Care Home: Bracken Lodge

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What the care home does well People who are considering moving in to the home are provided with some helpful information about what life is like there. There are admission procedures in place. People can be confident their physical needs are understood and met. Each person has a care plan which is easy for them to understand. People who live in the home benefit from the opportunity to attend day centres and colleges. They enjoy the meals served and are involved planning menus. People can be confident their health care needs are met. They are protected from harm through the safe handling of medication. People who live in the home are encouraged to offer comment or complaint. They are protected from abuse. People who live in the home enjoy a comfortable and homely environment. They are supported by a committed and caring staff team. Robust recruitment procedures protect people from harm. What has improved since the last inspection? Some amendments have been made to the Statement of Purpose following a requirement made as a result of our last inspection. Some improvements have been made in the premises: Some carpets have been replaced and new flooring has been laid in one of the bathrooms. some areas have been redecorated. A shower room is being refitted and a new boiler has been installed. What the care home could do better: Some of the information in the statement of Purpose is out of date and misleading and must be updated to accurately reflect what life is like in the home. Risk management systems must provide clear guidance for staff on how to manage challenging behaviours to ensure a consistent approach to keep people safe from harm. Care planning and risk management systems should promote people`s independence and support people to do as much for themselves as they are able. They should include assessments of people`s individual abilities to ensure they are provided with opportunities for personal development. Meaningful activities should be planned and provided both inside and outside the home in line with peoples wishes and abilities. People who have expressed a wish to attend church should be supported to do so. People should be supported to prepare and serve their own meals where they are able to do so within a risk management framework. A record of food served in the home should be maintained to ensure the diet is healthy. Communal soap and towels should not be used in the home to ensure people are protected from risk of infection. The home must ensure recruitment and retention of permanent staff improves to promote the wellbeing of people who live in the home. The provider must ensure a suitably qualified, competent and experienced manager is registered with the commission so people who live in the home can be confident the home is being managed in their best interests. There must be an effective quality assurance system to ensure continuous monitoring and improvement in the service people receive. The health and safety of people who live in the home must be safeguarded by ensuring all staff are trained in safe working practises including moving and handling, first aid and basic food hygiene. The electrical installations in the home must be checked to ensure the safety of people who live and work there. Key inspection report Care homes for adults (18-65 years) Name: Address: Bracken Lodge Bracken Lodge 155/157 Foxon Lane Caterham Surrey CR3 5SH     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: User doesnt belongs to any group     Date: 0 1 0 9 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 35 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 35 Information about the care home Name of care home: Address: Bracken Lodge Bracken Lodge 155/157 Foxon Lane Caterham Surrey CR3 5SH 01883348961 01883343127 brackenlodge@fsmail.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): A N J Coowar Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 10 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: 10 The registered person may provide the following category of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home Bracken Lodge is situated in a quiet residential area of Caterham, a short distance from the local shops and amenities. The property is two semi-detached houses that have been joined together. Care and accommodation is provided for up to ten adults with learning disabilities. The bedroom accommodation is provided on the ground floor and first floor levels, and consists of one shared and eight single bedrooms. Bathroom and toilet facilities are Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 10 Brief description of the care home provided on both floors. There is a communal lounge and a smaller quiet lounge on the ground floor for the individuals to use. The home has a large conservatory, which is used as a dining room and activities area with an additional chalet in the large well-maintained rear garden where individuals can have leisure and activities. Car parking facilities are available to the front of the home. The fees range from £600 to £800 per week. Care Homes for Adults (18-65 years) Page 5 of 35 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: The unannounced site visit, which forms part of the homes key inspection was undertaken on 1 September 2009. We were in the home for seven and a half hours from 08:00 to 15:30. We asked the owner to complete and return the Annual Quality Assurance Audit (AQAA)before our visit. This was returned to us and contained all the information we asked for. Evidence for some of the information provided was looked at during our visit. There are 9 people currently living in the home. We interviewed 2 people who live there and observed and spoke to the other residents during the day. We also spoke to 2 members of staff, the person in charge and the deputy manager. We looked at most areas of the premises. We examined a number of records including staff employment records, daily records, incident records, risk assessments, medication records, reviews Care Homes for Adults (18-65 years) Page 6 of 35 and care plans. Before the visit we sent ten surveys to people who live in the home; ten to their advocates; ten to members of staff; five to health professionals and five to care managers. 