Care Home: Cardinals Gate 55

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What the care home does well It was observed that there was a relaxed and happy atmosphere. People were laughing and animated and there was constant interaction between staff and people whose home it was. It was clear that people could express themselves and were listened to and responded to with respect. People had every opportunity to express themselves. One person told us, "staff are kind" and that she was happy living there. Another person who had previously had the opportunity to live nearer to his parents had chosen to stay at the home. Regular maintenance is carried out to the home. The induction programme arranged for new staff is arranged before people commence work in the home and is held at a training centre venue. The induction is thorough and comprehensive in content and is a structured programme that equips staff with good skills before they commence employment in the care home. Different levels of induction programmes are provided for managers and for care staff. Training arrangements are managed so that staff receive training in the appropriate topics expected for this type of service. The management structure is effective and the service have been able to effectively manage the home in the absence of an appointed manager. What has improved since the last inspection? Overall, the service has improved since the last inspection. One of the two Requirements made at the last inspection had been met. The other requirement is still within the timescale that was made. Regulation 37 events have been reported by the home when necessary. The incidents of abuse that have been reported by the home and others to the local Safeguarding teams have been appropriately responded to by the home. The results of the investigations carried out by the County Council Safeguarding teams resulted in one Local Authority suspending their placements at the home and asked for specific actions to be planned and implemented. The home has cooperated fully in these action plans and as a result the service has improved. Care plans have been reviewed, risks have been reviewed and re-assessed, risk planning has been focused on and staff training increased. On the day of this inspection there were four people living at the home. This was two less than the home is registered to provide and two less people than at the last inspection. The reduced numbers, including one less care worker, has made an impact on the environment and this may have had a beneficial effect on the potential for challenging behaviour. Redecorating had been carried out to all bedrooms and some communal areas. New carpets had been fitted and new mattresses bought. A new acting manager had been promptly recruited after the previous acting manager left. What the care home could do better: Care plans should include clearer details of each person`s arangements for any `one to one` care that should be provided. The medication administration records must be maintained so that the amounts of medication that are held by the home can be verified as accurate. An immediate requirement was made for this on the understanding that the home could implement this within 48 hours. They have since stated they have put this requirement into action. Suitable sleeping accomodation is needed for care staff who are expected to sleep on the premises. Additional and specialist training in Safeguarding Vulnerable Adults could be provided for staff. Staff undertaking NVQ courses should be steered towards taking the Learning Disability Qualification Awards. Key inspection report Care homes for adults (18-65 years) Name: Address: Cardinals Gate 55 55 Cardinals Gate Werrington Peterborough PE4 5AT     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: Don Traylen     Date: 1 4 1 0 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 29 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 29 Information about the care home Name of care home: Address: Cardinals Gate 55 55 Cardinals Gate Werrington Peterborough PE4 5AT 01733576660 01733576650 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.communitycaresolutions.com Community Care Solutions Limited care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Learning Disability (6) Mental Disorder (2) - Only associated with learning disability Date of last inspection Brief description of the care home 55 Cardinals Gate can accommodate up to 6 adults with a learning disability and for two of those people having associated mental health problems. The home is a bungalow in a residential area of Werrington, a village on the outskirts of Peterborough. It is no different in appearance from the neighbouring properties. There is a small parking area and garden to the front of the bungalow and a spacious enclosed garden to the rear. There are six single bedrooms, four of these have full ensuite shower facilities whilst two rooms have ensuite toilets and washbasins. There is a lounge, a dining room and a conservatory with doors to the garden. The home has its own transport. The nearby public transport provides easy access to Peterborough Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 0 6 2 0 6 1 1 2 0 0 8 Brief description of the care home City centre, which is approximately two miles away. Local amenities are within walking distance. The weekly fees start at £1300 per week. Copies of CQC inspection reports are available from the CQC website and a copy can be read at the home. Care Homes for Adults (18-65 years) Page 5 of 29 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: Two inspectors carried out this inspection on 14/10/2009. We started at 9:45 am and finished at 18:00pm. The acting manager and the relief manager were present throughout the inspection. We