Care Home: Brandon House

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What the care home does well The home provides consistent care to people with a range of complex mental health needs. The manager ensures people are assessed prior to admission, and they are only admitted if their needs can be met. The service welcomes people and makes them feel at home, taking into consideration personal preferences. Care plans are individualized, and contained good detail of people health and social care needs. They are regularly reviewed to make every effort to keep people healthy, and care for them when they are sick. The staff know what is written in the care plans, and are able to provide consistency when working with people. Risk assessments are completed to provide people with opportunities to live their life in the way they choose, whilst `keeping people safe`. The service has a good working relationship with health professionals, and can access services when needed i.e. when there is a change in mental health. The service is good at monitoring people`s medication, and supporting people to attend important appointments. Policies and procedures relating to complaints, and safeguarding are good, and residents spoke highly of the staff team that support them. One person said "It`s the longest i have been well, I am very happy here". The service has a good reputation for caring for people at the end of life within their own home; people not requiring to go into hospital. Care plans reflect the persons wishes, and staff work well with outside health professionals to ensure good quality care and support is offered. The staff are also very supportive to relatives in end of life situations, and this is appreciated, and comments were made in several surveys returned. What has improved since the last inspection? A new contract has been introduced since the last inspection that details the fees payable, and the service that will be offered. Residents meetings are held weekly by the activity co ordinator. They are recorded, and the minutes are available. No complaints have been received by the home in the last 12 months. The manager has introduced a mangers complaint book where all verbal complaints, minor or otherwise will be recorded, with the actions taken. The upstairs of the main house has been redecorated since the last inspection and is much improved. Pictures were on display, and it did have a much `warmer feeling` about it. A separate smoking facility has now been provided. What the care home could do better: The home was registered as a care home before the introduction of the National Minimum standards and provides an institutional style of accommodation which is difficult to change without extensive refurbishment. The shower facilities in residents bedrooms should either be removed, or be kept clean and useable. The current use for storage could lead to the spread of infection, and also, is not a positive model for the resident to practice. Medication administration and monitoring is good, but residents queue to receive their medication and this is impersonal, and an institutionalised practice. Whilst it is appreciated that a number of complex types of medications are taken by individual people, the home should consider ways in which medication could be administered in a more personalised manner, offering greater privacy. A number of residents smoke in their bedrooms. This is extremely dangerous and the manager should risk assess this activity if they are aware that it is happening on a regular basis. Tenants` are placing each other at risk by doing this, and this should be raised and minuted with social workers. Key inspection report Care homes for adults (18-65 years) Name: Address: Brandon House 15 Jackson Road Clacton-On-Sea Essex CO15 1JP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: June Humphreys     Date: 2 7 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 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 30 Information about the care home Name of care home: Address: Brandon House 15 Jackson Road Clacton-On-Sea Essex CO15 1JP 01255426024 01255224431 joan@brandon-house.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): RBS Care Ltd Name of registered manager (if applicable) Mrs Joan Carol Hemstead Type of registration: Number of places registered: care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 42 The registered person may provide the following categories of service: Care Home Code PC, To service users of the following gender: Either, Whose primary care needs on admission to the home are within the following categories: Mental Disorder: - Code MD Date of last inspection Brief description of the care home Brandon house is a care home registered to provide personal care to forty0two service users with a mental health condition. It is located in the seaside town of Clacton on sea and situated in the town centre. A range of facilities and services such as shopping, education, leisure, public transport and the beach are within walking distance. The care home is made up of three separate houses; the larger being an older type Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 42 Brief description of the care home property and two smaller detached properties adjacent to the main house. The three properties have one large communal garden and patio area. The smaller properties provide a domestic environment. The home does not provide a passenger lift in either properties and is therefore unsuitable for service users with mobility problems. Fees range between £460.00 and £660.00 Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means that people who use this service experience good quality outcomes. This unannounced inspection visit took place on the 27th November 2009 and completed by one inspector, June Humphreys, who spent seven hours at the home covering all the key national minimum standards. The inspection process included: discussion with the registered manager and responsible individual. An inspection of a sample of staff and residents records; discussion with six staff members and with four residents. Brief conversations were held with some other residents when touring the building, and observing medication being administered. Feedback from surveys were postive, and a total of eleven surveys were received from Care Homes for Adults (18-65 years) Page 6 of 30 residents, staff, professionals and relatives. This report also takes into account all the information CQC had received about Brandon house since the last inspection including information provided by the service, stakeholders, professionals who have worked in the home, and also the people living at the home and their families. