Care Home: Blenheim Care Centre

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What the care home does well The people we spoke to said that they were happy living at the home and that the staff delivered care in the way that they preferred. One person told us, `staff are always in and out to see if I need anything, nothing is too much trouble in my opinion`. Another person who was staying at the home for respite care said, `if I had to I would certainly come back here again`. The recruitment system makes sure that people who work at the home are suitable to do so. Staff are knowledgeable about the people they support and interact with them in a positive manner. The home has good links with outside agencies, such as district nurses and the tissue viability nurse. People have access to in house physiotherapy that can be arranged to suit their needs. What has improved since the last inspection? Care plans and risk assessment documentation has been reviewed and additional information added so that they provide staff with more information about peoples needs and preferences. People told us that they had been asked about their social preferences and basic social care plans have been added to their files. Complaints and concerns have been more consistently recorded. A general environmental audit had been completed to assess the areas of the home that need attention. New carpets had been fitted on the first floor corridor of the main building and new radiators and equipment purchased. People`s dependency levels had been assessed, but this information has not yet been used to calculate if there are sufficient staff on duty to meet people needs. Staff now receive regular supervision to help support them to do their job. The quality assurance system has been used to gain peoples views and audit the quality of the service being provided. The provider has visited the home regularly and produced reports of his findings. What the care home could do better: The timescales for four of the requirements made at the last key inspection have not been fully met,. However progress has been made in each area so new timescales for completion of the work have set. Although there has been improvement in some care records others still need more information and guidance for staff to make sure they are fully aware of their role in supporting people. Plans need to be more person centred so that they tell staff about peoples preferences, their involvement in decision making and their aspirations for the future. Files should also indicate if people have been involved in planning and evaluating their care, if this is not possible the reason should be recorded. Care plans need to demonstrate that the home has considered recent legislation about protecting people rights and choices regarding their mental capacity to make decisions about their daily lives, and planned their care accordingly. They need to make sure that staff understand their role in this process by providing appropriate training in this subject.Risk assessments must be completed more robustly so that any potential risks are identified and management strategies documented so that staff know what minimising actions they need to take. This includes topics such as the use of bed rails. The home must also assess anyone who is to be responsible for administering their own medications so that staff can make sure that they are able and safe to do so. Now that an environmental audit has been completed an action plan needs to be formulated that identifies any areas needing attention and the timescales for completing the work. All staff must receive training to meet the needs of the individual people currently living at the home. Three other areas would benefit from some attention. The information gathered about people interests and hobbies should be used to plan the social activities available at the home. The home should look at alternative ways that they can expand the types of stimulation and support available to people living at the home, such as participation in support groups and counseling for people who require additional support to come to terms with their disability. The home should review the arrangements for supporting people who smoke. This will help to make sure that the current arrangements are satisfactory and smoke does not affect other people living at the home. Since the last inspection the manager has assessed people dependency levels but she should now use this information along with her knowledge of the layout of the home to make sure that there are enough staff on duty on each shift. The management team should continue to maintain and monitor the systems introduced to help ensure that the quality of service provided continues to improve. Key inspection report Care homes for adults (18-65 years) Name: Address: Blenheim Care Centre Hemswell Cliff Gainsborough Lincs DN21 5TJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Dawn Podmore     Date: 1 9 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Blenheim Care Centre Hemswell Cliff Gainsborough Lincs DN21 5TJ 01427668175 01427668179 blenheimcentre@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Southwark Park Nursing Home Limited care home 80 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Blenheim Care Centre comprises of three units: Blenheim House, Blenheim Lodge and semi independent flats within Blenheim House. Blenheim House and Blenheim Lodge are detached properties situated in a rural trading/industrial setting in the village of Hemswell Cliff, which offers a range of amenities, such as an Antiques Centre and business services. The village also has a post office and shop. The home provides personal, respite and nursing care for up to eighty people of both sexes whose ages range from 18 years upwards, some with physical disabilities or acquired brain injury. Residents aged over 65 years are mostly accommodated in The Lodge. The home provides transport to enable residents to take part in activities in the community and for residents to visit the nearby town of Gainsborough or City of Lincoln. The units have large communal areas comprising lounge/dining-rooms and quiet areas on the ground floor. Bedrooms are located on ground and first floors. There are passenger Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 80 80 0 80 2 7 0 4 2 0 0 9 Brief description of the care home lifts to first and second floors in both units. The gardens are separated by fencing from the surrounding buildings, having grassed and paved areas for the use of the residents. A car park is situated at the front of the main building. At the time of the inspection the home confirmed that the weekly fees ranged from £351 - £846, depending on the residents assessed needs. Additional charges are made for things like toileteries, newspapers, chiropody and hairdressing. Information about these costs as well as the day-to-day operation of the home, including a copy of the last inspection report is available in the reception area. