Care Home: Charlton House

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What the care home does well Individuals live in a homely and safe environment that is meeting their assessed care needs. Individuals had a good level of activities both in the home and the local community. Individuals were being supported to maintain friendships and contact with family. Individuals were being supported by a competent and consistent team of staff. There were good links with other professionals taking on their advice in supporting the individuals living at Charlton House. What has improved since the last inspection? Individuals have benefited from a review of complaints with better recording. Individuals can be assured that better communication is being adopted with notifications being forwarded to the Care Quality Commission in respect of incidents that effect the well being. Individuals are better protected by the recruitment processes ensuring staff are suitable to work in the home. Individuals will benefit from clearer information being made available to them in respect of contracts. These clearly state the fees and any additional contributions that are made. What the care home could do better: Individuals must be assured there are robust systems in respect of the ordering of medication, storage and records of stock being maintained. There must be clear guidance in respect of staff`s roles in the event of a medication error or omission. Individuals must be assured that all money held by the staff can be clearly accounted for. The manager must continue with the planned works in relation to radiator covers and improving the fire systems as discussed during the visit. Key inspection report Care homes for adults (18-65 years) Name: Address: Charlton House 21 Walliscote Road Weston Super Mare North Somerset BS23 1EB     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: Paula Cordell     Date: 0 7 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Charlton House 21 Walliscote Road Weston Super Mare North Somerset BS23 1EB 01934625978 01934625978 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Lal Gunaratne care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: May accommodate 2 named persons aged 18 years and over with physical disabilities, requiring personal care only. Will revert to LD when named persons leave. May accommodate up to 15 persons aged 18 years and over requiring personal care only The Manager to gain a formal LDAF qualification by June 2006 Date of last inspection Brief description of the care home Charlton House provides care for up to fifteen people with learning disabilities. Though most of the people who live there are over fifty years of age the home also provides care for some younger adults, including two specific places for people with additional physical disabilities. There is an activity room in the garden in which a good range of activities are provided. The home is a short walk away from local shops and facilities, and a reasonable walking distance from the town centre and seafront.The current scale of charges is 475 to 700 pounds per week. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 15 0 15 1 1 7 0 3 2 0 0 9 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 was an unannounced visit as part of a key inspection process. The purpose of the visit was to review the requirements and recommendations form the visit in March 2009 and monitor the care to the individuals living at Charlton House. There have been no additional visits since this and the last visit in March 2009. The Care Quality Commission have not received any complaints. The visit was planned using information that has has been received prior to this visit including notifications in respect of incidents that effect the wellbeing of the individuals and general correspondence. The visit was conducted over 5 hours. During the visit an opportunity was taken to review the records that are required for the running of a care home, a tour of the communal areas and a review of health and safety practices. In addition to talking with Care Homes for Adults (18-65 years) Page 5 of 30 people who live at Charlton House, the manager and the deputy manager. Care Homes for Adults (18-65 years) Page 6 of 30 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 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 7 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 8 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient information is in place to inform individuals about the care that is provided at Charlton House. Individuals can be confident that there is a comprehensive assessment completed ensuring their care needs could be met. Evidence: A statement of purpose and a service user guide was in place. This met with the National Minimum Standards and had been reviewed since the last visit. There was one vacancy at the time of this visit. Three individuals have moved to the home since the last visit. Two of the individuals had moved from the sister home Southside. The move was completed in consultation with the placing authority and the individuals. Both individuals said they were happy with the move and had settled in well. The was a completed assessment for the third person to move to the home which has informed the in house care planning processes. Copies of the placing authoritys Care Homes for Adults (18-65 years) Page 9 of 30 Evidence: assessment and care plan had been obtained prior to them moving to Charlton House. The individual had been encouraged to visit and join in the activities in the home including an overnight stay prior to making a decision to move there. Contracts were viewed for three of the individuals. The contract did not capture the true fees for the placement but gave a range. In addition the contracts did not state what was included in the fees and any chargeable extras. Individuals contribute towards the running of the vehicle and £1 per week towards day care. The manager was able to demonstrate during the visit that the contract had been reviewed with a space