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The home was registered as a care home before the introduction of the National Minimum standards and provides an institutional style of accommodation which is difficult to change without extensive refurbishment. The shower facilities in residents Care Homes for Adults (18-65 years) Page 8 of 30 bedrooms should either be removed, or be kept clean and useable. The current use for storage could lead to the spread of infection, and also, is not a positive model for the resident to practice. Medication administration and monitoring is good, but residents queue to receive their medication and this is impersonal, and an institutionalised practice. Whilst it is appreciated that a number of complex types of medications are taken by individual people, the home should consider ways in which medication could be administered in a more personalised manner, offering greater privacy. A number of residents smoke in their bedrooms. This is extremely dangerous and the manager should risk assess this activity if they are aware that it is happening on a regular basis. Tenants are placing each other at risk by doing this, and this should be raised and minuted with social workers. 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 30 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 30 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 can expect to receive good information and a thorough assessment, and will be supported on admission to the home. Evidence: The service users guide is made available to all service users prior to admission. The manager usually completes the initial assessment by visiting the person in their own home or current placement. It is at this point that the service at Brandon House is discussed and a copy of the service users guide is provided. The manager advised that referrals are often made by telephone by a social worker. As part of the assessment process the manager usually requests to read the residents care plan that has already been put into place by the hospital staff, social workers and CPN.. This helps with making the transition to the home easier, has it provides vital information on the persons current support needs. The manager stated in the AQQA that the prospective resident is invited for coffee, and to view Brandon House. If the client is interested we then invite them for lunch, and to stay for around 4 hours. If we feel we can meet their needs we will offer an overnight stay, followed by a weekend stay. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: The current assessment format has been updated since the last inspection. The assessment documentation includes a personal history, a psychiatric, medical and physical history. The assessment looks at all areas of need including behavioural and safety issues, use of money, road sense and personal safety. Risk management plans will be in place at the assessment stage to ensure the safety and well being of the person. An assessment completed in April 2009 was looked at, and seen to contain sufficient information relating to the persons current health and social care needs. The information is then needs. The from the assessment on to the homes care plan format. A new contract has been introduced since the last inspection that details the fees payable, and the service that will be offered. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to have a plan of care that reflects their personal needs and wishes and to be able to make everyday decisions about their lives. Evidence: The care plans of three people were examined on the day of the visit and both contained a wide range of detailed information. The care plans were well laid out, consistent in style, and easy to understand the identified care need and how this was to be achieved. Two of the people who required support had enduring mental health conditions i.e. chronic schizophrenia which had impacted on their life, and ability to care for themselves. This had meant that they had spent long periods of time in and out of hospital. The care plan provided clear guidelines for staff on how to implement the care needs identified. The home accommodates up to forty-two people in several small houses, and one larger older style building. People who are able, and choose to be more independent live in the smaller houses. A kitchen is available to offer greater accommodates but Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: most residents spoken to continued to eat their main meals fully prepared by the kitchen staff in the main house. one person said I make snacks, toast, but would need alot of help to cook, and like to go over there to see others. It would appear from discussion with staff that eating and smoking are social opportunities which often people have developed when they were in hospital and that it is difficult to break away from this. One staff member said The social routines provide people with the chance to meet and talk, we have tried to change this by offering groups and activities, but this is not for everyone. From observation the home provides a community spirit and for some people this provides a high level of security which means they remain well, and do not go back into hospital. One resident said Its longest Ive been out, I am very happy here. Another resident said I would like to move out, but only when I am ready. The manager stated in the AQAA that all care plans are signed by the resident when they agree that their needs have been identified and if they feel their goals are achievable There is a range of people living at the home, and Service users lead reasonably independent lives according to their varying levels of ability. Staff understand the importance of allowing them to take sensibly evaluated risks in order to enjoy a range of opportunities. One staff member said A number of people do go, and come and go as they please. But for others they either want to go out accompanied by staff or for some, at times their illness is such that the risk of harm restricts their movement. Of course we can not stop people going out but observe some people more closely. The manager showed two risk assessments which had been completed for people who did go out but needed careful monitoring. There was clear direction to staff on what should happen if they do not return, and photographs were available to show police if necessary. Care Homes for Adults (18-65 years) Page 14 of 30 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. Residents can expect to have an individual care plan, and to be supported by staff to have a fulfilling lifestyle