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection visit was unannounced and took any previous information held by C.Q.C. about the home into account. Throughout this report the terms we and us refers to the Care Quality Commission (C.Q.C). Before the the visit the provider had returned an Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans for improvement over the next twelve months. We also sent out surveys to residents and staff, fifteen of which were returned in time to be included in this report. The inspection visit was conducted Dawn Podmore as the lead inspector and Mr D Tunmore as second inspector. We are trying to improve the way that we engage with people who use services so that we gain a real understanding of their views and experiences of social care services. During this inspection we used a method of working Care Homes for Adults (18-65 years) Page 6 of 29 where an experts by experience visited the home as part of the inspection to help us get a picture of what it is like to live in this service. The term Experts by Experience used in this report describes people whose knowledge about social care services comes directly from using them. The expert by experience spent 3 hours at the home speaking to people about life at the home and eating lunch with some of them. The main method of inspection used was called case tracking. This involved selecting 6 residents and tracking the care they received through the checking of records, discussions with them and the staff who care for them, and observation of care practices. A partial tour of the home was also conducted, which included looking at some bedrooms, communal areas and bathing and toilet facilities. We spoke with eight residents and six members of staff. They shared their views about how the home operated on a day to day basis and the support and facilities provided. The manager was available during the visit and the general outcomes of the visit were discussed with her. On the day of the visit 61 people were living at the home and another 2 were visiting for day care. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The timescales for four of the requirements made at the last key inspection have not been fully met,. However progress has been made in each area so new timescales for completion of the work have set. Although there has been improvement in some care records others still need more information and guidance for staff to make sure they are fully aware of their role in supporting people. Plans need to be more person centred so that they tell staff about peoples preferences, their involvement in decision making and their aspirations for the future. Files should also indicate if people have been involved in planning and evaluating their care, if this is not possible the reason should be recorded. Care plans need to demonstrate that the home has considered recent legislation about protecting people rights and choices regarding their mental capacity to make decisions about their daily lives, and planned their care accordingly. They need to make sure that staff understand their role in this process by providing appropriate training in this subject. Care Homes for Adults (18-65 years) Page 8 of 29 Risk assessments must be completed more robustly so that any potential risks are identified and management strategies documented so that staff know what minimising actions they need to take. This includes topics such as the use of bed rails. The home must also assess anyone who is to be responsible for administering their own medications so that staff can make sure that they are able and safe to do so. Now that an environmental audit has been completed an action plan needs to be formulated that identifies any areas needing attention and the timescales for completing the work. All staff must receive training to meet the needs of the individual people currently living at the home. Three other areas would benefit from some attention. The information gathered about people interests and hobbies should be used to plan the social activities available at the home. The home should look at alternative ways that they can expand the types of stimulation and support available to people living at the home, such as participation in support groups and counseling for people who require additional support to come to terms with their disability. The home should review the arrangements for supporting people who smoke. This will help to make sure that the current arrangements are satisfactory and smoke does not affect other people living at the home. Since the last inspection the manager has assessed people dependency levels but she should now use this information along with her knowledge of the layout of the home to make sure that there are enough staff on duty on each shift. The management team should continue to maintain and monitor the systems introduced to help ensure that the quality of service provided continues to improve. 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 29 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 29 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. A detailed assessment process helps to make sure that the home can meet the needs of the people who live there. Evidence: The Service Users Guide and Statement of Purpose had been reviewed and updated since the last inspection, but one person said that they could not remember ever having a copy of the Service Users Guide. People are assessed before they come to live at the home so that the manager can make sure that the home can meet their needs. A new resident confirmed that her admission had been a positive experience. She told us that she was very impressed by the way she was admitted when she arrived and said the staff were very good, they made me feel welcome. Although some people told the expert by experience that they had not personally chosen the home they said that they were happy that the home was chosen for them by their social workers or relatives. Care Homes for Adults (18-65 years) Page 11 of 29 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. There are shortfalls in the care planning and risk assessment