to fill in the above information but as yet this had not been discussed with the individuals or their representatives. In part this requirement had been met. The manager explained that this had been a busy year for the home supporting three individuals through periods of terminal illness and ensuring all individuals continue to lead active lifestyles with minimal disruption, hence some areas of record keeping had slipped. Care Homes for Adults (18-65 years) Page 10 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals can be confident that their assessed care needs are being met and there are systems in place to ensure their safety. Evidence: Three peoples care documentation was viewed as a means to determine the outcomes for people living at Charlton House. Information was clear and included information pertinent to the individual covering all aspects of daily living. Individuals confirmed during the last visit that they were involved in the planning of their care. Care documentation included information about daily routines including personal care. From the care documentation and talking with staff it was evident that individuals are encouraged to be as independent as possible. Care files were being reviewed every six months and more frequently for the older individuals and as needs change. For the three people admitted over the last twelve months some of the documentation relates to previous placements. Whilst this may Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: not be detrimental to the care of the individual it would benefit from being updated to ensure contact details were correct. Risk assessments were in place on any areas of particular risk for individuals. These clearly state what the risk was and what actions staff were taking to minimise it. The manager said at the last visit that she was planning to expand on the risks to cover all aspects of daily living and activities that individuals undertake. This remains outstanding but the manager said this has been a particular difficult year due to the death of three of the individuals and supporting them through terminal illness. People living in the home were being involved in the planning of their care and the running of the home. Individuals views were sought at house meetings and through an annual questionnaire. The manager said that the meetings had not been as frequent as they would like but this would be re-instigated. The last recorded meeting was in April 2009 and a member of staff said there had been one about a month ago but was unable to find the minutes. Care Homes for Adults (18-65 years) Page 12 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals were being offered a wide range of activities both in the home and the community meeting the diverse needs of both the younger and older group of people living in Charlton House. Individuals are encouraged and supported to maintain contact with friends and family. A healthy and varied diet was being offered to the individuals. Evidence: Individuals had both structured activities both in the home and the local community as evidenced in care records and conversations with the people living in Charlton House and the staff team. Some of the younger adults attend day centres, work placements and college courses. On the days that the individuals were at home they spend time in the Activity Room with staff participating in games, arts and crafts, gentle exercise, games and listening Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: to music to name a few. Some of the activities take place in the local community including going shopping, attending coffee mornings at the local church and a karaoke afternoon at a local pub. Individuals living at Charlton House have varying needs. From talking with staff, the manager and the people living in the home it was evident that activities were arranged to suit the individual. Some of the individuals have retired and enjoy listening to music whilst others enjoy going out and attending a coffee morning at the local church or going to clubs, swimming or the local sports centre. Good links had been made with the local church with some of the individuals attending regularly on a Sunday. On the day of the visit individuals were involved in putting up decorations in readiness for the Christmas celebrations. Individuals were putting on a pantomime at the local church. All if they wanted to had parts including the staff and the manager. Invitations are sent to friends and families and the local clubs that the individuals attend. From conversations with staff and the individuals it was evident that a variety of activities have been organised over the festive period including a party at Charlton House, going out for meals and Christmas shopping and activities at their different clubs. Those individuals that wanted to go on holiday were supported to go during the summer. Holidays included Cornwall and Devon in smaller groups with people of their choosing. Those that did not want to go on holiday went on day trips throughout the Summer. Trips included Cheddar Gorge, Minehead, Chepstow Castle and other places closer to Charlton House. Individuals were being supported to maintain contact with friends and family. This was recorded in the individuals care plan. Individuals as evidenced at the last visit were able to keep in touch by telephone and in person. Individuals were being supported to attend a local deaf club, a local social club for people with a learning disability and the Trefoil Guides. From talking with individuals during the last visit it was evident they enjoyed attending and keeping in touch with their friends. There are two staff working in the evenings and the individuals were supported to attend these groups by taxi although additional staff would be employed for organised activities. The home employs a driver to assist with individuals getting to and from their planned activities and social events. Menu planning was reviewed at the last visit in March 2009. It was evident then that the individuals were being