Care Home: Brampton View

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What the care home does well People at the home have good one-to-one support from staff with their personal care and hygiene if they need. People have their privacy, rights, choice and dignity respected. People at the home have good access to health and social care support and meet with professionals regularly or when they need to. People have their medicines on time. People have their different things that they do each day and they choose what they want to do. Some people like to help with the meals. They have a healthy and a good choice of meals. Staff at the home give support to the people who live at the home, help them to make decisions, plan and take part in activities. These include going to college, using the local services and leisure centre’s. Staff take people out in cars, which staff can use. This helps people to take part of more activities in the community. Some people look after their own money if they want to. Staff help other people to look after their money.There are regular `residents meetings`, where people plan the menu, plan the activities they want to do, let staff know what is upsetting them, any complaints and make sure the home is clean and safe for them at all times.People who live at Brampton View live in a modern property, which is large, spacious and is on ground level. All the bedrooms have lots of space and have an en-suite shower and toilet. The home is clean and tidy.The staff work well together. They support the people who live at the home, understands their needs and challenges and helps them to be as independent as possible. What has improved since the last inspection? The requirements we made at the last inspection of home have now been addressed.People who live at the home are asked about what they think about the help they get and the home.Some staff have learnt about learning disability, autism and how an illness affects people. Staff meetings take place every week to help staff keep up to date with changes in service and the people who live at the home. There are more staff on duty so that people can be supported to take part in activities. What the care home could do better: Brampton View needs to continue to improve how information is recorded such as care plans, daily records, reviews and the medication profiles to make sure information is up to date. The assessments of risks must be carried out to make sure people are safe.Staff should have regular support, supervision and training to make sure their practice, knowledge and skills.The remote controlled gates to get to the home must be repaired.To make sure there is leadership, direction and stability in the home an `Acting Manager` must be appointed. They must apply to CQC to become the `Registered Manager` for Brampton View. This is important as all health and social care services must meet the registration requirements for the new `Health and Social Care Act 2008`, coming into force next year.We have made a number of good practice recommendations, which we talked about with the two Interim Acting Managers. The recommendations made could improve the quality of life people experience and for the service to be more effective and efficient. This would promote the health, safety and well-being of the people who use the service. Key inspection report Care homes for adults (18-65 years) Name: Address: Brampton View 421 Welford Road Northampton NN2 8PT 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: Rajshree Mistry Date: 0 1 1 2 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 46 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 46 Information about the care home Name of care home: Address: Brampton View 421 Welford Road Northampton NN2 8PT 01604475333 01604472892 keithmsaada@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Msaada Care Limited care home 6 Number of places (if applicable): Under 65 Over 65 6 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is 6. The registered persons may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission are within the following category: Learning disability - code LD Date of last inspection 0 5 1 2 2 0 0 8 A bit about the care home Brampton View is a registered residential care home for six people with a range of learning disabilities and complex needs. Brampton View is owned and is part of Msaada Care Ltd. Brampton View is situated on the Welford Road 3 miles north of Northampton town centre. The home is Care Homes for Adults (18-65 years) Page 4 of 46 near the area of Kingsthorpe. There are shops, recreational and leisure facilities close by and the town centre is a short bus ride away. Brampton View offers ground floor accommodation, with en-suite shower and toilet facilities. Access to the home is via remote controlled gates. The communal areas are spacious, bright and contemporary decor. The Interim Acting Managers gave us the fees people have to pay. These range from £1500 to £1850 per week. There are additional personal expenses for personal toiletries, magazines, clothing, meals out and holidays. The fees are determined upon individual assessment of needs and requirements. People considering using Brampton View should contact the home directly to discuss individual needs and requirements. Full details for Brampton View and any specific requirements can be obtained in the form of the Statement of Purpose and the Service User Guide. The latest Inspection Report from the Care Quality Commission is available at the home or accessible via our website: www.cqc.org.uk Care Homes for Adults (18-65 years) Page 5 of 46 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 Care Homes for Adults (18-65 years) Page 6 of 46 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. We as written in this Inspection Report means the Care Quality Commission (CQC). We did this inspection by visiting Brampton View on 1st December 2009. We arrived at the home at 11.30am and stayed for 7.5 hours. Before we went to Brampton View we looked at the information the previous Acting Manager had sent to us, this gave us information about the home. We sent surveys to the people who live at the home, the health and social care professionals who provided support, guidance and care for the people who live at the home and the staff. We looked at the care plans and records of three people who live at Brampton View. We talked with the people who were at the home when we visited. We also talked with the staff and asked them how they help and support people. We have written about what we found out when we visited the home and what people told us. Care Homes for Adults (18-65 years) Page 7 of 46 What the care home does well People at the home have good one-to-one support from staff with their personal care and hygiene if they need. People have their privacy, rights, choice and dignity respected. People at the home have good access to health and social care support and meet with professionals regularly or when they need to. People have their medicines on time. People have their different things that they do each day and they choose what they want to do. Some people like to help with the meals. They have a healthy and a good choice of meals. Staff at the home give support to the people who live at the home, help them to make decisions, plan and take part in activities. These include going to college, using the local services and leisure centre’s. Staff take people out in cars, which staff can use. This helps people to take part of more activities in the community. Some people look after their own money if they want to. Staff help other people to look after their money. Care Homes for Adults (18-65 years) Page 8 of 46 There are regular residents meetings, where people plan the menu, plan the activities they want to do, let staff know what is upsetting them, any complaints and make sure the home is clean and safe for them at all times. People who live at Brampton View live in a modern property, which is large, spacious and is on ground level. All the bedrooms have lots of space and have an en-suite shower and toilet. The home is clean and tidy. The staff work well together. They support the people who live at the home, understands their needs and challenges and helps them to be as independent