21 surveys were returned: 9 from people who live in the home, 7 of which were completed by their key workers on their behalf, 7 from members of staff, 3 from health professionals, 2 from relatives and one from a care manager. Responses were mixed. The last inspection took place on 1 September 2007. We found the requirements made following that inspection have been partially met. There are 15 required developments at the end of this report. There is no registered manager for the service, feedback was given to the provider at the end of the visit. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Some of the information in the statement of Purpose is out of date and misleading and must be updated to accurately reflect what life is like in the home. Risk management systems must provide clear guidance for staff on how to manage challenging behaviours to ensure a consistent approach to keep people safe from harm. Care planning and risk management systems should promote peoples independence and support people to do as much for themselves as they are able. They should include assessments of peoples individual abilities to ensure they are provided with opportunities for personal development. Meaningful activities should be planned and provided both inside and outside the home in line with peoples wishes and abilities. People who have expressed a wish to attend church should be supported to do so. People should be supported to prepare and serve their own meals where they are able to do so within a risk management framework. A record of food served in the home should be maintained to ensure the diet is healthy. Communal soap and towels should not be used in the home to ensure people are protected from risk of infection. The home must ensure recruitment and retention of permanent staff improves to Care Homes for Adults (18-65 years) Page 8 of 35 promote the wellbeing of people who live in the home. The provider must ensure a suitably qualified, competent and experienced manager is registered with the commission so people who live in the home can be confident the home is being managed in their best interests. There must be an effective quality assurance system to ensure continuous monitoring and improvement in the service people receive. The health and safety of people who live in the home must be safeguarded by ensuring all staff are trained in safe working practises including moving and handling, first aid and basic food hygiene. The electrical installations in the home must be checked to ensure the safety of people who live and work there. 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 35 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 35 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. People who are considering moving in to the home are provided with some helpful information about what life is like there. However some of the information is out of date and misleading. There are admission and assessment procedures in place however these could not be tested as no one has moved into the home since the last inspection. Evidence: Some helpful information is available for anyone who may consider moving into the home. This information is contained in the statement of purpose and service user guide. It was noted at the last inspection that these documents are well written although a requirement was made to amend some of the content. Some amendments were made at the time however the information has not been updated since and the document contains a number of inaccuracies. For example: There are eight activities listed as provided for people who live in the home, only five of these are actually available. The information about the manager is out of date, there is no registered manager in the home. The documents do not contain information about numbers of staff. Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: There have been no admissions to the home since the previous inspection. There are assessment procedures in place should anyone consider moving into the home in the future. Care Homes for Adults (18-65 years) Page 12 of 35 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. People who live in the home can be confident their physical needs are understood and met. Each person has a care plan which is easy for them to understand. Current risk management and care planning systems are not up to date, do not provide clear guidance for staff or promote peoples independence. Evidence: People who live in the home can be confident their physical needs are understood and met. It was obvious that people are happy living in the home and have good relationships with staff. Staff on duty during our visit clearly know residents well and interaction observed throughout the inspection was warm, friendly and respectful. Each person has a care plan in a format which is easy for them to understand. We looked at 4 individual files as part of our inspection. People who we spoke to and who responded to the survey said they were happy in the home and were satisfied with their care. We noted at the last inspection in 2007 that the manager and staff had made a significant effort to improve the care plans for all people in the home and part Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: of the improvement has been the use of pictures and symbols. Unfortunately since the last manager left over a year ago, there is no evidence these care plans have been updated or are used by staff as a working document, guidance for staff in these documents is not individualised. There are 2 dates on the front of these documents. The original date of 2006 and a review date of 2009. However nothing in the plans appears to have changed during this period. The person in charge said he has made some additions however these have not been signed or dated and could not be tracked. There are a number of other documents in use. The individual files are very large and the information is fragmented and therefore not user friendly or easy for staff to access. Individual care reviews are carried out regularly however information recorded on reviews has not been incorporated into the care plan. For example one persons review noted some specific challenging behaviour in shops, there had been no mention of this in the care plan, no risk assessment and no guidance for staff on how to manage these behaviours. Another example was where one person has issues with weight