Care Home: Buttercups & Railway Cottage

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What the care home does well There are two people living in the home and staffing numbers have been maintained to ensure that there are sufficient numbers of staff on duty. The new manager has established good lines of communication with the staff team so that people understand their role and responsibilities and work well together. The staff spoken with and those who returned surveys said that they are receiving the training and support that they need. The staff we talked to spoke highly of the manager who is available for guidance when required and has set up regular meetings and support sessions for the staff team. Feedback from people working in the home shows that they have good opportunities for training to ensure they have the knowledge and skills that they need. The manager and staff communicate well with the relatives of the people in the home so that they are involved in care planning and review. What has improved since the last inspection? There is a cleaning routine for the home and all staff have attended training in infection control. New furniture has been provided for the communal lounge however there are areas of the home that are still in need of upgrading including the shower facilities for both service users. The systems for communication between staff and the manager has improved, regular meetings at different levels are held so that all staff are aware of their responsibilities and better team working has been established. The recording of complaints has been improved although the manager said she would consider ways to further improve the system so that actions and timescales are clear and confidentiality is protected. The manager has been communicating with staff from the local authorities responsible for placements in the home to ensure that annual reviews are held. Detailed review reports have been drawn up with each person living in the home. The manager said that she would make sure that the outcomes of the reviews and any new goals agreed would be clearly documented with timescales for action so that progress can be monitored. What the care home could do better: A new manager was appointed in March and has not yet submitted an application for registration; this must be done without delay to ensure that the home is complying with the legislation. The provider must establish adequate quality assurance systems to ensure that the quality of the service and outcomes for people living in the home meet the Regulations and National Minimum Standards for Care Homes for Younger Adults and that the quality of the service is kept under review. Regulation 26 visits must be carried out and shortfalls to the service identified and actions with timescales agreed with the manager. Areas of additional risks must be assessed as people`s needs change. A clear system must be set up for identifying triggers to challenging behaviours, providing detailed guidance to staff about actions to be taken in the event of an incident occurring and ways of recording and monitoring individual behaviours in order to protect people in the home and staff. The Commission must be kept informed of serious incidents and safeguarding alerts. A development plan for the home must be established with clear timescales to ensure that the environment meets the needs of people in the home and that the quality of care meets the required standard for people living in the home and people who may move to the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Buttercups & Railway Cottage 8 Ford Road Arundel West Sussex BN18 0BH     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: Annette Campbell-Currie     Date: 2 4 0 6 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Buttercups & Railway Cottage 8 Ford Road Arundel West Sussex BN18 0BH 01903889643 01903884105 buttercups@consensussupport.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Corich Community Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 12. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Buttercups and Railway Cottage is a care home, which is registered to provide personal care for up to twelve people who have a learning disability and are between the ages of 18 to 65 years of age. The service has been set up to provide care and accommodation for younger adults with autistic spectrum disorders and challenging behaviours. It is a detached property, which has been extended and adapted for its current use, and is located in the village of Ford. Although it is under one registration it comprises of two adjacent premises - one for three people and the other for nine. The Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 12 1 2 1 0 2 0 0 9 Brief description of the care home property provides private accommodation to residents in single bedrooms located on the ground and first floors. The bedrooms include ensuite WC and bath or shower facilities. Communal accommodation is made up of a lounge and a dining room in each of the premises; they are located on the ground floor. The smaller house has its own private courtyard that people living there can use. An enclosed secure garden, which is available to all residents, is located to the rear of the premises. The responsible individual acting on behalf of the organisation is Ms Julie Bendelow who is responsible for supervising the management of the care home. The registered managers post is currently vacant. The current fees for the service are from £1370.55 to £2300 per week. 