as possible. What has got better from the last inspection The requirements we made at the last inspection of home have now been addressed. Care Homes for Adults (18-65 years) Page 9 of 46 People who live at the home are asked about what they think about the help they get and the home. Some staff have learnt about learning disability, autism and how an illness affects people. Staff meetings take place every week to help staff keep up to date with changes in service and the people who live at the home. There are more staff on duty so that people can be supported to take part in activities. What the care home could do better Care Homes for Adults (18-65 years) Page 10 of 46 Brampton View needs to continue to improve how information is recorded such as care plans, daily records, reviews and the medication profiles to make sure information is up to date. The assessments of risks must be carried out to make sure people are safe. Staff should have regular support, supervision and training to make sure their practice, knowledge and skills. The remote controlled gates to get to the home must be repaired. To make sure there is leadership, direction and stability in the home an Acting Manager must be appointed. They must apply to CQC to become the Registered Manager for Brampton View. This is important as all health and social care services must meet the registration requirements for the new Health and Social Care Act 2008, coming into force next year. Care Homes for Adults (18-65 years) Page 11 of 46 We have made a number of good practice recommendations, which we talked about with the two Interim Acting Managers. The recommendations made could improve the quality of life people experience and for the service to be more effective and efficient. This would promote the health, safety and well-being of the people who use the service. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Rajshree Mistry Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA Tel: 03000 616161 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 set out on page 4. Care Homes for Adults (18-65 years) Page 12 of 46 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 13 of 46 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 14 of 46 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in the assessment of needs process to ensure their needs are met and would benefit from having up to date information about the service. Evidence: We wanted to find out what information people received about Brampton View to help them decide whether they want to use the service. The information gathered from the self-assessment completed by the previous Acting Manager stated people are given the Service User Guide. We read this and found it contained information about the range of services, facilities and opportunities available to people using the service. The Interim Acting Manager told us that the information can be made available in alternative formats upon request. We read the Statement of Purpose, which sets out the aims and objectives of the service and what people can expect to experience should they choose to use the service. We noted that there was no information about the manager and staff in both the Statement of Purpose and the Service User Guide, as the position is vacant. The majority of the surveys we received from the people who use the service indicated Care Homes for Adults (18-65 years) Page 15 of 46 Evidence: that they did have information and chose to move to the home. The people we spoke with during the site visit had varied experiences of how they moved to the home. Whilst one person we case tracked moved to the home in an emergency, another person we case tracked had a planned move to the home. Staff told us that they visited the newest person in their previous home to allow the person to get to know the staff and the staff to know the person. This further showed the person moving to the home had a planned move. We wanted to find out how individual care and support needs are known. The information we gathered from the self-assessment stated, an assessment of needs is carried out to ensure the persons needs can be met. We identified three people to case track, which included a person that was new to the home, a person who had complex needs and someone who had been at the home for a long time. We read the care files for the people we case tracked. All contained a copy of the assessment of needs carried out. This process helps to identify the individual needs, including any illness, disability, medication and any known challenging behaviours. The persons interests, activities and past-times including attending college is also detailed. The contact details of any family, health and social care professionals and college tutors were also included. The assessment also had guidance about the potential level of support the person requires and access to specialist equipment. This showed the issue raised at the last key inspection has been addressed. One person sat with us and showed us their care file. They were aware of the contents in the care file and confirming what help they needed, which was consistent with the information in the care file. They told us why they came to Brampton View and how they have been supported. This showed people are involved in assessment of needs process and how they want to be supported to ensure their needs are met. The staff we spoke with also told us they are involved and kept informed about any new person that may be moving to the home. They said this information is shared at handover meetings and detailed in the care files. We concluded the assessment of needs process is robust to ensure people who use the service have their needs met. Care Homes for Adults (18-65 years) Page 16 of 46 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 continue to make choices and decisions about life. The care planning and assessments of risk systems are not robust or up to date. Evidence: We wanted to find out how peoples needs are met and how people are supported to make individual decisions and choices. We were limited in gathering information from the self-assessment completed by the previous Acting Manager, as it was completed for an Older Persons service instead of a Younger Adults service. It stated people are supported as individuals to access and participate in chosen activities, user led care plans, which reflects their needs and more able users supported to access the community independently. The surveys responses received from the people who use the service all indicated that they are able to make decisions about what they do each day, evenings and at the weekends. The comments in the surveys with regards to what they do included music, watching TV and staff talk to me. Care Homes for Adults (18-65 years) Page 17 of 46 Evidence: We read the care files for the people we case tracked. The three care files had different forms of care plans, which detailed the range of care and support needs the individual required. For example staff were using the care plan used at the previous home from where the person had moved from recently. There were no assessments of risk in place, especially as the person had limited mobility and used special equipment to help them with their mobility. The Interim Acting Manager told us they are developing the care plan as they get to know the individual as they settle in the home and establish their own routines. This could place the individual and staff at risk. One person we case tracked showed us their care file and together we went through their care plan. The care plans was comprehensive and had good information about their support, lifestyle and preferences. These were divided into individual plans and written from the view of the person, which is known as person centred. The care plans ranged from support with personal care tasks to support with health and medication, supporting people with specific challenging behaviours and the tools used, social activities and keeping their bedroom and the home tidy. Individual risk assessments were completed and the agreed safety measures were reflected in the care plans. Each plan title was supported by a picture to help the person recognise what the plan was about. As we went through the care plans the person