gain, again this is not mentioned in the care plan, there is no risk assessment and no clear guidance for staff. The deputy manager said efforts were being made to contact a dietitian but no record of this had been made,it was noted that staff are making efforts to increase exercise for this person by taking them for walks. A serious incident was recorded in the daily diary of one resident, this had not resulted in any update to the care plan. There was no risk assessment on managing challenging behaviour for this person and no guidance for staff on managing such incidents. Staff who were spoken to said they just did what they could at the time to calm the situation. At the last inspection we made a recommendation that a further development with regard to peoples care plans would be to include more focus on individuals skills regarding their abilities to assist in their personal care and participate in the running of their home in order to monitor and maintain peoples skills and abilities. Nothing has been done since then in care planning, assessments or risk management processes to promote peoples independence or enable them to develop life skills in the home. In fact action taken by the home since then has decreased peoples opportunities in this area. We observed the breakfast meal and noted that staff prepared each persons breakfast in the kitchen and brought it to them at the table, toast was already buttered, had jam on, and had been cut up and cereal already had milk on it regardless of anyones individual abilities to do any of this for themselves. When asked why this was done we were told that it was too dangerous for people to prepare their own food, they might hurt themselves. We were also told people used to have more involvement in food preparation but this did not work. We were told Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: however that one person had prepared their own breakfast earlier that morning. It is very disappointing that people may lose skills because staff are doing it all for them rather than involving them to the level of each persons ability. Residents also told us they were not allowed to make their own food because they might burn themselves. The person in charge recognised there were problems with care plans and risk assessments but had just followed on from the way things had been done before the manager had left. The person in charge and other staff repeatedly told us that people do what ever they want. However inadequate care planning is hindering peoples personal development and does not support them to maximise their potential. Staff who we spoke to and who responded to our survey were happy working in the home however some comments were made about staff doing everything for people rather than supporting people to do things for themselves and there not being enough staff to do everything they would like to do with residents. Care Homes for Adults (18-65 years) Page 15 of 35 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 who live in the home benefit from the opportunity to attend day centres and colleges. However inadequate skills assessment and lack of opportunities to practise the skills learned are restricting peoples personal development. Inadequate planning means meaningful activities are not always provided and a lack of drivers has restricted activities outside the home. People enjoy the meals served but inadequate records mean it is not possible assess if the diet is healthy. Evidence: People who were spoken to during the visit told us they enjoy going to the day centre during the week. Some people also attend college. No one in the home does any paid work and no assessments have been done to see if anyone would benefit from this opportunity. At our last visit we noted: Further development with regard to peoples care plans would be to include more focus on individuals daily living skills in order to promote further engagement and achievement. It was noted that individuals had a Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: variety of skills yet there was little documented evidence to support how the peoples abilities or daily living skills could be maintained and improved. This remains a concern where opportunities to develop independent life skills are not being promoted in the home. Some people told us they were looking forward to going to Spain for a holiday later in the year. This has not been planned yet as they do not have passports. One of the staff has organised for birth certificates to be obtained so that passports can be applied for. On the day of our visit some residents went grocery shopping in the morning. After lunch all the residents sat round the table in the conservatory with paper and colouring pencils. We asked the person in charge if they felt this was a meaningful activity for all the residents. he said they all like it the weather was good and no one went out in the afternoon. One person told us he was looking forward to going to see Harry Potter that day but this did not happen as he did not have enough money left and it was unclear if there were enough staff to take him. The manager said that music sessions take place on Tuesdays but this did not happen either. There seems to be a lack of forward planning when arranging activities and outings. Comments in responses to our surveys included. when we have enough staff on duty we can take clients out more. Although they do organise day activities for service users, would like more involvement and community presence. The person in charge confirmed there was a problem with only himself and the deputy manager able to drive. None of the staff on duty at weekends drive. This severely limits opportunities for people who live in the home. The statement of purpose lists 8 activities which the home provides opportunity to take part in. Only five of these are actually on offer. There is a chalet in the garden where residents can play games such as darts or snooker. At least 2 of the residents would like to go to church according to their care plans, this has not happened recently. it is unclear whether this is due to lack of drivers or insufficient staff. Different staff who were asked gave different answers as to the reason why. One person particularly enjoys working with plants and flowers, he gets involved with watering the garden. he told us he used