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means that people who use the service experience adequate quality outcomes. The previous key unannounced inspection took place on 12th October 2009, at that time the home was also assessed as providing adequate quality outcomes for people living there. Four requirements were made following the inspection. We requested an improvement plan and the provider sent us a detailed plan of how and when improvements to the service would be made. During this visit we found that two of the requirements have now been met and two have not been met We (the Commission) carried out this site visit over four hours. The manager who began in post in March assisted with the inspection. The manager has not yet made an application for registration with the Commission. There were two people living in the home at the time of the visit and sixteen permanent staff were employed. Care Homes for Adults (18-65 years) Page 6 of 30 The manager completed an Annual Quality Assurance Assessment (AQAA) when we asked for one and the information was used in the planning of the inspection. Before the site visit we sent out surveys to find out what people think about the home. The comments that people made have been used to help make an assessment of the service. During the site visit we spoke with two members of staff and met both people living in the home. We saw the communal areas of the home, the bathroom, the kitchen and the bedrooms of the people living in the home. We read the following documents: the case records for both people, the complaints policy and records, menus, staffing rotas, samples of medication records and storage, some Regulation 26 reports and a sample of incident reports. The outcomes for people have been assessed in relation to twenty-two of the fortythree National Minimum Standards for Care Homes for Younger Adults; including those considered to be key standards to ensure the welfare of people living in the home. Two of the four requirements made at the previous inspection have been met; two are not met. Three additional requirements have been made following this inspection. 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: A new manager was appointed in March and has not yet submitted an application for registration; this must be done without delay to ensure that the home is complying with the legislation. The provider must establish adequate quality assurance systems to ensure that the quality of the service and outcomes for people living in the home meet the Regulations and National Minimum Standards for Care Homes for Younger Adults and that the quality of the service is kept under review. Regulation 26 visits must be carried out and shortfalls to the service identified and actions with timescales agreed with the manager. Care Homes for Adults (18-65 years) Page 8 of 30 Areas of additional risks must be assessed as peoples needs change. A clear system must be set up for identifying triggers to challenging behaviours, providing detailed guidance to staff about actions to be taken in the event of an incident occurring and ways of recording and monitoring individual behaviours in order to protect people in the home and staff. The Commission must be kept informed of serious incidents and safeguarding alerts. A development plan for the home must be established with clear timescales to ensure that the environment meets the needs of people in the home and that the quality of care meets the required standard for people living in the home and people who may move to the home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People would have their needs assessed before they moved to the home, however it is not clear that the home would be able to meet the needs of prospective service users until the planned development of the service is in place. Evidence: No new admissions have been agreed since the previous inspection. The manager said that the company provides guidance about the pre-admission assessment process and she said that she would be involved in the assessments of any prospective service users in consultation with the staff from local authorities responsible for commissioning placements. There is no clear development plan for the service although alterations to the building are due and planning permission has been granted for building development in the grounds. The timescales for the development are not clear or how this will impact on the people living in the home or new people who may move in. A requirement has been made regarding this matter. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: During this site visit it was evident that two requirements made at the previous inspection have not been met so that it is not clear that the health, safety and welfare of people moving to the home will be fully protected. We found that not all aspects of risk had been clearly assessed with guidance provided to staff to better protect people. The home has been without a manager registered with the Commission for two years. The quality monitoring systems are not sufficiently robust to ensure that improvements to the service are made in a timely fashion and that the quality of the service is kept under review. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs and aspirations documented in a plan of their care that is kept under review. People are assisted to make decisions in their daily lives. Staff are not provided with guidance about managing and monitoring all aspects of risk to people in the home, staff and people in the community. Evidence: At the previous inspection in October we found that the care and support plans had been updated and that a person centred approach had been taken to care planning. During the site visit we looked at the care planning documents for both people living in the home. Individual care needs and preferences were documented with guidance provided for staff. Peoples capacity for understanding was noted and their preferred method of communication clearly documented. The manager has made progress in supporting the staff to learn basic signing that is used by one person, to assist him with communication and the means to express choices he may wish to make. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: There was information about peoples background and likes and dislikes and there was input from family members to help staff better understand each persons needs and their potential for learning new skills. Peoples spiritual wishes had also been noted. The manager said that she would review the way that some information had been recorded to ensure that care records are written in an appropriate manner to reflect the age of the people living in the home. The manager has been liaising with staff from the two local authorities to ensure that they are part of the ongoing review and monitoring of the care plans. Detailed review notes had been provided with photographs to better enable individuals to be involved in the review process. These reports had been written by the key worker who knows the person well. One review was held recently, however there was no report of the outcome of the review with the new goals that had been set with the person and desired outcomes and timescales, so that progress in achieving goals can be monitored. The manager said that she would address this issue. It was not evident that changes to peoples care needs had been noted with updated guidance provided for staff. The manager said that she would ensure that key workers are aware of the need to update care and support plans to reflect changes of need. Risk assessments had been carried out for most aspects of individual need and review dates noted. Areas of additional risks were identified during the day but had not been clearly documented; the manager said she would ensure that these risks were assessed and guidance provided for staff. A key worker system has been set up to better assist people in making choices in their daily lives. Staff spoken with know the two people living in the home well. The manager is beginning to introduce information in symbol and picture format so that staff can support people to make simple choices in their daily lives. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a programme of activities that meets their individual needs. There is limited equipment available in the home that is appropriate for the age and ability of people who live there. People are supported to maintain contact with their families. A varied diet is provided however peoples nutritional needs are not always monitored and reviewed. Evidence: The activity room is not currently being used; this space would provide the opportunity for additional activities to take place in the home. Currently one person is living in each building so there is plenty of space for individual time with staff. The garden is also available for activities during the good weather. The manager said in the improvement plan that the weekly activity programmes have been reviewed and updated. Case records showed that detailed plans have been set Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: up, providing staff with better guidance about how one-to-one time could be spent. Picture cards and photos are now being used to help people with the structure of their day and to better involve them in making decisions about the activities they would like to take part in. There was very little equipment adapted for adults with learning disabilities available in the home. There was no evidence of sensory equipment that may support people to calm their behaviour when they become upset. There is an emphasis on supporting people to maintain contact with their families and communication books have been set up to improve communication between staff and relatives. People are encouraged and supported to use community facilities; the manager said more discussion is needed as to how this can be done in a way that meets individual needs. The home has recently employed a cook for five days of the week however this person has now left the home and care staff are providing all the food. The case records for both people showed that issues regarding nutrition and food had been identified and one person has recently seen the dietician. The outcome of dietary assessments had not been documented with clear guidance for staff. It was not clear that people have their weight checked, recorded and monitored each month in line with guidance about their nutritional needs. It was identified for one person that issues relating to food can be a trigger for aggressive or violent behaviours but there was no clear guidance about how this should be managed. There are no clear plans for improving the dining room so that meal times are a more pleasant experience for people although this has been identified in the past as an area for development. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their personal care and healthcare needs documented. The medication policies and practices do not always protect people. Evidence: Both people living at Buttercups and Railway Cottage need support with personal care. The bedrooms have ensuite shower facilities and there is a communal bathroom. Staff are provided with guidance about the way to provide personal care as part of their induction and ongoing training. The support plans that we saw include details about the way that people prefer to be supported and the aspects that they do not like or can cause them to become agitated. Male and female staff are employed so that people could choose whether they have a man or woman to support them. Health Action Plans have been compiled so that information about peoples healthcare needs is clearly documented. There was evidence that people are supported to have access to the healthcare services that they need. One person had recently had a medication review and their medication had been reduced due to an improvement in their health. Grab sheets for hospital and other medical appointments are now being used; key information such as allergies to medication is noted. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: There are medication policies and guidance for staff is provided. All staff who administer medication have completed competency training. The storage facilities for medication meet the current requirements. We looked at samples of medication records and it was not clear that all staff had followed guidance about the administration and recording of medication given. The medication records for one person who had been given medication as he required it (PRN) were not available so it was not clear that the guidance regarding the administration of PRN medication is being followed. Two bottles of the same liquid medication prescribed for one person, were found to be open; this showed that staff had not followed good practice guidance regarding the administration of medication. The manager said that she would follow up these issues as a matter of urgency. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints policy and system for recording complaints. There are policies and procedures to help protect people from harm however incident recording, reporting and monitoring needs to be improved in order to keep people safe from harm. Evidence: There is a complaints policy and procedure that is given to relatives or guardians of people living in the home who may not be able to make complaints for themselves. The key worker system has enabled staff to spend time with each person to support them to communicate concerns or anxieties. There is a procedure for recording complaints. Three complaints have been recorded since the previous inspection in October 2009. It was clear that these had been investigated, although the timescales and outcomes were not clear. The manager said that she would consider ways to improve the records of complaints and protect confidentiality. The requirement made regarding complaints recording has now been met. The home follows the West Sussex multi agency policy and procedure for safeguarding vulnerable adults. Staff have completed training in safeguarding procedures. The manager said that there has been one safeguarding alert made to West Sussex Adult Services by the home and this was investigated as a level one alert. It is a Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: requirement that the manager must inform the Commission of serious incidents and safeguarding alerts that are made. This matter has been of concern over the past two years and requirements have been made previously about the need for the home to keep the Commission informed of safeguarding incidents and other serious events that effect the welfare of people in the home. A further requirement has been made regarding this matter. There are behaviour support plans that have been drawn up by a specialist member of staff for the company. It was evident that incidents had been documented. There was no clear guidance for staff about how to manage all incidents of challenging behaviour with a system for recording each incident with triggers identified, the way the incident was managed, the outcomes for the people involved and any changes that may need to be made to the support plan. An issue was identified as an area of high risk to challenging behaviours for one person and there was no detailed guidance about how staff should support the person with this aspect of his life or how incidents should be recorded and monitored. The home must set up a robust system for managing, recording and monitoring incidents of challenging behaviours in order to protect people living in the home, staff and people in the community. A requirement has been made regarding this matter. 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. There is no development programme with timescales in place for the service although building work is planned. The home was clean and hygienic. Evidence: The manager said that building work is due to begin in the grounds and in the main building. There was no development plan available with timescales for work to be done or how disruption to people living in the home would be kept to a minimum. The providers must keep the Commission and placing authorities informed of planned development and changes to the service. A requirement has been made regarding this matter. A system has been set up to identify environmental health and safety concerns for each person living in the home and these are regularly checked. The manager said that she keeps senior staff informed of work that needs to be carried out in the home. One of the health and safety matters identified at a previous inspection has not yet been satisfactorily addressed. A bannister previously found to be loose with protruding nails had not been sufficiently well repaired to ensure that it could not be pulled out to reveal the nails and present a risk of harm. New furniture has been purchased for the lounge and areas of the home have been Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: redecorated. The shower facilities for both people living in the home are in need of upgrading and there is no clear plan for when this work will be carried out. People living in the home have been involved in planting flowers in the grounds so that this is a pleasant place for people to enjoy. There is a cleaning rota for the home and the cleaning is carried out by care staff. The home was clean and all staff have completed training in infection control so that they understand the need to prevent the risk of cross infection. The requirement regarding the cleanliness of the home made at the previous inspection has now been met. 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. People are supported by sufficient numbers of staff who are well qualified and receive the support that they need. The recruitment policy and procedure protects people in the home. Evidence: Staffing levels in the home have been maintained although there are only two people currently living there. Nine of the sixteen staff employed have achieved the National Vocational Qualification (NVQ) in care at level two or above, this exceeds the required standard that 50 of staff should have achieved this award. The new manager has set up a clear system of delegation for staff so that they understand their roles and responsibilities. Meetings and support sessions are held regularly at different levels; staff said that this has improved communication between staff and that they now work well as a team. The manager said that this has been her priority in the three months since her appointment. No new staff have been recruited since October 2009. We previously found that all the required checks are carried out before a new member of staff begins in post. There is an induction and training programme in place. The staff who returned surveys and those we spoke with said that they have good training opportunities so they have Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: the knowledge and skills they need to do their job. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to operate without a manager who is registered with the Commission. The quality assurance systems are not sufficiently robust to ensure that the home meets the Regulations and National Minimum Standards. There are some systems in place to better protect the health, safety and welfare of people living in the home and of staff. Improvements must be made in the way that incidents are recorded, reported and monitored. Evidence: The current manager has been in post since March of this year. She has the knowledge and experience she needs to run the home. The manager said that she is in the process of making an application for registration with the Commission. Buttercups and Railway Cottage has been without a registered manager for two years. It has been an ongoing requirement that the providers ensure the home meets the legislation and has a manager registered with the Commission. This has not yet been met and a further requirement has been made following this inspection. The manager has made good progress in improving the communication between staff Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: and the relatives of people in the home. She has an open style of management which means the staff team are now working well together and feel confident that she will support them in their work. The manager said that she had requested a meeting with her line manager to discuss issues regarding the running of the home. The providers must ensure that the manager has the support that she needs to ensure that the home meets the Regulations and National Minimum Standards for Care Homes for Younger Adults. The manager completed a detailed improvement plan explaining how the requirements made at the previous inspection would be met. There are no clear systems in place for the ongoing monitoring of the quality of service provided in the home. The last written Regulation 26 report was dated March when the new manager began. Shortfalls in the quality of service were noted but there was no evidence to show how these were being followed up to ensure that the required action is taken. A requirement was made following the previous inspection that the providers must ensure that quality monitoring systems are in place and kept under review. This requirement has not been met. There is no development plan for the service with intended actions and timescales. Due to the needs of the people living in the home any disruption to their living situation needs to be carefully planned and managed; there was no evidence to show that this is being done. It is of concern that there are plans for new admissions to be made to the home before there are clear and detailed development plans in place. The manager said in the AQAA that equipment is serviced as required. A fire risk assessment is in place and guidance provided for staff about what to do in the event of a fire. There are now regular safety checks of the environment for the two people living in the home. It was evident that incidents are being recorded however as discussed previously in this report a more detailed system for providing guidance to staff, recording and monitoring incidents needs to be established to ensure that everything is being done to protect people in the home, staff and people in the community. All serious incidents must be reported to the Commission under Regulation 37. A requirement has been made regarding this matter. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 37 8 The registered providers 30/11/2009 must recruit a manager who is suitably qualified and experienced to run the home and an application for their registration must be completed without delay following their appointment to ensure that the home is efficiently run and that the Regulations and National Minimum Standards are met. 2 39 24 The quality asssurance 30/11/2009 systems must be kept under review to ensure that improvements to the quality of the service are maintained and developed to ensure that people living in the home experience a good and safe quality of life. 3 39 24 The registered providers 30/05/2009 must ensure that the quality assurance systems are effective in identifying where improvements to the service should be made and making sure that these shortfalls are addressed in order to keep people safe and provide a good quality of care. 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 9 13 The registered providers 31/07/2010 must ensure that risk assessments are carried out for all aspects of peoples lives where a risk may be identified and clear guidance provided to staff about identifying, recording and monitoring incidents in order to minimise risks to people living in the home, staff and people in the community. 2 23 37 The registered providers 31/07/2010 must ensure that the Commission is kept informed of safeguarding incidents and events that effect the welfare of people living in the home in order to comply with Regulation 37 Care Homes for Adults (18-65 years) Page 28 of 30 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 3 24 23 The registered providers must establish a development plan for the service outlining planned changes with timescales to ensure that the disruption to people living in the home is kept to a minimum and placing authorities are made aware of planned changes to the service. 31/07/2010 4 37 8 The registered providers must ensure that the manager is registered with the Commission to ensure that the home meets the Regulations and National Minimum Standards 31/07/2010 5 39 24 The quality assurance 31/07/2010 systems must be kept under review and written reports of Regulation 26 visits provided to ensure that people living in the home experience a good and safe quality of life. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 30 of 30 - 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. 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