told us what they do and how staff support them. All the care plans had clear guidance for the staff to follow. This showed that they were involved in developing the care plan. The third care file we read for a person who had complex needs, caused us concerns. The care plan being used was written in 2007 and there was evidence of the persons needs changing including their medication, which was communicated to the home by the General Practitioner on 15.04.08. However, the care plan had not changed and there was no evidence of the care plan being reviewed monthly. This highlighted that whilst staff that we spoke with supported the person with their changing needs, records were not reflective of this. This also places the individual at risk as they have no verbal communication and staff may not have the current information to support the person appropriately, especially if staff are required to give medication. The staff we spoke with demonstrated a good understanding of the people who live at Brampton View. Staff spoke about peoples needs, strengths, weaknesses, vulnerability and strategies used to support people when they display challenging behaviour. Staff gave us examples of how they support people as some people are provided with one-toone time, to help promote peoples well-being, confidence and independence. This showed whilst peoples needs appear to be met, information available to the staff with regards to individual care and support needs is not up to date. The practice with regards to supporting new people at the home is reliant upon information provided by the previous care home and no assessments of risk carried out, where people require support with their mobility and the use of equipment. This could place people and staff at risk. Page 18 of 46 Care Homes for Adults (18-65 years) Evidence: We looked at three staff training records. We found some training certificates showing staff had received training in health and safety, first aid, epilepsy, challenging behaviour, infection control and safeguarding adults. There was a staff training matrix but it was not up to date. Therefore, it was difficult to establish the skills and knowledge of the staff. However, from our discussion with the staff it was evident that staff were caring and keen to support people using the service. We shared our findings, information in the care plans, risk assessments and reviews, including the lack of information and concerns with the two Interim Acting Managers. They accepted the findings and said the changes in the management of the service further highlighted the issue of recording. We wanted to find out what decisions people make, how they are supported to participate in social activities, take responsibility in the home safely. We observed people who use the service throughout our visit making decisions about what they do. Staff were seen responding to requests and engaging with people to help them recognise their strengths and plans for the evening. Some of the comments received in the staff surveys included: There are some very good support workers there, unfortunately consistency is lacking in the level of support throughout the support team At times the person I know has said it has been under staffed as a support team We spoke with some people on the day who told us how they spend their day and what they like doing. Each person had their own individual routine. These ranged from going out to the local shops, using public transport to go to town, going to the bank and to college. There was an activity plan displayed in the office, which had been agreed by the people using the home at the last residents meeting, and this could change at any time. People benefit from having a spacious environment to live in and bedrooms with en-suite facilities that promotes their well-being, privacy and independence. Some of the comments received from the people we spoke with included: I like it here because I can do different things and staff help me I can do what I want, within reason - there are some rules Im going college after Christmas We have residents meetings every week about what we do and the menu Care Homes for Adults (18-65 years) Page 19 of 46 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy individual lifestyles, routines and opportunities to take part in social and leisure activities that promotes their well-being and independence. Evidence: We wanted to find out what lifestyle and opportunities were available to people who use the service. The information we gathered from the self-assessment completed by the previous Acting Manager stated supported as individual to access and participate in their chosen activities. The responses and comments received in the surveys completed by the people who use the service indicated that they all made decisions about each day, evening and weekends. Some of the comments received in the surveys, which staff helped people to complete included: Activities, sometimes dont like My room is nice Care Homes for Adults (18-65 years) Page 20 of 46 Evidence: Watching TV, get good food, entertainment and nice staff We also received surveys from health care professionals such a Consultant Psychiatrist, General Practitioner and Care Management Learning Disability Team. The responses indicated peoples health needs including support with medicines, are usually met. Some of the comments received in the surveys to further support views about Brampton View were and how the service could be improved: 3 residents who are under my care are settled and happy with the care and support they receive There are some very good support workers there, unfortunately consistency is lacking in the level of support throughout the support team Listen to the individual who live there to a greater degree Support workers to support to a consistent level and understanding they are working in a persons house and not see it solely as a work base The two Interim Acting Managers accepted the comments received in the surveys with regards to staffing levels and consistency of staff. We were told that staffing levels had increased to three staff in the day to enable people to take part in social events and outings. We observed the lifestyle and routines of people who were at home during our visit. One person had several people were sat in the lounge, watching television, chatting with staff and doing artwork. We saw one person go out in the car with their key worker and were told that another person was at college. One person who uses the service was singing along with the song,’ Michelle and then had visitors. We saw another person who wishes to continue to smoke have a cigarette standing outside the home. There was a relaxed atmosphere in the home, people were clearly choosing to do what they wanted to and there were enough staff on duty to provide the one-to-one support if required. The people who use the service spoke about the things they like to do ranging from going into town using public transport, going to the bank, pub, the cinema and being responsible in the home such as cleaning, doing their own laundry and helping with the preparation of meals. Everyone we spoke with told us about the residents meetings, where they do have their say, plan meals and let staff know what social activities they want to do such as going to the pub, swimming or the cinema. Some of the comments received from the people we spoke with included: I had to get myself ID so that I could buy cigarettes and Ive now got a bus pass I like to keep my CDs and DVDs organised Care Homes for Adults (18-65 years) Page 21 of 46 Evidence: They help me keep my bedroom clean and tidy I can do what I want, within reason, there are some rules I went to the bank and felt like a plonker because I forgot my bank card We were invited to view two peoples bedrooms. They were personalised, spacious and decorated to reflect their interest and personalities. All the bedrooms had en-suite shower facilities that promotes privacy and independence. One person was proud to show us their organised collection of CD and DVDs. We spoke with staff regarding how they support the people who uses the service. Staff said they have individual staff that they support, known as key working. Staff demonstrated a good understanding of the individuals they