which takes into consideration their personal preferences and needs. Evidence: The provision of activities within the home is good with positive feedback being sought by residents regularly talking to their key worker, who had recorded the contact and discussion. Care plans provided evidence of the use of a range of community facilities such as libraries, the post office, colleges and cafes. The activity co ordinator was in the process of developing an activity plan for each person. The co ordinator said The plan could then be reviewed, to ensure residents enjoy, and gain a positive experience from the things they are involved in. This is important within a larger service such as Brandon House, as it could be possible for people to choose not to be involved in any activities which would not be beneficial to the persons longer term development. Even Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: residents who do not join in should have an activity plan . If people chose not to participate then this should be recorded, and monitiored. All plans should be regularly reviewed to ensure that the service demonstrates that residents are encouraged to particpate in meaningful activities both inside and outside the home. Staff help residents to make choices, for example in relation to clothes, menu planning, room colour schemes, leisure and social activities. Most of the residents spoken to were not able to do this without assistance. One resident said the chair cannot remain, it has to go. Staff reported that often the person had thrown out nice personal belongings because they said he had been told to. Several examples of this was available, and daily recordings noted that certain residents sometimes would only wear certain clothes, or shoes. Contact with relatives and friends is encouraged by the home and visitors made welcome. One relative spoken with said she was always made welcome when they visited and was kept up to date with any relevant information. The registered manager informed the inspector that they made a point of ensuring staff always speak to visitors, and if there are any concerns then they will undertake this themselves. several relatives were contacted by telephone and it was evident that some families had experienced trauma over finding suitable support for their relative. One relative said she wants to be independent, but when this has happened in smaller settings we have been continuously contacted for help and advise. Another relative said this is the best there is, limited independence, supported by caring and knowledgeable staff. The service has a number of key celebrations throughout the year that relatives are always invited to i.e. barbeques, birthdays and a Christmas party. A number of residents also go home to family at weekends. The food served both at lunchtime and teatime was hot, homemade, and a choice of curry and rice or steamed fish. The inspector tasted the teatime meal of soup and ham sandwiches. The soup was homemade and residents spoken to said that was nice. The food is nice, and I can always have more. The manager stated that a healthy diet was offered to residents. But that often the unhealthy option would be chosen. Care Homes for Adults (18-65 years) Page 16 of 30 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. Both health care and personal support is provided in a manner preferred by the individual service user. Evidence: The people who live at Brandon House are either people who have significant mental health needs,or have enduring mental health. This means that their mental health often impacts on their ability to do all the others things in their life that they would often like to do. An example of this is the resident who said they would like to live independently, but looking at there previous personal history they had tried this on a number of occasions and each time had required to be hospitalised. The manager said that why we would not wish to discourage someone living independently. I would want to be sure that all that this person has achieved is not lost. The service is looking at the possibility of developing a smaller separate service which will be supported by staff but not on a 24 hours basis as Brandon house is. Because of the needs of the people who live in the home the service provides a high level of care in relation to the monitoring and recording of peoples health needs, both physical and mental. As previously stated, in the section individual needs and lifestyles care plans are clear and percise. Care plans had evidence that they had been reviewed, this is Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: undertaken by the manager on a monthly basis. A weekly report is completed by the keyworker and a formal four monthly review is also completed. The review system covers medication, changes to daily routine, mental health, physical health,mobility, diet and any other significant areas of concern or improvement. This system provides a clear process to enable residents possible changing mental and physical health to be monitored and recorded. Evidence can then be used if and when necessary to alert other professionals to a possible relapse in mental health i.e. social workers, CPNs, G.P or psychiatric help. Three positive surveys were received from health professionals who have contact with the service regularly. Comments made were The home gives care and consideration to individual needs. Accommodates at short notice changes to patient care, i.e. medication reviews,out patient appointments.On going patient care is good and reliable. Residents also echoed that support with healthcare needs was good. One person said I receive my injection at home when I need it. Another person said Staff are caring and help me when I am down. No residents were adminstering their own medication at the time of the inspection. The manager advised that several residents had been risk assessed, and it was agreed to wait for a further review prior to starting this process. The manager stated in the AQAA that the home has a stringent medication policy which is adhered to at all times by senior staff, with an on-going training programme. Controlled drugs are stored within the Medication Guidance Act. All CD drugs are recorded in a CD register and double-signed for, and Care plans highlight what the medicines are for. An examination of the homes medication room and records was undertaken with the ordering, storage, administration, including controlled drugs and their disposal found to be correct. Individual Mar sheets (medication administration records) had pictures on the front to clearly identify the person who the medication