spoke to each of the four people living at the home and had continual contact with them throughout the inspection. We asked three care staff about their training and the needs of people. We looked at four peoples care plans and read two of these in detail. We assessed medication records, staff recruitment records and processes and their training. We made observations of the interaction between staff and people living at the home. The home completed an Annual Quality Assurance Assessment when we asked for this. Care Homes for Adults (18-65 years) Page 6 of 29 What the care home does well: What has improved since the last inspection? Overall, the service has improved since the last inspection. One of the two Requirements made at the last inspection had been met. The other requirement is still within the timescale that was made. Regulation 37 events have been reported by the home when necessary. The incidents of abuse that have been reported by the home and others to the local Safeguarding teams have been appropriately responded to by the home. The results of the investigations carried out by the County Council Safeguarding teams resulted in one Local Authority suspending their placements at the home and asked for specific actions to be planned and implemented. The home has cooperated fully in these action plans and as a result the service has improved. Care plans have been reviewed, risks have been reviewed and re-assessed, risk planning has been focused on and staff training increased. On the day of this inspection there were four people living at the home. This was two less than the home is registered to provide and two less people than at the last inspection. The reduced numbers, including one less care worker, has made an impact on the environment and this may have had a beneficial effect on the potential for challenging behaviour. Redecorating had been carried out to all bedrooms and some communal areas. New carpets had been fitted and new mattresses bought. A new acting manager had been promptly recruited after the previous acting manager left. Care Homes for Adults (18-65 years) Page 7 of 29 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 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 8 of 29 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 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured their needs are comprehensively assessed before they move into the home and they have the opportunity to visit and decide if the home is suitable. Evidence: No person had moved into the home since the last inspection in November 2008 when this standard was found to have been met. Any person considering moving into the home is given the opportunity to visit the home and make a decision about living there before they decide to move. A Statement of Purpose and a Service User Guide in pictorial format had been given to people and copies of these were kept in their files. Care Homes for Adults (18-65 years) Page 10 of 29 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 are assured their individual needs are planned and that they can make choices about their care arrangements. Evidence: Four people were living at the home. We looked at each person care plan and read two peoples care plans in detail. The plans were neat, indexed and clearly referenced. They had comprehensive and detailed descriptions about offering care and support. Differing elements of care were listed. Risk assessments were recorded. Each of the four care plans had been reviewed. One persons plan included his challenging behaviours and associated needs, including restraint and the instructions to reduce stress and strategies for staff to use in these situations. His choices and freedoms about financial matters had been recorded and this included his contribution to the running costs of the vehicle used by each person. There was an up to date record of the night checks for this person. There was an individual timetable that included, ball games, arts and crafts, playing pool, swimming, regular day trips, going out for a drive, and weekend visits to his relatives. Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: Risk assessments for the identified risks, such as travelling arrangements and signs of aggression, had been undertaken and these had been made to reduce self harm and harm to others. ABC, or Antecedent Behaviour and Consequence charts had been used to record incidents of challenging behaviours and these contained detailed records of the actual incidents. Further risks assessments were read for swimming, physical support, finances, domestic tasks and personal care. The four people living at the home were there throughout most of the day. One person had returned from college earlier than anticipated. Three of the four people had arrangements for one to one support commissioned by a local authority. Eight hours of one to one support were acknowledged as a need in one persons care plan. His care plan and the other plans included the routines of weekly activities and a chart of these activities was kept by each person in their room. There were records in the daily notes of the one to one support that had been given. Walks to the shop and going to the gym, or to the park were recorded in the daily notes as a one to one activity. One persons records showed a period of activity that included going to the shops and to the gym as lasting one hour, when it was likely this had taken longer. It was discussed with the acting manager and relief manager during the feedback, that care plans could include a part that would make it clearer how each persons one to one support will be given and if this includes any of the planned activities. In one persons schedule/timetable it was shown that he likes to visit his relatives each weekend, although