support, their vulnerability and how they support them to be more confident and praise them when they do well. A member of staff spoke about the support and arrangement they made to take one person on holiday for a short break. This showed people do have the opportunity to go on holiday if they choose with the support from staff. Staff showed us the weekly activity planner, displayed in the office. This showed the range of activities people had identified that they wish to do. Staff said people are encouraged to maintain contact with family and friends, if they choose. We observed one person having family visit and later spoke with another relative on the telephone. Another person who uses the service said they keep in contact with their mother. A member of staff who took one person on holiday said they liaised with the parents when making the holiday arrangements and budgeting. Staff recognised the importance of people maintaining contact with family and understanding relationships and the importance of rights, consent and protection, if they choose. Some of the comments received from staff that showed they understood people and how they support them included: We are still getting to know ...., what she likes doing, which is usually arts and painting We know she wants to go to college, she use to do pottery but we have to wait till after Christmas now She goes to college, uses a wheelchair but is quite able and vocal to express herself I spend about 2 hours with her on a 1:1 basis and we talk, shes gradually opening up. I just talk about life in the sense that sometimes life is not a bed of roses and there are things that happen outside of our control Page 22 of 46 Care Homes for Adults (18-65 years) Evidence: Try to be happy and do the things that make them happy I was drawn to him when I met him, I was interested in ...., he has autism and is diagnosed with PKU, which is a genetic disorder He doesnt speak but still able to communicate I tried to find out about PKU and how it affects people and .... does have complex needs but is very intelligent We read the care files for the people we case tracked. We already established that care plans ranged from being current and up to date to being out of date by 2 years and using information from the previous residency. All the care files did have daily records, which are completed by the staff and reflect peoples well-being, any concerns or incidents and the things they did. The daily records were dis-organised and in some instances incomplete. For example we found two body maps were completed following an injury or incident but only one body map was referred to in the daily record. Therefore, it was difficult to establish what actions were taken to ensure the persons well-being and safety. It was also difficult to see whether people did take part in the events detailed in the activity planner. We shared our findings with the two Interim Acting Managers, who both accepted the issue. They also told us since working at the home, they have had to organise and file paperwork left. This indicated that management systems for recording and organisation needed to improve. We observed staff preparing meals for the evening and was assisted by a person who uses the service who was chopping the vegetables for a pasta bake. Staff wore gloves and aprons when preparing meals and staff training records showed staff had completed training in food and hygiene. Staff were aware of individual likes and dislikes of food including special dietary needs. There were comments exchanged by two people who use the service, teasing the member of staff who was preparing the meals but then said shes a good cook and so is ..... Staff told us people confirm the proposed menu at the residents meeting and some people like to help with the food shopping. This showed people who use the service are encouraged to be involved in planning and preparation of meals. The people we spoke with were happy with the choice of meals provided. The care files contained information about individual preferences of meals; likes and dislikes of foods. This showed peoples health and well-being is promoted as they positively choose the menu for each day. Care Homes for Adults (18-65 years) Page 23 of 46 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 are supported to be independent with their personal care and health needs. Record keeping and accuracy of records needs to improve to ensure the well-being is promoted. Evidence: We wanted to find out how people are support with their personal care and health needs. The information we gathered from the self-assessment completed by the previous Acting Manager stated have service user led care plans, detailed risk assessments, some support with personal, psychological and social care needs and access to additional support from Psychologists, Psychiatrists and Community Nursing Team. There was little information with regards to systems, practices and how people are supported with their medication. The responses in the surveys from the people who use the service were generally positive with regards to being supported with their personal care and health needs support. Some of the comments in the surveys indicated that staff do not understand the people who use the service, such as: Sometimes its hard when staff dont understand Care Homes for Adults (18-65 years) Page 24 of 46 Evidence: Need to understand better The responses and comments in the staff surveys indicated that they have good information about individual needs and have had training to support the people who use the service. Some of the comments received with regards what the service could do better included: Get more staff and change some of the furniture Get a cook and get some staff trained We also received surveys from health care professionals such a Consultant Psychiatrist, General Practitioner and Care Management Learning Disability Team. The responses indicated peoples health needs including support with medicines, are usually met. The comment received with regards to what the service could do better included: As the service is providing care for people with a learning disability and challenging behaviour, there should be more staff available on shift to provide structured care and managing behavioural problems The people who use the service that we spoke with all said that they are supported with some personal care tasks or staff often remind them. People said they make choices about the time they choose to get up, clothes they wear, going out and retiring for the night. One person told us that they still prefer a member of staff to support them when they attend health appointments or check-ups. They said: I wash my private parts and they wash my back I want .... to come in with me when I see the doctor Staff help with showering and change my pads The staff we spoke with that key work the people we case tracked knew about peoples individual needs and levels of support that they required. They gave examples of how they support individual with their personal care needs and daily routines that promotes independence and well-being. This showed staff had a good understanding of the needs of individuals and also encouraged people to be as independent as possible. The care files we read, specifically the care plans and the daily notes varied from being up to date to being out of date by 2 years. We found evidence of reviews being done for the person whose care plans that was up to date. The daily records did show that people were supported with their personal care needs and there were records kept of health visits and appointments. We also found records of the review meetings held with professionals but the information had not been reflected in the care plans. There were Care Homes for Adults (18-65 years) Page 25 of 46 Evidence: records such as the body maps detailing injuries but not linked to what support or emergency treatment, if any, was given. This highlighted that records relating to the people who use the service are not kept up to date or accurate. We have also referred in the earlier part of this key inspection report that the care plans used for the newest person were from their previous place of residency. There was no evidence of any assessment carried out to confirm the