorded and signed for on receipt and a weekly audit is completed for all medicines not in the medisure monitored dosage cassettes. At each handover between shifts the medication is also checked as correct and all returns to pharmacy are recorded. The storage was secure, however, external and internal medication should be stored separately to avoid contamination and errors. Fridge storage temperatures were monitored. The administration records were correct and contained pictures of the people and any allergies where required. We saw two good examples of protocols for as required medication to help staff decide when to administer. The homes staff should be part of the medication ordering process to avoid medication appearing on the administration records when not required and continually being deleted manually, which may be confusing and cause an error. The home should have an updated medication reference for guidance. All staff administering medication are trained by Brandon Trust. 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. The staff listen to peoples concerns and deal with them as they arise, however, records should be kept. Staff training and the homes procedures help to ensure that people are protected from abuse Evidence: The manager told us there have been no formal complaints from relatives or people living in the home. Concerns that arise are dealt with, an example given to us was that one person was concerned about the heating, the manager told us this was dealt with but there was no record. We recommend that any concerns should be written in the daily records and the outcome recorded. We spoke to three care staff and they told us they are able to communicate with people to make sure they are listened to. We spoke to a healthcare professional who told us the staff are very attentive, including people when they visit, and help to complete any assessments required. We looked at the homes safeguarding procedure and asked three staff about protecting people from abuse. All the staff spoken to had received training in safeguarding people and knew about abuse and what they should do if they suspected abuse. The manager informed us that all staff had received training in the protection of vulnerable adults. We looked at the recording of peoples personal monies, some people also have a savings account. The system used is excellent and bank statements are reconciled Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: monthly with all receipts kept and two staff signatures are required on all cheques to help safeguard people from financial abuse. Care Homes for Adults (18-65 years) Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was generally clean and many areas were well maintained but there are issues that require attention to ensure that peoples needs are met, the home is safe and that people are valued. Evidence: We looked around the home, the communal areas had recently been decorated but there was a bedroom which needed some wall repair work done on the ground floor and two other bedrooms that required decorating. However, bedrooms were well personalised and clean. The manager told us that one bedroom was not always warm enough and may require additional heating to make the room more comfortable. One bedroom should have had a wash handbasin fitted for the new person admitted in May 2008. This was an agreement with us and must be completed or the room returned to a lounge area. The bedroom now used as an upstairs lounge was untidy with Christmas decorations waiting to be placed in the roof, and people would not find it easy to use. A staff survey told us Beech View has an antiquated central heating system, which continually breaks down or doesnt work properly, and the water pipes in the bathrooms, especially upstairs, are exposed and in a disgusting state. We spoke to a carer that told us the bathing facilities at the home were poor as one person used Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: to love having a bath, which was impossible now a hoist was required. Staff had also noticed that some people were finding it difficult to use the stairs as they became older. A relative told us that they thought the stairs were hazardous as their relative almost fell down them. Two lights upstairs did not have lampshades, which looked unsightly and may indicate a lack in valuing people and their surroundings. The staff said maintenance issues were not always completed as soon as they should be. Care Homes for Adults (18-65 years) Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team are experienced and have completed NVQ training, however, they require additional training to help them meet the needs of people with dementia. There are times when there may not be sufficient staff to meet all the needs of the people accommodated. The homes thorough recruit records and procedures help to ensure that people are safeguarded Evidence: The manager told us there was a full-time care vacancy that is filled by internal bank staff and currently there are three people with high dependency needs, which include two with physical needs and one with dementia care needs. A staff survey told us that I have had one supervision in four years and one informal chat . A member of staff commented that there is no in depth information available in the home about some peoples disabilities, for example autism and dementia. The AQAA told us that it has always been difficult to recruit in the area and that the home has only been fully staffed for about a month in the last year. The manager told us that she has struggled to do staff supervisions, however, recently a senior carer has Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: been assisting and this has improved. The manager told us that agency staff were used to fill three shifts in the last six months. The home should complete a regular review of staffing levels to ensure that there are sufficient staff to meet all the needs of the people accommodated, particularly at peak times of activity and when people are taken out. The manager has had to complete a lot of shifts due to staff shortages. This may mean when the manager is off duty and staff are transporting people to their activities that there are insufficient staff on duty, which may present problems when challenging behaviours occur. We discussed this with the manager who told us a new member of the care staff was starting the following week and would be shadowing for three weeks, which would increase the staffing numbers. The AQAA told us that a new member of staff had been appointed in the last year who was experienced and enthusiastic,and was a valued member of the team. The home has six permanent care staff, three have NVQ level 3, one has NVQ level two, and two of the six had completed specific training to care for people with a learning disability. Three internal bank staff are used regularly and the manager was unsure about their qualifications. Brandon Trust bank staff should have the same training opportunities and support as permanent staff to help ensure that people are well cared for at all times. The manager agreed to copy the rotas and provider monthly inspection reports for us to look at. The two recruitment records we looked at were complete, there were good interview notes and copies of staff training certificates.. We interviewed three care staff and both thought there should be more staff at peak times of activity, and when transporting people to