offered a healthy and varied diet. An opportunity was taken Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: to join the individuals for the lunch time meal. Individuals confirmed they had a choice of what to eat and they enjoyed what was offered to them. Individuals had a cooked meal at lunch time and a light tea with supper being offered later in the evening. Care Homes for Adults (18-65 years) Page 15 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals personal and health care needs were being met. Improvements could be made to the medication system ensuring that there is guidance for staff in relation to medication errors and ordering which will afford individuals better protection. Evidence: Care files included information about how people like to be supported with their personal care and health care needs. Records were maintained of health care appointments and follow up treatment. There was a form for each individual that could be pulled from the file and taken to hospital with them. The information varied in quality and for three individuals had the incorrect address on the form and related to their previous placements. Both the content must be reviewed to ensure it remains current and the contact details. Reading the care files it was evident that the individuals had regular access to Dentists, Opticians, Chiropodists and other health professionals including the local Community Learning Disability Team. All the individuals are registered with a local GP. The manager had recently forwarded a quality assurance questionnaire to visitors to Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: the home including professionals. Feedback was extremely positive with comments ranging from good to excellent. A hospice nurse said all staff are extremely helpful and the individuals are well cared for and the atmosphere is always friendly. Another professional said there is good communication between us, and the individuals always look well cared for and happy. On the day of the visit a distinct nurse on the day said the staff were proactive in supporting the individuals and follow the advice that is given, they make appropriate referrals and there is always a welcoming atmosphere. From the conversations with the district nurse it was evident that the staff support individuals in a dignified manner and respect their privacy. The home was commended on the support that individuals have had in respect of wound care management. The medication system was looked at during the visit. Records were maintained of medication received, the administration and disposal. Less apparent was a stock record for as and when required medication and topical creams. It was noted that there was excessive topical creams and paracetamol for one person. The manager said that she was addressing this with staff. However, if a stock record is maintained this could be closely monitored in relation to the ordering of medication and their use. The medication was stored in the office in a suitable lockable cabinet attached to the wall. Medication that required refrigeration was being kept in the fridge in the kitchen. Some steps had been taken to make it more secure in response to a previous requirement by purchasing a box . However, this was still not secure and in accordance with the Royal Pharmaceutical Guidelines so therefore remains outstanding. This was noted by a visiting pharmacist who audited the medication system in June 2009. The medication policy still requires expanding in respect of the role of staff in the event of an error or omission. Whilst it is evident the manager has gathered some information relating to the administration and disposal it did not include the above. There have been five deaths over the last twelve months. It was evident that this had been a difficult time both for staff, the people living in the home and the manager. The staff and the manager were commended for their care and support by the hospice nurses during this period of time. From conversations with staff advice and support was sought from the primary health care team ensuring both equipment and professional support was in place. Additional care staff were employed during the period when individuals were unwell. Since the last visit new packs have been introduced to support individuals with decisions on how they would like to be Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: supported if they become ill and during the last stages of life. This was still work in progress and will be followed up at future visits. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals can be confident that their concerns were being responded too and better recording is in place. Good systems are in place to protect the individuals from harm however this will be enhanced with better recording of finances held in the home. Evidence: There was a complaints procedure in place that clearly described how concerns would be responded to and when. During the last visit in March 2009 individuals stated that they would tell a member of staff or the manager if they had any worries or were upset or had a complaint about the care they were receiving. Since the last visit evidence was provided that the manager and the staff had reviewed what constitutes a complaint as it was noted the staff were using the complaint record as a communication book about household chores that had not been completed. The record now has been organised so that the complaint, the investigation and the outcome could be recorded. The manager completes the investigation and signs to say that it has been completed. Staff were aware of safeguarding and confirmed that they had attended training with the local council during the last visit. Training records confirmed that some staff had completed this as part of their induction and others had attended refresher training in April 2009. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: The home has financial procedures in place. Finances were discussed during this visit and it came to light that individuals were being given a weekly personal allowance. The amount varied depending on the individual. Individuals had signed for a record detailing the amount given to them. However, personal allowances were still being kept in the office with no record being maintained. It was noted that the purses were kept in the managers office and were not secure. The manager and the administrator kept a clear record of what was held in the safe and did not realise this must extend to the individuals purse held on their behalf. The manager has agreed to review this practice to ensure that a comprehensive record is maintained. The manager said she will consider whether some of the individuals could have the responsibility of looking after their own purses. Lockable storage in bedrooms was provided ensuring individuals could keep items of valuables safe. The review of finances must be within a risk assessment framework ensuring the individuals have some financial awareness. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Charlton House is a safe and homely place to live. The works that have been planned will further enhance the safety of the individuals. Evidence: Charlton House is in a residential area close to amenities including shops, a church, local colleges and the seafront of Weston Super Mare. The home was in keeping with the local neighbourhood. The home was well decorated, maintained and comfortably furnished creating a pleasant and welcoming environment. All areas of the home were clean and free from odour. There were two communal lounges and a dining room. In addition the individuals have access to an Activity Room situated in the garden. Individuals were observed accessing both the communal lounges and the activity room throughout the visit. Individuals confirmed they could access their bedrooms whenever they wanted and could have a key. Bedrooms were not viewed on this occasion. However during the last visit it was noted that bedrooms had been personalised by the occupant and were comfortably furnished. The manager said that previously there had been two double Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: bedrooms but one of them is now a single bedroom. The manager was aware that where a vacancy occurs in a double bedroom that this should be reviewed. The other double room was occupied by a married couple. Bedrooms are situated on both the ground and first floor. Individuals could access the first floor by a stair lift. Adequate bathrooms and toilet facilities were situated throughout the home. These were lockable and contained adequate hand washing facilities, towels and toilet paper. The home supports two individuals with a physical disability. As noted at the last visit appropriate equipment is in situ to assist staff with lifting and to aid the individuals with personal care. Staff had attended training in manual handling and were observed assisting individuals safely. The manager said that a builder has been sought to commence the work on providing radiator covers throughout the home. A plan was in place to complete this work in all high risk areas first and then continue to proceed throughout the home covering all radiators ensuring individuals were not at risk from scalds. In addition the contractor was to replace all fire seals and install eight smoke detectors in bedrooms and complete remedial works to an under stair cupboard in accordance with the recommendations made by the local fire officer. The kitchen area was clean and well organised. Policies and procedures were in place to guide staff on safe handling of food. Staff had attended training in food hygiene. The care staff complete all food preparation as part of their duties. An Environmental Health Officer visited the premises in August 2008 and Charlton House was awarded a five star rating. Clear records were being maintained to demonstrate that good food hygiene practices were being completed. These included records of food and fridge/freezer temperatures and cleaning that was being routinely completed. Routine cleaning is completed in the home by the care staff and domestic staff. Records were maintained of the cleaning completed. Staff had attended training in infection control as evidenced in training records. 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. Sufficient and competent staff support the individuals living in Charlton House. Improvements could be made to training records and supervision ensuring staff are competent and more supported in their roles. Individuals were being protected by robust recruitment practices. Evidence: Charlton House is staffed 24 hours a day. There was a minimum of three carers in the morning and two staff working in the evenings. Nights were covered by one waking and one sleeping member of staff. In addition to the care staff there were domestic staff, a driver/handyman and an administrator. The assistant manager said there was a full established team working at Charlton House. From reviewing staff files it was evident that the many of the staff have worked in the home for a number of years. Staff spoken with said that morale was better. Staff said it has been a difficult year with supporting some of the individuals through periods of illness and the deaths of some of the older people living in the home. However, from talking with staff it was evident that they had been supported through these periods. The manager works in the home Monday to Friday along with an assistant manager. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Staffing is increased at times when individuals are ill and to assist with social activities in the evenings for example the theatre or trips to the pub. Some of the individuals go out independently and others attend activities in the evenings but were taken by taxi. Compliance had been demonstrated in respect of recruitment by ensuring two references were obtained. Recruitment information was stored securely in a lockable cabinet in the managers office. All other records were in place to demonstrate a thorough recruitment process had been completed including criminal record bureau disclosures. Training records were viewed for three members of staff. It was difficult to navigate the information as certificates were filed under the course title rather than the individual member of staff. The manager was unable to find the individual training records other than the certificates. This should be rectified as this would make auditing and planning of training easier. Staff had attended mandatory training in first aid, manual handling, food hygiene, fire and health and safety. In addition staff had completed training in medications, dementia and infection control. The manager said further training was being planned for dementia, epilepsy and medication. Some of this was through distance learning. Evidence was provided that staff complete an induction and this had been signed of by the member of staff and the manager in response to a requirement made at the last visit.. However, as noted at the last visit staff do not complete the Learning Disability Qualification as part of their induction as recommended for staff supporting individuals with a learning disability. As noted at the last visit the National Minimum Standard had been exceeded with 50 of the workforce having an National Vocational Qualification. Eighteen staff had completed an NVQ at level 2 and two were now completing the National Vocational Qualification at level 3. This is good practice and demonstrated a commitment to ensuring staff have the necessary skills and knowledge to fulfil their role. Staff supervision records were seen for a number of staff. This was an area the manager said could be improved. Staff have only received one supervision in the last twelve months. The manager said the assistant manager would take on this responsibility. From talking with staff it was evident that they felt supported in their role and met with the manager on an informal basis. The National Minimum Standards recommends that staff meet on a one to one basis to discuss their roles, performance and training at least six times per year. This will be followed up at the next visit. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals benefit from a well managed service where their safety is paramount. Evidence: Mrs Veronica Bishop is the registered manager. She has completed the Registered Managers Award. Mrs Bishop has many years experience of supporting people with a learning Disability and older people. The manager and staff said the owner Mr Lal Gunaratne visits regularly. It was evident from conversations that he spends time with the staff, the manager and the people living in the home. There was a Quality Assurance policy and guidelines as seen at the last visit. Surveys had been sent to professionals, families and visitors. Feedback was extremely positive with many of the areas highlighted as excellent. Comments included always a friendly welcome when visiting, good communication, the staff and manager are really caring and Individuals appear happy and well cared for. The manager said that surveys were being sent out annually. Views of individuals were sought through care Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: reviews and during house meetings. Good health and safety systems were in place ensuring the safety of the individuals. This included records relating to checks on the fire equipment, fire training and drills for staff, checks on the manual handling equipment and checks on the electrical and gas appliances. Records were seen confirming this. An independent organisation completes an annual audit on the premises in respect of health and safety. They had recommended that doors have improved fire seals, eight of the bedrooms to have smoke detectors and some repairs to be completed to an under stair cupboard. The manager said that a builder would be starting the following week to complete all works including radiator covers throughout the home. This was further confirmed in conversations with the assistant manager and the handyman. Staff training was in place in relation to health and safety including manual handling, food hygiene, health and safety, infection control and first aid. Good records were maintained in respect of food hygiene including fridge/freezer temperatures, food probing and routine cleaning. 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 20 13 Medication must be stored in 17/04/2009 accordance with the Royal Pharmaceutical Guidelines. A secure medication fridge must be purchased. 2 24 24 To continue with the programme of ensuring that radiators are covered in line with the homes risk assessment. To ensure the safety of the people living in the home. 28/04/2009 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 5 5 Ensure each person has a contract of care specifying the fees to be paid and any additional costs. Ensuring an open and transparent service is provided. 08/02/2010 2 20 13 For a stock record to be 10/01/2010 maintained of as and when required medication and topical creams in accordance with the Royal Pharmaceutical Guidelines. So that the ordering of medication can be audited and monitored and avoid surplus medication being ordered. 3 20 13 To review the medication 08/01/2010 policy to ensure guidance is clear for staff in the event of a medication error. Ensuring individuals are protected. 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 4 23 17 A record of all finances held 30/12/2009 by staff must be maintained. Offering better protection for the people living at Charlton House. 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 19 Ensure the records detailing the support and health care needs are current in respect of information that is taken to the hospital if admission is required. For each member of staff to have an individual training record. For staff to complete the Learning Disability Qualification. For staff to receive formal supervision six times per year with records maintained. 2 3 4 35 35 36 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. 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