needs detailed in the care plan were current. Therefore, this could place not only the individual at risk but other people who use the service and the staff. We were made aware of a safeguarding concern by the Care Management Team. Safeguarding means the protection and promotion of well-being of a vulnerable adult from harm, risk or abuse. The issue brought to our attention related to the wrong care plan and allegedly the wrong quantity of medicines sent with a person who was leaving Brampton View. We discussed this with the first Interim Acting Manager who said they did not know as the matter was managed by the second Interim Acting Manager. This highlighted how issues with regards to communication, record keeping, procedures for discharge from the home and the management places people at risk. The second Interim Manager admitted an error was made and the correct care plans were printed. However, the first Interim Manager was yet to deliver the care plan to the person in their new place of residency. We wanted to find out how people are supported with their medication. We had received a copy of the monthly visit report dated 19th October 2009 for Brampton View, conducted by the Quality Assurance and Development Manager for Msaada Care Ltd. The report highlighted a number of issues and plans for improvements. These included medication procedures, individual medication profiles, completion of medication reports and staff training. The two Interim Acting Managers told us of the progress made in respect of the actions required from the monthly visits. One of the Interim Acting Manager said they had checked the medication records following the safeguarding allegation regarding the medication transferred with the person moving out of the home. They showed us the records to demonstrate the quantity that had been administered, which showed records were accurate but could not be checked against the medication. This highlighted the need to have some guidance or a procedure should be in place for when people move out of the home to ensure people have the correct medication, which is recorded. The medication is kept in the locked medication cabinet in the office. There is also the controlled (very strong) drugs medication cabinet, which is secure and complies with the British Pharmaceutical Society, although no-one takes controlled medicines. Staff training records showed staff who have the responsibility for administering medication have received training. We checked the medication remaining in the blistered packs against the medication records sheet, which accurately reflected people receive their medication on time. People we spoke with said they have their medication on time. Care Homes for Adults (18-65 years) Page 26 of 46 Evidence: We saw the medication profiles in the care files for the people who we case tracked. These have been developed since the last key inspection of the service to show the current medication people are taking. However, for one person we noted that the medication profile was out of date, as there was information in the care file of the changes in medication confirmed by the GP. This further highlights the record keeping and management of records needs to improve to ensure peoples health and well-being. Care Homes for Adults (18-65 years) Page 27 of 46 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are confident to complain to improve their quality of life. Staff knowledge and practice in protecting people from harm, risk or abuse could be improved. Evidence: We wanted to find out whether people who use the service were aware of the complaints procedure and what support is available to them to make a complaint. The information we gathered from the self-assessment completed by the previous Acting Manager stated there are detailed policies on concerns and complaints made available to all residents and should there be a complaint made by a resident or staff, we will act promptly to resolve any disputes. We read the complaints procedure that was also available in alternative formats such a pictorial, easy read format, Braille and on tape. The process of how complaints made are investigated was clear with set timescales. The contact details of the local Advocacy Services were provided. The surveys responses received from people who use the service indicated people were aware of how to make a complaint and who to speak with if they are unhappy. The surveys from the health care professionals also indicated that when concerns have been raised these have been addressed promptly. This was consistent with what people who use the service told us on the day: All should be nice to each other Care Homes for Adults (18-65 years) Page 28 of 46 Evidence: Id tell her (pointing to the key worker) she has to do something about it I will talk about it at the residents meeting The staff surveys responses indicated staff were confident to receive concerns. Staff we spoke with on the day also demonstrated what they would do if someone had a complaint, which was consistent with the complaints procedure. Staff were confident that the two Interim Acting Managers would be able to address the complaints quickly. Staff also told us that since there has been several changes in the management of the home the staff team have pulled together to ensure people who use the service are not affected. This showed staff recognised the potential negative outcome that could affect on the well-being of people who use the service. Some of the comments received from the staff we spoke with included: Weve pulled together as a team, we communicate well and have weekly meetings whether the manager is here or not I know the clients and dont want them to be affected by the changes with the manager In fact, its been a positive reaction as we are a team and a family in many ways for the residents here The information in the self-assessment stated that the service had received no complaints. We looked at the complaints log and noted that there was a complaint made since the last key inspection. The investigation and actions taken were recorded. Therefore, the information in the self-assessment was not true. The Care Quality Commission also received a complaint. This was referred to the home to investigate and we were advised of the remedial actions that were taken with regards to this complaint. The Care Quality Commission received information from the Care Management Team with regards to a safeguarding issue. Safeguarding means promoting and protecting the well-being and safety of people who use the service from risk, harm or abuse. The safeguarding issues related to the wrong information with regards to the care plan and inaccurate quantity of medication was given at the time when a person moved out of the home. It was also reported to us at the time that there was a previous safeguarding incident that had not been reported to us with regards to the same individual using the service. We spoke with the two Interim Acting Managers with regards to the two alleged safeguarding issues. They admitted these incidents had taken place. They said the care plans have been corrected but had not been taken to the persons new place of Care Homes for Adults (18-65 years) Page 29 of 46 Evidence: residency. Following the allegation regarding the medication, records were checked and confirmed the quantity was correct. They also told us that the service was still pursuing investigation and disciplinary action with regards to the second safeguarding issue. This highlighted concerns that improvements needed to be made with regards to communication, recording and management of the service, which could have We wanted to find out whether staff knew what safeguarding meant. ‘Safeguarding’ means protecting and promoting vulnerable people from risk, harm and abuse. The majority of staff we spoke with demonstrated a good understanding of safeguarding, the various forms of abuse that could occur, the vulnerability of the people who use the service and the actions they must take if they suspected abuse. Staff confirmed they had received training as part of their induction training. However, one member of staff was unable to show they had an understanding of the forms of abuse, action they are required to take and said they had not attended