college etc. as it sometimes leaves one person on their own. All staff had completed mandatory training e.g first aid , manual handling, food hygiene, health and safety, fire safety and one had discussed starting NVQ level 3 in care at supervision. In house medication training had been completed, however, one carer told us they would like additional medication training, some staff had not had any dementia care training. They also told us that the use of agency staff at night, working alone, may be unsatisfactory when they may not know the people there very well. One carer told us we have a lovely staff team and that staff meeting are held regularly. Subsequently we spoke to the deputy manager about the staffing levels as we did not receive copies of the rotas. One person had been transferred to another home to live since we completed the fieldwork for this inspection and the staff felt able to manage the care of the five people accommodated with the current staffing levels. However, the home must ensure that there are sufficient staff at all times to meet peoples needs. The deputy manager told us that there will be four shifts in the next two weeks where four staff will be on duty from 8:00 to 15:30 to include the a manager. We were Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: also informed that recruitment is improving and another full-time carer will be employed soon. Care Homes for Adults (18-65 years) Page 25 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. The home has a well qualified manager who has had some difficulty completing care plan reviews, which may be due to staff shortages. Most of the staff are well managed through regular supervision and staff meetings. Quality assurance procedures do not include all stakeholders. Evidence: The registered manager is experienced and qualified to complete all the duties in the home and has completed the NVQ Registered Managers Award at Level 4. We interviewed three care staff, two of them told us they received regular formal supervision where their training needs were identified. The manager had recently completed the deputy managers appraisal for the year. We discussed quality assurance systems with the manager, and as there is very little contact with the relatives no further questionnaires have been given to them since the last inspection in 2007. We looked at two internal quality assurance documents completed by the manager in November 2008, which looked at reflecting the diversity of our communities and person centered support. The overall score and comment about Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: diversity indicated that people were not discriminated against in the community but were not actively involved either. There was a good record of incidents and accidents in the home. We recommend that a monthly audit should be completed where any actions for prevention are noted. Accident reports should be kept in individual files to aid care planning and person centered care. One recurring incident was one person playfully striking another on the head. Specific advice had been sought about this matter but it remained unresolved. We observed the person who strikes as being very active around the home with cleaning and it may be that additional activities with the staff within or outside the home may help to prevent this unwelcome activity. There does not appear any organisation of activities in the home and staff have commented that people need to go out more often. The manager told us that health and safety and fire risk assessments have been completed, we looked at the fire assessment, however a fire drill is overdue. A personal evacuation plan for each person was completed in September 2008. All staff will be having fire safety training on 2 March 2009. We looked at the fire safety records for the home, which were up to date and well completed. Managers responsible for health and safety should have completed an appropriate course to help ensure their competency. The manager told us that health and safety is discussed at staff meetings. The AQAA told us most of the policies and procedures had been reviewed, however, Brandon Trust need to ensure that all company policies are updated regularly. The manager had recently spent some time reviewing procedures and care records. Care Homes for Adults (18-65 years) Page 27 of 32 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 28 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 6 15 The registered person shall prepare a written care plan as to how the service user needs, in respect of health and welfare, are to be met. Peoples identified needs must have a care plan to help ensure that their needs are well met and reviewed regularly. 17/04/2009 2 14 16 The registered person shall provide facilities for recreation including having regard to the needs of the service users. All service users must have access to suitable activities and trips out as required by them to meet their needs. 17/04/2009 3 24 23 The registered person shall provide sufficient washbasins with a hot and cold water supply. 17/05/2009 Care Homes for Adults (18-65 years) Page 29 of 32 One bedroom must have a wash-basin if it is to be used by service users. 4 24 23 The registered person shall having regard for the number and needs of the service users ensure that the care home is kept in a good state of repair. One bedroom requires wall repair work, two bedrooms need decorating, and bathroom pipes require painting or guarding if too hot. 5 33 18 The registered person shall 17/04/2009 having regard for the size of the care home, the statement of purpose and the number and needs of the service users ensure that at all times there are staff working at the care home in such numbers as appropriate for the health and welfare of service users. Staffing levels must be able to meet all service users needs and a record kept of regular reviews to reflect the changing needs of service users. 17/04/2009 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 1 1 The Service User Guide should be updated as required and Page 30 of 32 Care Homes for Adults (18-65 years) summaries should be in an easy read format for people with a learning disability to understand. 2 3 2 20 A more detailed social history should be obtained if possible before admission to help ensure that all needs can be met. The homes staff should be part of the medication ordering process to avoid medication appearing on the administration records when not required and continually being deleted manually, which may be confusing and cause an error External and internal medication should be stored separately to avoid error and contamination. We recommend that any concerns should be written in the daily records and the outcome recorded. It is recommended that all light fittings should have a suitable shade. Brandon Trust bank staff should have the same training opportunities and support as permanent staff to help ensure that people are well cared for at all times. Brandon Trust need to ensure that all company policies are reviwed regularly. We recommend that managers responsible for health and safety should have completed an appropriate course to help ensure their competency We recommend that a monthly audit should be completed of all accidenst and incidents where any actions for prevention are noted. 4 5 6 7 20 22 24 33 8 9 40 42 10 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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