to have a vegetable patch, the person in charge said this had been got rid of because he didnt look after it. During our visit we saw people chatting between themselves. Two residents were discussing their unhappiness with one member of staff, otherwise everyone appeared relaxed and happy in the home. Comments in responses to our survey included, I have always been happy with the care but I do worry at times as they seem to change staff quite a lot and I think this does cause a little concern as the residents have to get to know new people. get a driver for more activities, day trips would like more days Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: out want more parties There is a menu displayed on the kitchen wall. Records of residents meeting show that people who live in the home are involved in planning the menu. People can choose what they want to eat. Staff are expected to record food served on daily sheets however these are not always completed which means there is no consistent record of food served in the home. We saw in one persons daily diary that he had had chips for lunch and for dinner on the same day recently. When this was raised with staff they said people could have whatever they wanted. The person in charge agreed to make sure a consistent record is maintained in future to ensure people receive a varied and nutritious diet. Answers in our surveys to what the home does well included. cook nice food nice food always clean good food love the food Meals are served in the pleasant conservatory which overlooks the garden and people enjoy the food served in the home. The provider was advised during feedback that people who have expressed a which to attend church must be supported to do so; peoples abilities to access employment should be assessed and access to transport must be provided. To ensure people have the opportunity to fulfil their spiritual needs; they are supported to maximise their potential and are able to pursue their chosen lifestyle and activities.. Care Homes for Adults (18-65 years) Page 18 of 35 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 who live in the home can be confident their health care needs are met. The way in which their personal care needs are met promotes their privacy and dignity. They are protected from harm through the safe handling of medication. Evidence: People who live in the home can be confident staff who support them with their personal care needs will do so in a way that promotes their privacy and dignity. Care plans seen contain guidance for staff on how to provide personal care to each person. People are encouraged to choose their own clothes. Some discussion took place about the need to make guidance for staff more person centred in terms of how to support people to maximise autonomy and independence in these matters. People who live in the home can be confident their health is monitored. We sampled 4 care plans, these all contained health action plans, a pictorial health care booklet and checklist, body weight chart, clear records of health care appointments attended including GP, optician, dentist, chiropodist, specialist health care professionals. Three GPs responded to our survey, their comments included. Genuine care for clients. When discussing health needs seem to know about the client and answer questions Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: fully. Take care to maintain dignity. I have no issues re the service. Staff have undertaken specialist training to support an individual with PEG feeding and the district nurse is available to the home should any concerns arise. People are protected from harm through the safe handling of medication. There is a comprehensive medication policy and procedure regarding administration of medication. Medication is managed via a Monitored Dosage System (MDS) system, which is overseen by senior staff. The home have a robust recording system of medication brought into the home and returned to the dispensing pharmacy. Medication is stored in a secure cabinet. The home works closely with the local pharmacist and the person in charge confirmed that all staff who administer medication have been trained to do so. Care Homes for Adults (18-65 years) Page 20 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are encouraged to offer comment or complaint. They are protected from abuse. No complaints have been recorded. Evidence: People who live in the home are encouraged to offer comment or complaint, regular residents meetings provide an opportunity for this. There is a complaints procedure. No person has contacted the commission with any concerns about the service since the last inspection. One person who lives in the home who responded to our survey said. They listen when I want something Surveys received show people know how to make a complaint. People were heard talking freely to staff during our visit about a variety of issues. Staff were patient and sensitive in their responses. Some discussion took place about the lack of any record of complaints raised by residents and the need to record all complaints, not only formal complaints that are received from external sources. People who live in the home are protected from abuse. Staff are aware of the local authorities multi agency procedures for safeguarding adults, a copy is available in the home. The home also has a safeguarding adults procedure which has recently been updated and a whistle blowing policy and procedure. Staff training records and employment files seen during the visit show staff have received safeguarding vulnerable adults training and all new staff are checked through the Criminal Records Bureau before they start working in the home. Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: Care Homes for Adults (18-65 years) Page 22 of 35 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 who live in the home enjoy a comfortable and homely environment. Some areas of the home still need upgrading. People may be at risk of infection where soap and towels are used communally. Evidence: The home provides a homely and comfortable environment for the people who live there. The person in gharge recognises there are still areas where redecoration and repair is required. Carpetting still needs replacing in a number of areas. A maintenance/decoration plan is in place and improvements have been made since the last inspection. The two lounge areas have comfortable sofas and adequate seating for people to use and receive their visitors. The home has 3 bathrooms, only one has a bath. One bathroom is out of action and is being refitted as a shower room, a contractor was working on tiling this area during our visit. The other two bathrooms needs some attention and upgrade. The person in charge said people preferred to have showers rather than baths. There is one shared room in the home. Everyone else has their own rooms, some of which were seen during our visit. Bedrooms are comfortably furnished and people have personalised them to their own taste. In each of the bedrooms there are personal possessions, furniture and leisure items which include televisions, music and photos. One person Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: who responded to our survey told us they like the colour of their room. There are two laundry rooms, each has a washer and a tumble dryer. One groundfloor bathroom with wc has a communal tablet of soap and communal towel which could pose a risk of infection to the people who live there. At the end of our visit the provider was advised that all areas of the home must be maintained and decorated to a reasonable standard and communal soap and towels should not be used in shared bathrooms and toilets to ensure people are not exposed to risk of infection. Care Homes for Adults (18-65 years) Page 24 of 35 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. People who live in the home are supported by a committed and caring staff team. Robust recruitment procedures protect people from harm although difficulties in staff retention and recruitment are having an adverse effect on people who live in the home. Evidence: People who live in the home are supported by a committed and caring staff team. There are currently 9 permanent care workers. Five staff have left in the last year. The person in charge told us that staff recruitment to replace those permanent staff who have left has been slow to find the right skilled candidates. We discussed ways of improving staff retention in the home. One relative who responded to our survey said, I have always been happy with the care but I do worry at times as they seem to change staff quite a lot and I think this does cause a little concern as the residents have to get to know new people. Seven staff responded to out surveys, the responses were mixed and included the following comments. Staff and management are very supportive, I get along with all the staff. Carers are not valued or understood when we have enough staff on duty we can take clients out more. We interviewed two members of staff during our visit and also spoke to the deputy manager and person in charge. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: The person in charge told us in the AQAA that staffing levels are appropriate for the needs of the residents and regularly reviewed. However our findings during this inspection indicate there are not enough staff with the right skills to provide a good service to the people who live in the home. The shortage of drivers is having a negative effect on people who live in the home. The rota shows 3 people on duty during day, 8 am to 8 pm and 2 at night, one waking, one sleeping. Robust recruitment procedures protect people from harm. We looked at 3 staff files. Two are overseas students who work 20 hours per week and 40 hours during the term holidays. Files contain records of face-to-face interview. The files are up to date and well maintained, they contain all the required documentation including application forms, current Criminal Records Bureau clearances and 2 references. We discussed concerns with the person in charge about one file where the student visa had expired and a new application had been made to the Home Office. He told us he was waiting for the member of staff to bring in confirmation of his new college course for the file. People who live in the home are supported by staff who are provided with training to do their jobs. People can be confident the majority of the staff team are well qualified. Six of the nine support staff are currently involved in achieving or have achieved their National Vocational Qualification in Care (NVQ) awards. One of the staff we interviewed has achieved NVQ level 4 and is currently undertaking a leadership and management qualification. The person in charge tells us in the AQAA that staff have clearly defined job descriptions and through induction and supervision understand their role to support the needs of the residents and uphold the aims and objectives of the home. All staff are given a copy of the General Social Care Council Code of Conduct. The keyworker system operated within the home provides an opportunity for staff to develop an interactive relationship with their key resident. Staff receive regular feedback through performance supervision and opportunity to discuss any issues or concerns as well as highlight any skills shortage. Six out of the seven staff who responded to our survey confirmed they had received induction training which told them everything they needed to know about the work they do. Care Homes for Adults (18-65 years) Page 26 of 35 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. People who live in the home cannot be confident the home is being managed in their best interests. There is no effective quality assurance system to ensure continuous improvement in the service. People cannot be confident their health and safety is promoted where staff are not trained in safe working practises and not all installations are checked regularly. Evidence: The failure to register a suitably qualified and experience manager has had a detrimental effect on the standard of service provided to people who live in the home. There has been no registered manager in the home for over a year. The person in charge during our visit has been acting manager during that time and has begun his NVQ level 4. The lack of proactive leadership and effective quality assurance systems has meant the service has stopped developing and people who live in the home have fewer opportunities for personal development. Staff responses to our survey were mixed and included: The manager and deputy manager is always helpful if I need to speak to them they make time for me. The