training on this topic. When we brought this to the attention of the two Interim Acting Managers we were shown the training certificate for safeguarding completed on-line. This showed that whilst staff are trained through various methods, individual understanding and competency was not tested or measured, which could place people at risk. We wanted to find out how people are supported to manage their money. One person told us they now have their own bank account and manage their own money, saying I felt like a plonker in standing in the bank without my bank card and came home again Staff told us other people who use the service have their money held in safe-keeping at the home, which they can have at any time. Staff described the system in place for people to have their money. We were shown the financial recording systems. The balance of individual accounts were accurately reconciled with receipts. However, we noted there were a number of missing signatures indicating procedures were not followed, which could give rise to allegations of financial abuse or mis-appropriation with regards to peoples money. This showed that the issues raised with regards to ensuring staff countersign transactions in the monthly visit report of 19th October 2009 had not been addressed. Care Homes for Adults (18-65 years) Page 30 of 46 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, clean and tidy home that promotes their well-being and taking responsibilities for being independent. Evidence: We wanted to find out what type of home and accommodation people live in. The information gathered from the self-assessment completed by the previous Acting Manager stated very homely for some, always clean of any physical hazards or offensive odours, all bedrooms have en-suites increasing individual privacy and house is furnished with new furniture, fixtures and fittings to give it a contemporary finishing. The self-assessment also detailed the improvements made to two bedrooms, with the replacement of the flooring and new systems for reporting faults, repairs and maintenance. The responses and comments received in the surveys from the people who use the service, health care professionals and staff were very positive, indicating the home is always fresh and clean. On our arrival at the home, we were unable to gain entry as the remote controlled gates were chained together with a padlock. We contacted the home by telephone and staff unlocked the padlock and chains to let us in. There is car parking to the rear and the home looks out onto open green space. The two Interim Acting Managers told us that the Care Homes for Adults (18-65 years) Page 31 of 46 Evidence: electronic mechanism for the gates were broken. We highlighted to them that in case of an emergency not only are people who use the service unable get away from the building but the emergency service would not be able to get in. They accepted this and gave assurance that the gates are being repaired. Brampton View appears to be a purpose built home with ground level accommodation and accessible to people with limited mobility or those who use walking aids. Two people showed us their bedroom, which had en-suite shower and toilet facility. The bedrooms were spacious, complimentary decoration and furnishing. People had personalised their bedrooms to reflect their interests, and personality with photographs and ornaments. People also had the use of the large bathroom with an assisted bath. The staff have to clean my room, that what they get paid for - no they do really help me The communal areas consisted of the large lounge and a spacious kitchen and dining room. All areas of the home were well decorated, bright, clean and tidy. We saw people relaxing in the lounge, talking to each other, with staff and visitors to the home. It was a homely atmosphere where people appeared to be at home. We observed staff wearing gloves and aprons whilst they were preparing meals. Staff showed a good understanding of health and safety and infection control procedures. Staff training records showed staff had received training in health and safety and infection control. The staff that prepare meals said they had also completed training in food and hygiene and confirmed by viewing the training certificates in their files. People who use the service said they do their own laundry with the help of staff. The laundry room is past the rear door to the home, near the car park. The cleaning products are stored cupboard away from areas where meals are prepared. People said they had particular days when it is their turn to do their laundry. People also said they are helped by staff to keep their bedroom clean and tidy. This showed people are involved in the household tasks and take responsibility for keeping the home clean and tidy. Care Homes for Adults (18-65 years) Page 32 of 46 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 protected by good staff recruitment process and communication. Staff training and skill-mix could be improved to promote peoples well-being, independence and quality of life. Evidence: We wanted to find out whether the staff recruitment process, the skill-mix of staff and the staffing levels met the needs of the people who use the service. The information gathered from the self-assessment completed by the previous Acting Manager stated all staff have relevant CRB checks and references, all staff are well trained and some undertaking NVQ3, undergone extensive BTEC training in learning disability to understand and support our client group with confidence and the manager is a registered learning disability nurse. The staff surveys we received indicated all staff were recruited with the employer carrying out pre-employment checks such as the criminal records bureau (CRB) checks. We spoke with the newest staff on duty who described the recruitment process they completed. The said they had an induction over 2 months as they had not worked in a care home setting before. We checked 3 staff files to ascertain the recruitment practice. All the files contained evidence of the pre-employment checks carried out carried out. These included two satisfactory references, crb check and a protection of vulnerable adults (pova) check. These are checks to assess the suitability of applicants to work with Care Homes for Adults (18-65 years) Page 33 of 46 Evidence: vulnerable people. Staff told us that they have attended regular updates in training, which included health and safety, food and hygiene, infection control, manual handling, first aid and medication training. Staff said they have completed training courses and on-line training with a series of multiple choice questions. The staff training certificates and records in the individual files had some certificates. These included first aid, moving and handling, challenging behaviour, risk management, epilepsy, safeguarding adults, person centred plans (PCP), communication, medication, learning disability awareness, record keeping, breakaway and control/restraint and the some had attended the Mental Capacity Act training. However, it was difficult to establish whether they had received refresher training and updates since as the records were not up to date. In addition, not every staff file we looked at contained all the certificates mentioned above. The two Interim Acting Managers showed us the staff training matrix. Unfortunately, the information contained in the training matrix was not up to date. Therefore, it was difficult to assess the staff skill-mix and the validity of training completed by the staff. There was no formal training programme in place to show the continuous training and development programme for staff. We were unable to confirm the information received in the selfassessment that staff had completed extensive BTEC training in learning disability. We had already establish following our discussion with one member of staff that they knowledge was limited with regards to the on-line safeguarding training they had completed. The two Interim Acting Managers acknowledged that there is no systems or process in place to check staff comprehension and responsibilities with regards to the knowledge they have gained from attending the training. The numerical information we gartered from the self-assessment indicated