his care plan did not explain how this arrangement was facilitated. We spoke to another person who had seen and read her care plan and was satisfied with it. She explained how she was wanting to achieve greater independence and how she was working towards this with the help of the acting manager and her Social Worker. She stated she felt it was time to move on and said that the home are helping her in this. She described the domestic tasks and cooking she does in the home and going to college twice each week. She told us she was planning to take a cycling proficiency test and was hoping to manage her own medication. The acting manager said her care plan would be updated to include these recent changes. During the afternoon the three care staff went out with three people and one person chose to remain at home helping the maintenance worker to paint and lay new carpet in his room. He was receiving attentive and practical support from the maintenance person whom he worked well with. The relief manager was attentive and offered support throughout. From the observations we made and the discussions we had with two people, it was seen that people made choices about which activities they wanted to do, such as, returning from college, or remaining at home and not going out, and Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: choosing the colours in the redecoration of their room. It was noticed that sign language, as a means of communication with one person was used for some exchanges but not effectively by all staff. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured their lifestyle is promoted by the home and that it is appropriate and fulfilling. Evidence: One person attends college twice a week and another person attends college and has a job. Recent re-arrangement had been made for one person to change his work and college placements to those that he was interested in. Two people travel independently by public transport to some of their work and college placements. Staff accompany people to enjoy community facilities such as the gym, a swimming pool and a pub that includes weekends and evenings. The home has two vehicles to use to access community facilities. During the afternoon of the inspection three people went to a forest for a walk which they chose to do and told us they like going there. Family contacts and opportunities to see and stay with relatives are promoted and Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: openly encouraged and three people told us enthusiastically about their relatives and the contacts they had with them. A meal was observed being prepared and one person was assisting in this task as part of her plan to become more independent. She said the food was usually good and she always had plenty to eat. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured their personal care and health care is promoted and they are adequately assured their medication is safely managed. Evidence: Care plans and observations of interaction showed that staff were offering support in a manner that was respectful when they listened to peoples views and choices. Care plans showed that support with personal hygiene was required for some people, whilst others were sufficiently independent to manage themselves. Two people expressed their opinions about their clothes and told us they decided what they wear and buy. Two people who receive support and assistance with their personal hygiene were supported to be as independent as possible in this. One persons care plans showed he had oral health care needs, although it was not clear what arrangements for dental treatments had been made in respect of this. Each person is registered with a GP. All people are entitled to support through the PCT Learning Disability Partnership multi disciplinary team. For example, one person had recently been supported with his speech and language needs and his care plan had been re-evaluated because of certain behavioral concerns. One person told us she would like to manage her own medication. She explained how she was being supported by the acting manager to Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: commence this and what she would have to do. The acting manager explained this plan was being considered within a general plan to enable her to achieve greater independence. At the time of the inspection all four people were being administered their medication. Medication records were checked. The Medication Administration Records charts did not include any brought forward or carried forward amounts of each persons medicines. It was not possible to verify if the amounts of medication held by the home were correct. The manager showed us the audits that had been carried out as part of the Regulation 26 reports of the Care Homes Regulations 2001. These audits were dated 27/08/2009 & 29/06/2009 and included weekly audits of medication for each week in August. However, it was not clear if these audits had included a count of the amounts of medicines. We were unable to clarify from any available records if the amounts of medication were accurate. At the last inspection on 06/11/2008, the medication amounts were written in the charts and we had previously been able to verify the amounts of medication in the home. We were informed by the acting manager that the home would in the immediate future include these figures in their records. The use of the letter F written in the medication administration record charts was not explained on the record we saw. There was not a medication record chart for one person who was prescribed Paracetamol, as and when required. The process for people taking medication out of the home was assessed. The record kept for this transaction showed there were some entries when medication went out with one person when he visited his relatives and some entries when medication was returned. However, these were not consistent, or completed so that it could be checked what went out and what was returned in every instance. The acting manager discussed that she would make enquiries about a separate prescription for people who regularly stay with their relatives and who need a supply of medication for this duration. An immediate requirement was made in respect of the medication records. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured they are safeguarded by the home although some further assurances could be initiated. Evidence: The home has a complaints procedure and records the complaints they have received. The home has been involved in recent cases where abuse has been investigated by the Local Authority Safeguarding teams. The issues had been reported by the home and they have been fully involved and responsive to requests to improve their safeguarding practices as a result of these investigations. All staff have received recent Safeguarding training provided by the organisation and Safeguarding of Vulnerable Adults (SOVA) training is provided at the induction stage for all new staff. It was discussed with the new acting manager that the local authority have developed a range of awareness and specialist training for Safeguarding. We read the homes operational policy and procedures for safeguarding vulnerable adults/children. Their policy stated that staff have a duty to report any allegations or concerns of harm to their line manager and the organisations Safeguarding lead who will initiate any relevant local authority SOVA proceedings, although it also stated that, It is not up to individual staff to make judgements about whether abuse has occurred. Staff told us they would confidently report abuse to their managers and were aware of where they could report directly to the local safeguarding teams should Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: they need to. It was discussed with the manager how all care staff are responsible for safeguarding vulnerable people and their policy could reflect how staff are enabled to contact the local safeguarding team directly, should this be necessary. The telephone number shown in their policy for the Peterborough Safeguarding team was not correct. On the day of inspection there was not a copy of the local authority guidelines referred to in the policy, although the acting manager was aware of the discussion taking place with the local Safeguarding team about this policy. Care Homes for Adults (18-65 years) Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured the home is well maintained but do not have access to all parts of the home at all times. Evidence: At the time of this inspection there were two less people living at the home and this meant the environment was better, in that there was more personal space. The environment was improved in other ways too. The home was clean and tidy and well decorated. The building is a comfortably furnished bungalow that is ordinary and homely in a residential area. Four rooms have full en-suite facilities with a shower and the two other rooms have an en-suite toilet and washbasin. A bathroom with toilet is shared by two people and by staff. There were no noticeable offensive odours. There was a pleasant aroma of food when an evening meal was being prepared. A considerable amount or redecoration, new furnishings and new carpets had been provided. The four bedrooms in use and the two vacant bedrooms had been completely redecorated. People told us they had chosen the colours for their rooms and some of furnishings. One person told us she did not like the colour of her room and had discussed with the manager about painting the lounge herself. The hallway and the lounge had been redecorated. New mattresses had been bought. One person was busy painting and assisting the maintenance worker decorate and fit new carpets Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: in his room. The managers office is small and contains various documents and a medication cabinet. The home has two vehicles that staff use to take people to various leisure, or educational and work places. There is an arrangements for any necessary repairs to be written in a book for the maintenance worker to action when he attends the home every week. The home has a secure and well kept garden. We observed the garden being used by two people playing handball at various times throughout the inspection. At the last key inspection it was reported that staff used the conservatory for their sleeping accommodation, where a fold-up bed that staff use was stored. This room was continuing to be used as sleeping accommodation. Two care staff and the acting manager confirmed they had each used this room as sleeping accommodation. Care Homes for Adults (18-65 years) Page 21 of 29 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 assured staff are safely recruited and receive appropriate training. Evidence: Three care staff and the newly appointed acting manager and the relief manager and the maintenance person were working on the day of the inspection. Four people were at home including one person who had returned from college earlier than anticipated. Three of the four people have arrangements for one to one support. Staff were observed to treat people with respect. They spoke to them with respect and gave people time to answer. One person told us that staff are kind and that they liked living at the home. 50 of staff have achieved NVQ level 2 awards in care and one new care worker was expected to commence this course in the near future. There is an induction programme that is mandatory for all new staff. It is a comprehensive programme that has the benefit of being provided in a classroom situation away from the place of work. The induction is provided by the organisations trainers and is flexible in that new staff are given this whenever they commence employment. This induction is planned over 10 days for new care workers and over 28 days for new managers. The training takes place prior to anybody commencing employment, or entering their place of employment. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: We asked for the recruitment records of two staff. The records are retained at the organisations Head Office. We were given a record of the checklist of documents obtained for each person in respect to their recruitment process. Both records showed appropriate documents had been completed and received for each person, although the records showed they had both started employment with the company prior to their POVA First check being received. These two staff had respectively attended a 10 day and a 28 day induction programme before they commenced work at the home, during which period they had both received their Criminal Records Bureau disclosures. It was discussed that the records could include the date when a new worker actually starts working at the home. The home has a training budget and training topics that are appropriate to peoples needs associated with their learning disabilities. We read the training arrangements provided for the month 12/10/2009 - 07/11/2009 and the topics included: Basic First Aid, Deprivation of Liberties, Epilepsy, Medication, Managing Challenging Behaviour (that included Non Abusive Physical & Psychological Intervention or NAPPI), Food Hygiene & Nutrition, Infection Control, Autism, Dementia and Multiple Sclerosis. Training profiles and plans are managed through the organisations head office after the home has identified staff training needs. The training matrix showed an appropriate amount of training for staff, including one recently employed member of staff who had received training in restraint (NAPPI) at level 1 and 2. It was noticed that sign language, as a means of communication was used for some exchanges but not effectively by all staff. It was discussed with the manager that staff undertaking NVQ courses in the future, should be steered towards taking the Learning Disability Qualification Awards. Care Homes for Adults (18-65 years) Page 23 of 29 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. People are assured the home is managed in their best interests. Evidence: The home appointed an acting manager on the 01/09/2009. She is an experienced manager. Records of Fire drills, fire alarms tests and emergency electrical lighting were seen. The records of the maintrence of the home was read. Medication records were assessed and have already been referred to in this report. Risk assessments showed that risks to people have been identified and reduced. Meetings for residents are held monthly and a member of staff facilitates these events. It was not clear how peoples views are translated in actions or plans. Regulation 37 events have been sent to us in a timely manner and Regulation 26 reports kept at the home were read for August and July 2009. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: Policies read included safeguarding and restraint. The restraint policy did not clarify what training (ie NAPPI) is being provided, who will be trained and if any associated protocols and procedures related to this training will be followed. The management response to safeguarding concerns that have been raised in the investigations conducted by the Local Authority Safeguarding teams has been positive and has shown the organisation has acted in the best interests of people living at the home. Care Homes for Adults (18-65 years) Page 25 of 29 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 28 23 The home must provide suitable sleeping accommodation for staff where this is needed. So that people are assured their home is suitable for its stated purpose and they have access to their communal rooms at all times. 01/01/2010 Care Homes for Adults (18-65 years) Page 26 of 29 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 1 18 13 Accurate recordings of the administration and handling and disposal of medicines must be kept so that people are assured the home is managing their medication safely. 16/10/2009 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 6 15 Care plans must be reviewed 01/12/2009 so they include details of how any one to one support will be offered and include the arrangements made when people visit and stay with relatives. So that peoples care arrangements are recorded in their care plans. 2 39 24 A record, or a quality assurance approach to measuring and responding to the views of people and their relatives must be developed and sent to the Commission. 01/01/2010 Care Homes for Adults (18-65 years) Page 27 of 29 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 So that peoples views can be used to influence the quality of their care. 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 2 23 23 Additional and specialist training in Safeguarding Vulnerable Adults could be provided for staff. The safeguarding policy should be reviewed to include the correct telephone numbers to report abuse to the Local Authority Safeguarding team; to reconsider if staff are enabled to contact the local safeguarding team; and the relevant training that staff should receive. Staff undertaking NVQ courses in the future should be steered towards taking the Learning Disability Qualification Awards. Staff should be trained in the use of sign language. 3 35 4 35 Care Homes for Adults (18-65 years) Page 28 of 29 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). 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