home is doing perfect well need good management support to staff members. Carers are not valued or understood (Staff Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: refer to the person in charge as the manager.) The person in charge completed the Annual Quality Assurance Audit (AQAA) In it he tells us what the service does well: The home has a cosy and friendly atmosphere in which residents feel comfortable, happy and most importantly safe. Residents are consulted regularly about what happens in the home in terms of decorating and improvements and are encouraged to participate in all decision-making about their care and daily living. Each resident is treated by our staff team as an individual with their own personalities with likes and dislikes. They are given choices, treated with respect. Care is delivered sensitively, affording a high level of dignity to each individual. Our residents look upon each other as part of their family and enjoy participating in birthdays and other celebrations. Appropriate referrals to professionals are made as required and outcomes suitably recorded. Our findings at this inspection concur with this assessment. He goes on to say: The Residents are encouraged to maintain links with the community, using the homes minibus to access places of their choice and to participate in what external activities they wish, ensuring an awareness of their surroundings. The home seeks the views not only of those who use our service, but relatives and visiting professionals, taking compliments and complaints seriously so that solutions can be found to enable improvement. These statements are only partially correct in that community links are minimal, a lack of drivers is having an adverse effect on this aspect of the service as stated throughout the report. it is true that surveys are sent out annually to residents and other parties however, the responses are not evaluated as part of any quality assurance system. The lack of any recorded complaints does not indicate that complaints are taken seriously. The person in charge could not provide evidence of an effective quality assurance system to monitor standards in the home. Staff meetings are held regularly but points raised, such as the need to draw up a procedure for managing one persons behaviour are not followed up. The service is reactive with no evidence of an effective cycle of planning, action and review. Requirements from the last inspection have been partially complied with. In that some changes were made to the Statement of Purpose by the previous manager but it has not been updated since to reflect the current situation. Partial compliance with the requirement relating to repairs and maintenance has been achieved but more work needs to be done. People who live in the home are not always protected where not all staff have been trained in safe working practises. Not all staff have received training in moving and handling. We were concerned to find that one person had been working in the home Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: for a year without this training. One other member of staff had also not received this training. Not all staff who prepare and serve food have received training in food hygiene or first aid. Equipment and installations are checked regularly however the electrical certificate for the home expired in January this year and re testing of the system has not been booked or carried out to ensure the premises are safe. Care Homes for Adults (18-65 years) Page 29 of 35 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 30 of 35 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 1 4 The Statement of Purpose and Service User Guide must be kept up to date, reviewed and amended as changes occur. To ensure people have accurate and up to date information about what life is like in the home.home. 31/10/2009 2 6 15 Care plans must be reviewed 31/10/2009 and updated as needs change and provide clear guidance for staff. Care plans must include assessment of individual abilities goals and aspirations and provide clear guidance for staff on the levels of support required. To ensure peoples individual needs continue to be met in the home and to ensure people are supported in a way that maximises and promotes Care Homes for Adults (18-65 years) Page 31 of 35 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 their independence.. 3 14 12 Leisure activities provided 31/10/2009 should be suitable and meaningful, planned in consultation with the people involved. Access to transport should be provided and those who wish to attend church should be supported to do so. To ensure peoples individual interests and abilities are catered for. 4 17 17 People should be actively 31/10/2009 supported to prepare and serve meals within a risk management framework, a clear record of actual food provided in the home should be maintained. To ensure people have opportunity to practice their life skills and have a well balanced, nutritious and healthy diet appropriate to their individual needs. 5 33 18 The home must ensure the recruitment and retention of staff is improved. To ensure there are sufficient numbers of staff with the right skills to ensure people are provided 31/10/2009 Care Homes for Adults (18-65 years) Page 32 of 35 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 with consistent supported pursue their chosen lifestyle and activities. 6 37 18 The registered person must appoint asuitably qualified, skilled and competent person to manage the home and arrange for this person to submit an application for registration to the Commission To ensure the home is managed in the best interests of the people who live there. 7 39 24 There must be an effecive quality asseurance system that takes account of the views of service users. To ensure continuous improvement in the service people receive. All staff should receive all the mandatory training in safe working practises. The electrical safety certificate must be up to date. To ensure people are protected from harm. 31/10/2009 30/11/2009 8 42 13 30/09/2009 Care Homes for Adults (18-65 years) Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 34 of 35 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). 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. Care Homes for Adults (18-65 years) Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!