that 90 of staff have attained the National Vocational Qualification (NVQ) in care, level 2 and above. A number of staff said they have started the NVQ 3 award to continue their learning and promote better support to people who use the service. The surveys we received from the people who use the service, health care professionals and staff highlighted some issues relating to the numbers of staff and the quality of staff. The comments received included: Need to understand better Sometimes its hard when staff dont understand There are some very good support workers there, unfortunately consistency is lacking in the level of support throughout the support team At times the person I know has said it has been under staffed as a support team Care Homes for Adults (18-65 years) Page 34 of 46 Evidence: As the service is providing care for people with a learning disability and challenging behaviour, there should be more staff available on shift to provide structure care and managing behavioural problems The people who use the service spoke positively about the staff and their key workers. They said staffing was better. When we explored this we found out that staffing levels have improved with 3 staff working in the day and evening and 2 staff working at night. Staff told us that they were able to do more social activities with the people who use the service in the day, evenings and weekends, such as going into town, the local pub or to the cinema. This is an improvement from the last key inspection of the service that promotes a better quality of life for people who use the service. We concluded that there have been improvements made to the staffing levels and to provide further training and develop staff competencies. We observed staff interacting with the people who use the service. They showed kindness and were firm when required to help people understand they need to be respectful and kind to others. Staff said communication between staff had improved. There are weekly staff meetings so staff are aware of changes that affects people to ensure their wellbeing. We noted the staff supervision schedule on the notice board in the office. Staff we spoke with said they have recently started having supervisions with the Interim Acting Managers. Staff acknowledged that due to changes in the management of the service, the staff team have supported each other to benefit the people who use the service and each other. This was reflected in the staff files as there was little evidence to suggest that staff had received regular supervision even though the staff supervision schedule was displayed. Some of the comments received from staff supported this and highlighted the needs for knowledge and information about specific disabilities and diagnosis that affects people: Its more important since .... left - weve actually have worked better as a team, we talk, communicate all the time because we need to for the residents I learnt about ...., autism and his illness PKU, which is a genetic disorder After we received the self-assessment the Acting Manager at the left. Since then the service has been overseen by managers from other services within the Msaada Care Ltd. This highlights the impact on the service with regards to leadership, systems and management of records, which we have referred to throughout this inspection report. Care Homes for Adults (18-65 years) Page 35 of 46 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. Management and leadership of the service and the management of accurate records must be improved to promote the health, safety and well-being of people. Evidence: We wanted to find out how the management of Brampton View benefited the people who use the service, protects and promotes their well-being. The information gathered from the self-assessment completed by the previous Acting Manager stated, staff are supported with regular supervisions in order to develop contact within the team and developmental needs. It identified the areas for improvements which included regular monitoring of all health and safety areas, personal information in files to be placed in a systematic manner and to monitor all records. Since the completion of the self-assessment that Acting Manager left and the service had been managed by managers from within the organisation, Msaada Care Ltd. Whilst the two Interim Acting Managers are physically present at the home, the lack of consistency in management, direction and guidance has affected the staff. Examples of how the impact of management has affected the service has been referred to throughout this inspection report, with regards to systems, communication, records management and the Care Homes for Adults (18-65 years) Page 36 of 46 Evidence: safeguarding issues. We discussed with the two Interim Acting Managers the registration requirements for all health and social care services for the new Health and Social Care Act 2008, coming into force next year. This further highlights the importance of the service having a Registered Manager and must appoint a qualified and suitable post to this position. The people who use the service appeared to be comfortable with the two Interim Acting Managers, calling them by their first names and occasionally joking with them. The rapport people had with them and the other staff in the home was positive and clearly demonstrated people were confident to express their views. We wanted to find out what other systems are in place for the people who use the service to express their views, be informed and make decisions about what happens at Brampton View. Two people we spoke with said they have residents meetings, where they choose the menus, plans their activities for the week, express grumbles and complaints and address any health and safety issues. These meetings are attended by staff and minutes of the meeting are maintained. The Interim Acting Managers told us that a quality assurance survey was conducted in November 2009 and surveys were sent to the people who use the service and to health care professionals. The outcome of the quality assurance exercise is not known and it was not clear whether there were any plans to analyse the results. We discussed with the Interim Acting Manager the importance of analysing the results, sharing the outcome with the people who use the service and measuring the results against the aims and objectives of the service. This would show if people who use the service experience a quality service whilst living at Brampton View. We read the monthly visit reports, carried out by the Quality Assurance and Development Manager on behalf of the Responsible Individual. We received the last visit report conducted on 19th October 2009. It demonstrated people who use the service were consults, records were checked such as care files, menus, medication profiles, residents and staff meetings and health and safety checks. The report was concluded with a number of areas that needed to be addressed by the Acting Manager at the time. We have not received any further information or copies of the monthly visit reports since the visit on 19th October 2009. The people who use the service were aware of the information held in their care file. One person was happy to show us the contents in the care file and took delight in recalling things that they had done when looking at pictures and photographs. The records generally with regards to the daily records, reviews and updating care plans, accident and incident records, risk assessments and the medication profiles, could be better organised and completed accurately. We have referred to a number of issues with regards to record keeping throughout this inspection report and how it has proven to Care Homes for Adults (18-65 years) Page 37 of 46 Evidence: have a negative outcome for people. In addition, concerns about record keeping resulted in a safeguarding issue for a person who was moving out of the home. We shared our findings with the two Interim Acting Managers and both recognised the work that needed to be done. They also told us that since they have been managing the service, they have managed to organise and file paperwork that was left by the previous Acting Manager. This highlighted the need for the management of the service to be reviewed, provision of