Care Home: Brookfields

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What the care home does well The home provides detailed information about the service it provides through its Statement of Purpose and Service User Guide in suitable formats. The environment is homely, comfortable and well maintained for the people living the home. The bedrooms for the people living in the home are comfortable and personalised including things that they like. The support plans for the people living in the home are well detailed and tell the staff how they are to be supported safely. The home provides a well balanced and healthy diet and support is provided appropriately at mealtimes. Some of the people are supported with continuous peg feeding. Contact with relatives is encouraged so that the people living in the home are able to keep in touch with them. There is good liaison with a variety of healthcare professionals to ensure that the medical needs of the people living in the home are met safely. What has improved since the last inspection? Since the last inspection some areas of the home have been redecorated providing a homely environment for the people living there. The service user guide and statement of purpose have been updated and now includes information about fees charged in the home so that people know how much the service costs. What the care home could do better: The manager must ensure that equipment is serviced in a timely manner to ensure that is safe to be used. Staff must follow people handling instructions to ensure that the people they are supporting are not exposed to unnecessary risks. More documented evidence should be available to show how the people living in the home are supported to make day to day decisions. Staffing levels should be sufficient to ensure that the people living in the home can do the things they want. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Brookfields 81 Dogkennel Lane Oldbury West Midlands B68 9LZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kulwant Ghuman     Date: 2 5 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Brookfields 81 Dogkennel Lane Oldbury West Midlands B68 9LZ 01215446715 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) : Milbury Care Services Ltd care home 6 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: 6 6 The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disabiity (LD) 6 Physical disability (PD) 6 Date of last inspection Brief description of the care home Brookfields is a converted and extended residential dwelling owned by Milbury Care Services. The property is two storey with bedrooms accommodated on the ground floor only, the first floor is used for meetings and office space, and it also provides the laundry area and staff toilet. The home provides nursing care for up to 6 persons with a learning and physical disability. Aids and adaptations are provided which meet the assessed needs of the people living in the home. The home is located in a quiet residential area of Oldbury, with local shops and amenities a short distance away. There is limited off road parking to the front of the house with a large spacious garden to the rear. Each of the rooms is single occupancy, and a communal lounge, dining kitchen and activity area are available. The home does not offer ensuite facilities. Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home Overall the home is decorated and maintained to a good standard. People living in the home are enabled to participate in a wide range of in house and community based social and recreational pursuits, plus a healthcare programme, which utilises various resources within the local area. The home has its own wheelchair adapted vehicle. The fee for this service is 1108.84 pounds per week. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out over one day during February 2009. The home did not know we were going to visit. The last key inspection to this home was carried out in March 2007 and an Annual Service Review (ASR) was carried out in September 2007. As a result of the ASR we decided not to change our plans for inspecting this home. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we had received, or Care Homes for Adults (18-65 years) Page 6 of 32 asked for, since the last key inspection. This included notificiations received from the home. These are reports about things that have happened in the home that they have to let us know about by law. An Annual Quality Assurance Assessment (AQAA) had been sent to the home. The AQAA is a document that provides information about the home and how they think that it meets the needs of the people living in the home. Two of the people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files and focussing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around the home. A sample of care and health and safety records were looked at to see if the home was being managed safely. We looked at the file of one person who worked in the home to make sure that the people living in the home were supported by people who had been checked and trained appropriately. The people living in the home could not comment verbally about the home so some comments made by their relatives have been used in the report. We had received two concerns and one issue of adult protection in respect of the home since the last key inspection. These were forwarded to the provider and social work team to look into. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 32 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was information available for the people living in the home, or their representatives, to help them decide whether the home would be suitable for them. The amount of money it cost to live in the home was included so that people knew how much they were paying for the service. Evidence: There was information availabe for the people living in the home to enable them or someone acting on their behalf to decide whether the home would be suitable for them. The information was available in a format that made it easier for people to understand with the use of pictures and simple words where possible. The service user guide had been updated to make sure that all the information included in it was correct however, there was an error in the telephone number if anyone wanted to contact us at the Commission for Social Care Inspection. The people living in the home had all been there for some time and at the previous Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: inspections it had been noted that their assessments had been carried out appropriately. We talked to the manager who was in the home at the time and we were confident that he knew about the admission process and the importance of knowing the needs of the people thinking about moving into the home. This meant that we were confident that anyone moving into the home would know that their needs could be met there by the staff. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of individuals were recorded in their files so that staff knew how to assist them. The records did not clearly show how the people living in the home were enabled to make choices. Risk assessments were not always followed by the staff in the home and this can expose individuals to potential risk of harm. Evidence: The two files that we looked at contained individual care plans and risks assessments that gave detailed information about the individuals personal and health care needs and the actions to be taken by the staff. There was some brief information on the likes and dislikes of the individuals, medical conditions, medication being taken and financial details. Due to the limited verbal communication of some of the induividuals there was some information about how they communicated. It was noted however that aids such as picture cards were not always used. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: The above information was supplemented by the plans of support which had been drawn up with the support of other relevant people such as parents. Plans of support were in place for health, elimination, temperature regulation, skin integrity and support with eating. The information included in the support plans included some very good information particularly in respect of managing medical needs such as peg feeding regimes, epilepsy and regulation of temperature. Risk assessments were in place indicating there was a need for 1 to 1 support for some people. The risk assessment seen did not clarify what was meant by one to one support, eg should the person be supervised at all times whilst in the lounge, or lying on their bed. This was not happening during the inspection. Waterlow, nutritional, and people handling assessments were in place. The people handling assessments needed to be in more detail as it was noted in discussions with staff that they were doing things differently to how the manager expected them to be done. It was noted that there were many support plans and risk assessments in the files. This was a large amount of paper work for staff to refer to and it was recommended that this could be condensed down to a brief overview of care that could refer the staff to the individual support plans for specific details. It was difficult to evidence how individuals were assisted to make decisions on a day to day basis for such things as meals or activities where people had little verbal communication. For example, staff told us that for one person there were picture cards to be used at meal times however these were not seen in use during lunch. The daily activities plan also were very similar for the two people whose care plans were looked at and the activities were mainly the same but moved around to different times of the day. For example, massage was in the morning on one day and during the afternoon the next. During discussions with staff it was noted that staff did not always follow the patient handling assessments. We were told that one person was transferred from the bedroom to the bathroom with the hoist whilst the manager told us that this was not the process. In addition, some staff were using the hoist alone when the risk assessment clearly indicated that two staff were needed. This could pose a potential risk to the people being assisted. Care Homes for Adults (18-65 years) Page 14 of 32 Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home were provided with different activities in which to be involved giving them a variety of experiences. Friends and relatives were able to visit the home and made welcome. The food provided in the home was varied, nutritious and healthy. Evidence: Since the last key inspection three of the people living in the home had started attending college. One person was able to say that he wanted to go to college and the others have been supported to attend college to develop their commmunication skills. Two of the people living in the home were on a continuous peg feeding system so their days were structured around this however, they could be taken out with their mobile packs. Dieticians and parents were involved in making the decision for the peg feeding Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: regime to be instigated as the individuals could not make the decision for themselves. One of the relative surveys returned to us said X is not capable of making a choice but the carers make a great effort to understand his likes and dislikes and to make his life more comfortable and as varied as possible. Physiotherapists have been involved in developing a sleep system and good posture for some of the people living in the home. This means that the individuals are as comfortable as possible in their beds. The people living in the home had an individual plan for daily living. Opportunities were available for them to participate in joint activities such as music sessions, disco, holidays and daytrips at the weekends. There were also opportunities available for individuals to access the local amenities such as the cinema, swimming baths and medical facilities. The individuals likes and dislikes are known to the staff. One person had recently purchased sensory equipment for use in their bedroom and another had purchased a reverberating chair in which to listen to music. The activity plan for one of the individuals showed that after having their peg feed connected up the individual would go out for a walk 4 times a week and have a hand or foot massage twice a week. The walks out were not evidenced in the daily diaries as having taken place regularly but that hand or foot massages did take place. The manager needed to ensure that people who were not able to express their views verbally did not miss out on trips out because it was easier for staff for them to have an activity in thehome. Some staff told us that people are not taken out regularly because drivers are not always available or on occasions people did not go out due to staff shortages or because staff did not want to go out one to one with some people. Their were opportunities for families to visit the home and for individuals to vist them if appropriate. One relative survey told us We have been welcome to visit X at any time. We were able to join in during the mid day meal. It was pleasing to see that staff generally ate with the people living in the home. Assistance was provided appropriately where it was needed. Pureed meals were presented in a way that kept each item separate and looked appetising. One of the people living in the home had taken on the responsibility of giving out drinks. This included making cups of tea. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: The meal time was a sociable event and it was a shame that people who were on a continuous feeding regime missed out on the social aspects of meal times. There was no evidence seen on how the people living in the home had been involved in planning menus but we were told that the staff and one individual who lived in the home decided the menu. A healthy eating regime had been introduced in the home and this was having a positive effect by reducing the number of medicines being given to the people living in the home. Care Homes for Adults (18-65 years) Page 18 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home received support to have their personal and medical needs met appropriately. Evidence: All the people living in the home are registered with a local general practitioner and are supported by staff to visit them for consultations. The records of all healthcare appointments are well maintained. Health care professionals such as physiotherapists and dieticians are involved in the home ensuring that the people living in the home are getting the advice needed to ensure that their health needs are met. At the time of this visit a physiotherapist was visiting the home and was heard to say that she was very happy with the progress that had been made by one of the people living in the home with the support of the staff. The management of medicines in the home was good ensuring that the people living in Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: the home received their medicines as prescribed. A recent visit and audit from the pharmacist stated that everything was fine. The system ensured that medicines were booked in when received into the home. There were no gaps on the MAR (medicine administration record) ensuring that the medicines could be audited easily to determine if people had had their medicines. Only the nurses gave out the medicines although the support staff had undertaken training in the management of medicines. The people living in the home were assisted with personal care as needed. Some of the people were totally dependent on the staff for meeting these needs whilst others were able to undertake some tasks with supervision. Relative surveys returned to us said keep him clean and happy at all times and we are satisfied with the care X received. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home were safeguarded from harm by the policies and practices in the home. Evidence: The majority of people living in the home were unable to raise issues verbally and were reliant on staff and other people to raise any issues if needed. Relative surveys indicated they knew how to raise any concerns but had never had cause to do so. There were no complaints recorded in the complaints book. Since the last key inspection some concerns had been raised with us regarding some manual handling practices and some concerns regarding practice issues within the home. These concerns had been referred back to the provider who told us that the concerns had not been substantiated. One adult protection issue had been raised regarding the home. The issue had not be substantiated. The records for the management of monies were looked at. These were being audited on a monthly basis. There were receipts in place but two signatures for expenditures were not always in place. Care Homes for Adults (18-65 years) Page 21 of 32 Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home were provided with a warm, comfortable and homely environment in which to live. Evidence: The home continues to be maintained to a good standard. The furniture and fittings are homely and comfortable. A tour of the home found the home to be clean and odour free. Each of the people living in the home had their own bedrooms that were personalised to their liking. Some had special sleep systems and sensory lighting fitted. All the bedrooms are located on the ground floor. Bathrooms and toilets had the appropriate adaptations in place making them accessible to the people living in the home. One of the bathrooms was in the process of being redecorated and refloored. The kitchen was kept clean and the fridge and freezer temperatures were monitored on a regular basis to ensure that food was kept at safe temperatures. Some meat in Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: the freezer was beyond its use by date and its quality and safety could not be guaranteed. On the first foor of the building is an office, bathroom and laundry. The laundry was not locked and one person living in the home regularly went into the laundry to get clothes. The laundry should be kept locked as it did contain soiled laundry. Slabs in the garden were uneven, as identified at the last inspection, and needed to be relaid to make it totally safe for use by the people living in the home. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number of staff on duty and the skills mix during the day does not always allow the people living in the home to take part in the activity of their choice. Recruitment processes meant that only suitable people were employed in the home. Training records did not show that the staff had received up to date training to enable the people living in the home to be safe. Evidence: The staffing rota showed that there were 3 support staff on duty during the day in addition to the nurse and manager. At night there was a nurse and one support worker on duty. There were indications that the level of staffing was not sufficient for people to be able to go out when they wanted. Staff were responsible for cooking, cleaning, laundry and the support of the people living there. Since the last key inspection there had been a number of staff changes however, at the time of this inspection the staff team was more stable and the use of agency or bank staff had reduced. This was good for the continuity of care for the people living in the home. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: Some staff were working long shifts which could mean that they become very tired. The manager must ensure that people have adequate breaks during these shifts. There was a board accessible in the kitchen that showed the people living in the home which staff were on duty. The file of one new staff member was looked at. This showed that the appropriate recruitment checks were undertaken to ensure that the people living in the home are cared for by suitable people only. We were told that as part of the recruitment process prospective staff visited the home so that they could decide if they wanted to work there and that one of the people living in the home would speak to them. The file did not show any evidence of induction training having taken place. We were told that this was kept at the head office. Evidence of satisfactory completion of induction should be kept in the home. A staff training matrix was displayed on the wall however, there were no dates to indicate when refresher training was needed. Staff told us that they had had a variety of training courses including POVA, fire and challenging behaviours. The home was using the EL box for some training. This is a computer based training programme. Some staff felt that this was not always sufficient training and hands on training was also needed. The AQAA told us that of the 18 staff employed 11 have been trained to NVQ level 2 or above. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has been through a period of significant change and there was no registered manager in post who had day to day responsibility for the home. The people living in the home could be assured that all the equipment in the home was safe and well maintained. Evidence: At the time of this inspection there was no registered manager. The acting manager had been not yet been registered. Some concerns had been raised regarding the management of the home and this had had an impact on the registration process along with some shortfalls in the submitted application for registration. The AQAA told us that the fire equipment and gas appliances services were overdue. Since the inspection we have been informed, and evidence provided that showed that this information was incorrect and that the fire equipment was last in November 2008 and again since the inspection. The gas appliances had been serviced in June 2008. This showed that the equipment was being maintained to ensure that it was in safe Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: working order. Since the acting manager had been in post he had looked at organising college places for some the people living in the home. These placements seemed to be enjoyed by the individuals. The manager needed to ensure that agreement to attend these placements by the people living in the home was fully documented. There have been some complaints at the home since the last inspection and some staff have been dissatisfied with the management of the home. Senior managers have been managing this situation but the issues do not appear to have fully been resolved. Some staff surveys returned to us indicated that the level of leadership in the home was poor and that issues raised with senior managers have not been addressed to their satisfaction. The last report available in the home by the providers representative was from September 2008. These should be available to show that issues arising in the home have been followed up and addressed in a timely manner. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Risk assessments needed to be sufficiently detailed to ensure the staff know how to manage the individuals safely. This will mean that the people living in the home are supported in a way that is consistent and safe. 30/04/2009 2 7 13 The manager must ensure that moving and handling plans are followed by staff. This will mean that the people living in the home are supported in a safe manner. 30/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 Care plans and risk assessments should be condensed down into an easily accessed format for the staff to use on a daily basis which would refer the individual to the specific Page 30 of 32 Care Homes for Adults (18-65 years) support plan for more detail. 2 6 The manager should ensure that communication aids are used as often as possible where people have limited verbal communication skills so that they can be assisted to make choices. The manager should ensure that people unable to express their views verbally are not disadvanted in any way. The people living in the home should be assisted to make choices at mealtimes. The manager should ensure that there are always two signatures for monies being received and expenditures being made on behalf of the people living in the home to ensure that they are safeguarded from financial abuse. The manager should ensure that there are sufficient staff to enable the people living in the home to undertake the activities they want to. Evidence of completion of satisfactory induction training should be available in the home. This will ensure that the people living in the home are supported by staff who have the skills and knowledge required to do this safely. The manager should ensure that the training provided is suitable and sufficient for individual staff needs. This will mean that staff will be confident in how they carry out their roles. Copies of the monthly report by the providers representative should be available for inspection. This will ensure that issues are picked up and progressed in a timely manner. 3 4 5 16 17 23 6 31 7 32 8 35 9 37 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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. 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