documentation which could lead to residents care needs not being fully met. However people are receiving a satisfactory level of care which is delivered to suit their preferences. Evidence: The content of the care plans we looked at had improved since the last visit, however they varied in the information provided. For example one plan described the persons needs regarding the personal care in detail, such as hair care, nails and bathing, but another plan gave only basic information such as needs assistance with all care. Additional records have been introduced regarding peoples social history and preferences, but these were not yet completed for every resident. Some plans had been signed by residents or their representatives to show that they had been involved in the care planning process but others had not. The people the expert by experience spoke with said that they had been involved in the planning of their care. All the people she spoke to told her that staff always checked with them Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: informally to see if they were happy with the care being provided to them. One person said that he was consulted at least four times a year about his provision of care. Risk assessments information had not always been incorporated into the care plans. Therefore some risks associated with peoples care, and the actions staff needed to take to minimise them, were missing. For example one person had safety rails fitted to their bed, but there was no assessment outlining why these were needed and their safe use. In another file the plan told staff about the persons manual handling needs and what equipment was being used to move them in detail, but there was no formal manual handling assessment in place. The decision making process regarding the use of a lap belt to stop one resident from falling out of their wheelchair had not been documented to show that this was being used with their consent or in their best interest. Although other files contained assessments to evaluate the risks associated with things like moving people safely and developing pressure damage some had no review date on them to demonstrate that the information was up to date. Detailed daily notes were being maintained describing how each person had spent their day and monthly evaluations of the planned care had taken place. The content of the Mental Capacity Act and Deprivation of Liberties Guidance, which is new legislation that is aimed at protecting peoples rights and choices, had not been incorporated into the care planning process. Residents told us that they were happy at the home and that staff were meeting their needs. They said that they were able to make decisions and choices about their daily lives and that staff respected their preferences. One person said the staff always watch me when I go to the toilet and when when I press my buzzer they come quickly to help me. Another commented, they provide superb care and resolve problems. Care Homes for Adults (18-65 years) Page 13 of 29 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 receive activities and stimulation to meet their individual needs but records are inadequate. The home provides people with nutritious meals that offer choice. Evidence: The home has someone who is employed to provide activities between the 2 buildings for 25 hours a week. The activities person told us that there was no formal programme of stimulation because not many people wished to take part, however small group and one to one activities were arranged on a daily basis. People had been given the opportunity to take part in things such as barbeques, outings to The Deep, Meadowhall and Skegness and the monthly Karaoke session. Social plans had been added to the care plan files, but the information remained minimal. The manager said that additional information was being collated using new forms detailing peoples past history and interests. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: People told us that they did not take part in activities, but this was their choice. The expert by experience said it is good to see that residents are encouraged to undertake hobbies e.g. keeping chickens. However there is no greenhouse on the site and very little facilities to encourage them to undertake hobbies. The expert by experience ate lunch with the residents. She told the manager that the meal was very good, the best I have ever had in a care home. She said that all the people she spoke with expressed satisfaction with the meals provided and told her that they were excellent and delicious. People said that they were consulted on the range of meals to be provided and that the catering staff were very flexible in providing alternative meals should a resident not want to eat a meal on the set menu. One person told us, theres plenty of choice. I get what I want. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive appropriate support to meet their health and personal care needs, however shortfalls in some medication practices puts people at risk. Evidence: People told us that they were happy with the way staff supported them regarding their health needs. They said that they had access to outside agencies, such as doctors and chiropodists, and these visits were recorded. The manager told us that health action plans were to be introduced to record peoples medical history and plan for future health involvement such as well women/men checks. Residents said that a physiotherapist was available at the home to provide one to one support. A relative commented, they dealt with a hospital admission well and relatives are kept informed of their condition, people are treated very professionally. Since the last visit the manager has developed and undertaken an audit to make sure that staff are following the homes policies and procedures concerning the receipt, storage, administration and disposal of medications. The use of an outside pharmacist to monitor the homes systems was also discussed with the manager so that there Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: would be an independent review of the systems in place. We found that although some people were responsible for administrating their own medications there was no assessment tool or risk assessment available to demonstrate that people had the ability to do this safely. Although one person had a lockable drawer to enable them to keep their medication secure they were not using it. Before the visit ended this had been changed so that the medications were stored safely. The manager also said that an appropriate assessment documentation would be introduced as soon as possible. Another concern was identified, this was regarding the dispensing of medications to a resident for them to take later. This could lead to the wrong person taking the medication or it being taken at the wrong time. Staff said that this had only recently taken place because the person concerned was temporarily incapacitated. The manager said that this procedure would stop immediately. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by clear policies and procedures for handling complaints and allegations of abuse. Evidence: The home has a complaints procedure, which tells residents and relatives how to make a complaint and how it will be handled. The manager said that a copy is given to all new residents as part of the Service User Guide and displayed in the home. Information provided by the manager stated that the home had received four complaints since the last inspection. These had been appropriately addressed and recorded. The people we consulted said that they knew who to raise concerns with and overall they were happy at the home. Although nobody raised any concerns with us they did highlight some areas that could be improved, these were shared with the manager. The home has a policy and procedure about safeguarding people from abuse so that staff know what they should do if they have any concerns in this area. Training records, as well as staff comments, demonstrated that some staff had received training in this subject, but others had not. At the last inspection the manager said that further training in this subject would take place within 2 months, but this had not happened. At this visit she said that by the end of December 2009 80 of staff will have completed the training which is facilitated internally. Care Homes for Adults (18-65 years) Page 18 of 29 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. People live in a spacious and comfortable home, but some areas are not adequately maintained and decorated. Evidence: We took a partial tour of the home which included looking at communal areas and some of the bedrooms and bathrooms. The corridor carpets on the first floor of the main building had been replaced. Some bedrooms had also been redecorated. The manager told us that there was a problem with the heating system which was currently being looked into. This had lead to 22 radiators being replaced, including the one missing in the bathroom at our last visit. The management team have recently undertaken an environmental audit to assess which areas still need to be addressed. We were informed that an action plan was to be formulated that would prioritize the areas that need attention first. Concerns have been raised regarding the drifting of smoke from the smoking room in The Lodge. We did not detect any problems on the day of our visit however the expert by experience spoke to people about the subject. People in the main building said, the smoking shed is not big enough for a few of us in wheelchairs to congregate and we feel that this needs to be looked into. Another resident told her Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: that they were not consulted about the new smoking arrangements, saying that they had just been told they had to smoke outside. The home was clean throughout with no unpleasant odours. Seven of the nine people who returned surveys to us said that the home was always fresh and clean while the other two said that it usually was. Care Homes for Adults (18-65 years) Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff who have been robustly recruited and are knowledgeable about their day to day needs. However shortfalls in staff training could lead to peoples needs not being fully met Evidence: The manager had completed dependency level assessments to assess each persons needs. However this information had not yet been used to calculate if the numbers of staff on duty were adequate. People told us that in the main there was usually enough staff available. One person said that when they called for assistance staff always answered promptly. Some people told the expert by experience that they felt that there should be more staff on duty during the night. The home has a recruitment process that includes completing an application form, obtaining written references and a C.R.B. (Criminal Records Bureau) check. These help to make sure that prospective staff are suitable to work with vulnerable people. Staff told us that they had received a satisfactory induction to the home when they started work. Staff said that they felt that the training provided was good, but discussions and records did not demonstrate that they had all received essential and specialist training Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: to meet the needs of the people they were supporting. Individual staff training evaluations had been completed and the manager was putting a spreadsheet together highlighting training shortfalls. Essential training that had taken place, or was booked for the near future included, manual handling, food hygiene, infection control, dementia awareness and protecting people from abuse. At the last inspection we had highlighted the need for more specialist training to meet individual peoples needs. Although this had not been fully addressed the manager said that the following sessions were planned for early 2010, Parkinsons disease, multiple sclerosis, wound care and oral hygiene and nutrition. Training has been provided to a few staff about the Mental Capacity Act and Deprivation of Liberties, which are aimed at protecting peoples rights and choices, however other staff had not had this training The manager told us that more sessions were planned and by the end of December 80 of staff would have received this training. The manager encourages staff to undertake an N.V.Q. (National Vocational Qualification) in care. Information provided in the AQAA showed that over 50 of staff had completed this award. Records and staff comments demonstrate that regular supervision sessions and annual appraisals were now taking place. Although most staff told us that they felt well supported two people said that they thought staff support and training could be better. Observation of care practices at the home demonstrated that staff were supporting people in an appropriate manner. They were seen to interact with residents positively and encouraging independence. One person told us that staff were mindful of their privacy and dignity and that she felt comfortable receiving personal care. Another