additional support to ensure robust record keeping and organisation of record. The care files read for the three people we case tracked some have current safety measures reflective in their care plans. However, we found one person still had in use old care plans, medication list that was not reflective of the current medication. In addition, when we read the care file we found no assessment of risk carried out for moving and handling and no assessment of the care plan that they brought over from their previous place of residency. This shows checks are not routinely carried out and where checks are carried out such as reviews, new information is not included. Records of incidents and accidents have been logged but the actions taken are not known. We have referred to this in the earlier sections of this inspection report. The information we gathered from the self-assessment completed by the previous Acting Manager detailed the programme of routine maintenance, servicing and testing of equipment. One member of staff has the responsibility for the health and safety within the home and show us the records of the fire tests and checks carried out on the equipment in the home. The monthly visits reports conducted on behalf of the Responsible Individual also showed records were checked for compliance. The member of staff confirmed that the home had a 3 star rating from Environmental Health Officer following the site visit on 12th October 2009 and we read this letter. Care Homes for Adults (18-65 years) Page 38 of 46 Are there any outstanding requirements from the last inspection? Yes  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 Care Homes for Adults (18-65 years) Page 39 of 46 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 Description 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 Description Timescale for action 1 6 15 The Registered Person must 15/01/2010 ensure care plans are reviewed at regular intervals, which is recorded and changes are reflected in the care plan. This would ensure peoples care and needs are known, met by the staff to promote their well-being. 2 6 15 The Registered Person must 15/01/2010 ensure care plans are up to date and reflective of the current care and support needs. This includes developing even a basic care plan for new people moving to the home. This would ensure peoples well-being and independence is promoted. 3 9 14 The Registered Person must 31/12/2009 Care Homes for Adults (18-65 years) Page 40 of 46 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 Description Timescale for action ensure risk assessment are carried out where there are moving and handling needs or equipment may be used. This is to ensure the health and safety of all. 4 18 14 The Registered Person must ensure a risk assessment is completed to ensure any care plans provided for new people are valid and reflective of current needs. 15/01/2010 This would protect and promote peoples health and safety. 5 18 15 The Registered Person must ensure personal care and health care needs are accurately reflected in the care plans. 15/01/2010 This would ensure clear guidance is provided to staff to promote well-being and independence of people who use the service 6 20 17 The Registered Person must 15/01/2010 maintain an accurate record of medication profiles and to update records following changes in medication. This would protect and Care Homes for Adults (18-65 years) Page 41 of 46 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 Description Timescale for action promote peoples health and well-being. 7 23 16 The Registered Person must ensure the recording procedures for financial transactions for people are completed accurately at all times. 15/01/2010 This would ensure peoples money held in safe-keeping by the home is protected. 8 24 23 The Registered Person must 15/01/2010 ensure all areas of the home, internally and externally are maintained in good state of repair. This includes maintenance of the gates to the premises at all times to prevent restrictions. This would ensure peoples health and safety is protected and rights are not restricted. 9 35 18 The Registered Person must ensure staff have training, knowledge and information to support the people who use the service, in line with the registration of the service. 15/01/2010 This would ensure people are supported by staff that have an understanding of the Care Homes for Adults (18-65 years) Page 42 of 46 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 Description Timescale for action disability and can ensure well-being and independence is promoted. 10 36 18 The Registered Person must ensure staff receive supervision and support, at regular intervals. 15/01/2010 This would ensure staff are supported to ensure best practice and support that promotes peoples well-being and safety. 11 37 8 The Registered Person must 30/01/2010 appoint a suitably qualified and experience person to the position of an Acting Manager for the service. the details of the appointed Acting Manager and start date must be provided to CQC. This would ensure the service is managed and protect peoples health, safety and well-being. 12 41 16 The Registered Person must maintain accurate and up to date records with regards to the people who use the service, staffing and management. This include; care plans, medication profiles, daily records and staff training and skill-mix matrix. 15/01/2010 Care Homes for Adults (18-65 years) Page 43 of 46 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 Description Timescale for action This would ensure peoples needs are met safely and maintain staff skills to protect people. 13 42 16 The Registered Person must 15/01/2010 ensure assessments of risks are completed to meet individual needs. This includes risk assessments for moving and handling and where care plans being used are from the persons previous place of residency. This would protect peoples health and safety and ensure their needs are met. 14 42 37 The Registered Person must 15/01/2010 submit timely notifications of events, incidents and accidents that affects the health and safety of people who use the service and the actions taken to ensure their well-being. This would protect and promote their health and well-being. 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. Care Homes for Adults (18-65 years) Page 44 of 46 No Refer to Standard Good Practice Recommendations 1 1 The homes Statement of Purpose and Service User Guide should be kept up to date to reflect the changes in the management of the service. There should be consideration made to developing care plans in alternative formats suitable to individual needs and means of communication. There should be consideration to developing a system with supporting documentation and procedure to be used when people who use the service move out of the home or are admitted into hospital. The daily records should be organised and written as a chronology of events reflecting support provided by the staff and other health care professionals. To consider developing a system or procedure for recording of medication for when people move out of the home. To consider developing a system to method making sure staff knowledge, competency and understanding is in line with procedures with regards to staff completing on-line safeguarding training. There should be consideration to develop a staff training programme to ensure staff skill-mix, competency and knowledge is maintained in line with the current best practice. The Acting Manager should submit an application to the CQC to become the Registered Manager for the service. To consider: (i) Developing a report on the findings from the quality assurance survey in a suitable format that is shared with the people who use the service; (ii) Measure the findings from the quality assurance survey against the statement of purpose to ensure peoples experiences and expectations of the service is consistent with the aims and objectives of the service. This would also assist in the review of the ethos of the service. 2 6 3 6 4 19 5 6 20 23 7 35 8 9 41 42 Care Homes for Adults (18-65 years) Page 45 of 46 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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 46 of 46 - 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!