should be adminstered to. The tea time administration of medication was observed. Residents queue to receive their medication and this is impersonal, and an institutionalised practice. Residents are use to this practice both in the home, but would have also experienced it in hospital. The home now has a trolley that is currently fixed to the wall. Whilst it is appreciated that a number of complex types of medications are taken by individual people, the home should consider ways in which medication could be administered in a more personalised manner, offering greater privacy. There are a number of older people living in the home. There has also been several terminally ill people. The service has a good reputation for caring for people at home, and not requiring to go into hospital. Care plans reflect the persons wishes, and staff work well with outside health professionals to ensure good quality care and support is offered. The staff are also very supportive to relatives in end of life situations, and this is appreciated, and comments were made in several surveys returned. Care Homes for Adults (18-65 years) Page 18 of 30 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. Residents can be assured that the appropriate practices and procedures in place within the home will protect them from possible abuse, and that any complaints will be acted on. Evidence: A complaints procedure is in place within the home, and. staff spoken with had a basic awareness of the whistle blowing policy. Several residents were asked if they knew how to complain and they said they would tell the manager or the relative who visited them. Several residents also said that the manager had made them aware of the complaints procedure as part of the admission procedure. The complaints procedure was also seen to be on display in the hallway. The activity co ordinator offers residents the opportunity to meet together on a Friday each week. These meetings are time for residents to raise concerns, and generally be involved in the running of the home. The meetings are recorded, and the minutes were seen. Both staff and residents have found this helpful. One resident said the meetings are good, we can talk about anything we are unhappy about, and usually it is followed up. No complaints have been received by the home or the Commission in the last 12 months.The manager stated in the AQAA that the managers open door policy encourages resident to come and complain and express any concerns. The service is also in the process of introducing a mangers complaint book where all verbal complaints, minor or otherwise will be recorded, with the actions taken. In place already is a suggestion box, and the staff are trying to encourage residents to use Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: this. All staff have received training in working with vulnerable adults, and the safeguarding procedures in place both within the home, but also the Local Authoirty. The manager has completed training for her to be a trainer on this topic and regularly attends updates. The manager has attended training on the Mental Capacity Act, and has purchased several DVDs to show to staff to ensure they understand understand infringement of rights, and what this means in turns of daily practice and recording. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe and a generally satisfactory environment that could be improved through further decoration and refurbishment. Evidence: Whilst this was the first inspection since the current proprietor changed the name of the company, the service has been in operation for a number of years. The home was registered as a care home before the introduction of the National Minimum standards and provides an institutional style of accommodation which is difficult to change without extensive refurbishment. The facilities in relation to bathrooms are only adequate, and toilets at times seem to have been tucked into the smallest of places. Bathrooms and toilets have in most cases been re decorated since the last inspection, and although cleanner, still remain plain, but functional. On the day of inspection it was noted that a lot of maintenance was being undertaken. This included the fire alarm system being updated, and the stairway being painted. The upstairs of the main house has been redecorated since the last inspection and is much improved. Pictures were on display, and it did have a much warmer feeling about it compared to other parts of the home. In Whiteleaf there are five people sharing one bathroom. There is a shower in room 5 Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: which is not in use. This was seen to be filled with various bags, and personal belongings. The same applied in room 7 of the main house. The showers should either be removed, or be kept clean and useable. The current use for storage could lead to the spread of infection, and also, is not a positive model for the resident to practice. One persons room had no radiator cover. The flooring was covered in cigarette burns. There was no curtains at the window. Whilst it is acknowledged that some residents do destroy their personal belongings, the manager must be able to evidence that every effort has been made to enable the person to live in a clean, safe and comfortable living space. This was discussed with the manager who has agreed to replace the items listed above and record carefully brakages, and any new purchases. A separate smoking facility has now been provided. This was in full use on the day of inspection. However it was evident that a number of residents smoke in their bedrooms. This is extremely dangerous and the manager should risk assess this activity if they are aware that it is happening on a regular basis. Tenants are placing each other at risk by doing this, and this should be raised and minuted at reviews with social workers. New furniture was in place in both lounges, and new activity area had been created at one end of the building with tables and chairs made available. The manager applied for a grant to redevelop the external areas, and for a new garden to be developed. The proprietor stated that the grant had been approved, and showed the work that had been completed. This was very attractive but there remains alot of work outside which is yet to be complete. There is concern about the area dirctly behind the fence which is uneven and could result in residents having trips or falls. The proprietor must give attention to this as soon as possible to ensure the safety of people living in the home. Care Homes for Adults (18-65 years) Page 22 of 30 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. Residents