said, the staff are very caring and helpful. The expert by experience reported that some residents were extremely happy with the service provided and that they thought staff were polite and professional and treated residents with respect and dignity. Care Homes for Adults (18-65 years) Page 22 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Satisfactory leadership, guidance and direction are provided to staff on a day to day basis, but consistency of management processes have not always been maintained, which could lead to peoples needs not being fully met. Evidence: Since the last inspection systems for auditing, maintaining and monitoring the homes policies and procedures and the environment have been put in place to address the shortfalls we found. However some have not yet been fully implemented. People told us that they were happy living at the home and that in the main their needs were being met to a good standard. When we asked people what the home did well their comments included ; everything, they provide superb care and resolve problems, days out, meals and care and it does its best to take care of me and all aspects of my daily care. A relative told us he is looked after excellently right across the board. When asked what the home could improve people highlighted the following. employ Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: more staff especially in the afternoons as staff dont have time to interact with residents and take more care over equipment such as radiators that dont work and provide better furniture in communal rooms. Two other people said that the general environment and the gardens could be better maintained. Staff also commented positively about the home, the friendly atmosphere and the high standard of care they felt was delivered. Areas they highlighted that could be done better included, the cleanliness of the home and better training. One person commented, give more support to staff when needed and communicate more with the day to day running of the home. The home has a quality assurance system to gain the views of people who use the service. Surveys had been sent out to people, with more planned for the future, and regular meetings had taken place. There is a system in place for residents monies to be held in safe keeping by the home. This includes keeping a running total of all transactions and obtaining receipts and two signatures. The monthly visits by the home owner had taken place and staff said that he had also attended meetings. Reports of his visits were available but the content lacked consistent and accurate detail about the issues on the day of the visit and what actions were to be taken to address them. The home has health and safety polices and procedures to guide and instruct staff. There is also a programme in place to service and maintain equipment in the home on a regular basis. Information provided demonstrated that checks on equipment had taken place, however the portable appliance check had still not been completed due to delays with the service engineer. The manager said that this was being addressed The Environmental Health Officer awarded the kitchen a 5 star rating for the systems in place, this is the highest rating available. Care Homes for Adults (18-65 years) Page 24 of 29 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 6 15 Care plans must include all areas of need and be in sufficient detail to enable care staff to provide comprehensive care. Including peoples choices and preferences. They must also be be reviewed and updated regularly. This helps to make sure that staff have to access up to date information and can therefore meet peoples needs. This requirement has not been fully met but progress has been made. 01/02/2010 2 9 13 Comprehensive risk 11/01/2010 assessments must be completed that identify all potential risks associated with peoples care. This must include management strategies to minimise identified risks. This will help to make sure that staff have a clear picture of their role in managing and minimising any potential risks. This requirement has not been fully met but progress Care Homes for Adults (18-65 years) Page 25 of 29 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 has been made. 3 24 23 All areas of the home must be decorated, furnished and maintained to a satisfactory standard. This will enable people to live in a suitable environment which is decorated and furnished to suit their needs. This requirement has not been fully met but progress has been made. 4 35 18 The training programme must include specialist subjects to meet the needs of peoples living at the home. This will help to make sure that staff have the knowledge and skills to meet the needs of the people living at the home. This requirement has not been fully met but progress has been made. 01/03/2010 01/03/2010 Care Homes for Adults (18-65 years) Page 26 of 29 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 9 15 Decision making regarding the use of any restraints, such as lap belts, must be appropriately recorded and include the outcome of best interest meetings if appropriate. This will help to demonstrate that peoples rights and choices are being respected. 14/01/2010 2 20 13 There must be a formal 28/12/2009 procedure in place to assess people who wish to administer their medications themselves. This will help to ensure that they are able to do this safely and any risks have been minimised. Care Homes for Adults (18-65 years) Page 27 of 29 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 12 The home should look at alternative ways that they can expand the types of stimulation and support available to people living at the home. This could include group activities, participation in support groups and counseling for people who require additional support to come to terms with their disability. The arrangement for people to continue to smoke without it affecting other people should be reviewed to make sure that they are suitable. This will help to make sure that the facilities are adequate to meet peoples needs and smoke does not affect other people living at the home. 2 24 3 33 The completed dependency level scores should be used to assess if the correct number of staff are available to meet peoples assessed needs throughout the day and night. The systems introduced to assess how the home is operating should be maintained to ensure that people receive a consistently high standard of care and support. 4 37 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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