will receive support from Staff who have appropriate skills, knowledge and experience to identify and respond to their individual needs in a consistent way. Evidence: The staff rota was inspected and evidenced a minimum of five carers, and one senior on duty throughout the day with two waking carers, and two sleeping in at night. In addition, cooking, domestic and maintenance duties are undertaking by additional staff. The management team comprises of the registered manager, and the proprietor who work together in managing the overall care provision within the home. The manager descibed herself as a working Manager, and this was certainly observed to be the case on the day of the inspection. There is also a senior carer on every shift to lead and support staff. Staff spoke of a good team spirit, and everyone working together. Staff said that they felt well supported and received a good range of training whilst working at the home. They felt that they had the skills to do their job, and were not asked to carry out tasks that were outside of their abilities. Over 50 of staff have completed N.V.Q training and a number have also completed level 2 in palliative care. Whilst other staff has completed the new level 2 training in Mental health.The manager stated in the AQAA that We have joined the consortium arranged by Essex county council which has saved money, but also allowed the home to access a range of new training. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Staff consulted felt that there was a high level of skills within the team, and were able to offer good support to residents.The Six members of staff who were spoken to as part of the inspection all stated it was postive to work at the home. One person said I love working here,the staff work together to provide the best possible service to the people who live here. Another person said I have attended alot of training which has really helped me to understand people who have mental health problems. There are five staff on duty to forty residents, and the building is such that it makes it difficult to ensure peoples needs are met. There are long corridors, and bedrooms that are tucked away out of view. This was discussed with several residents during the day, and there was no evidence to suggest that that residents were not in receipt of the support they needed. Several commented on the size of the home, but all said their needs were met. One resident said you rarely wait long, there is usually someone around to help. Another resident said I am pleased to say the staff are very kind and helpful. Three Staff files were inspected and those seen contained application forms, two references, Criminal Records checks, job descriptions, evidence of training, contracts of employment,and induction records.There were also photographs which provided evidence of identity. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is manmaged in the best interests of residents, and health and safety practices protect staff and residents. Evidence: The manager and proprietor demonstrate an active and ongoing committment to developing the home, and always acts promptly on any requirements made. There is a postive ethos within the team, with a strong commitment to raise and sustain standards, with residents personal wellbeing and safety being promoted through staff training, comprehensive policies, procedures, and regular health and safety checks. There was clear evidence that the manager accesses relevant , current guidance on new legistration that is associated with the care home. They attend relevant meetings and workshops to update their knowledge i.e. Mental Capacity training which they then cascade to staff to ensure that they have sufficient knowledge to enable them to put it into practice in the home. Since the last inspection the home has increased the number of Residents meetings, Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: encouraging residents to be more involved in the running of the home by enabling them to make suggestions. The activity co ordinator has introduced a set time for meetings, with a relaxed atmosphere which encourages residents to join in. The manager has also been increasing staff responsibilities, with senior carers managing the shift. This has proven successful, ensuring that all necessary tasks are completed on each shift. Feedback from residents spoken to determined that the home is well managed. Comments received were extremely positive regarding the running and the management of the home. Residents said that they felt their views were listened to, and that the home was run in the best interests of all the people living at the home. The home continues to operate safe practices for looking after money on residents behalf. This is stored individually and securely, and clear individual records are maintained. Two peoples money and records were checked as part of this inspection, and the cash held balanced with records and receipts. The home has appropriate systems and procedures in place to ensure residents are kept safe; as part of the inspection, recruitment, training and supervision records were looked at. All staff is supervised regularly, including the manager who was not receiving recorded supervision at the last inspection. The service has a range of quality monitoring tools in place. This includes, regular residents meetings and recorded meetings with key workers and residents. A questionnaire is sent to stakeholders, which is available in an easy read format. Regular residents reviews are held which all residents are encouraged and supported to attend. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 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 24 23 Showers must be fully working or diposed of in residents bedrooms to ensure the safety and control of infection within the home. To ensure the safety and control of infection within the home. 31/01/2010 2 24 23 The registered person must ensure that the external grounds are safe for residents to access without the risk of potential harm. To ensure the physical safety and wellbeing of residents. 31/12/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 The service should aim to develop a system that provides Page 28 of 30 Care Homes for Adults (18-65 years) 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 greater privacy to residents when adminstering medication. This is to ensure that privacy and respect is provided to people living in the home when receiving medication. Care Homes for Adults (18-65 years) Page 29 of 30 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. 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