Care Home: Charlton Road

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What the care home does well To staff are well trained and provide a sensitive and respectful service to residents. The residents families and health care professionals who visit the home said that staff are very good and very good job in providing care.Page 9 of 40Care Homes for Adults (18-65 years)Health care needs and are well managed.The home is well decorated and well maintained, and fits the needs of residents well. The home is well managed, and staff and others say that management is very supportive, and that good quality training is provided for staff. What has improved since the last inspection? The garden has been improved and is now more usable by residents, but further improvements are needed. Policies and procedures had been updated to help staff to be clearabout how to do their jobs. While the homes manager has temporarily become unavailable the provider has provided good support and direction for staff in his absence. What the care home could do better: The home needs to improve the information provided for residents in their contracts, to show that service costs and how costs such as transport and food are paid for. Care plans could be improved by the use of pictures which would help residents to better understand their plans. Person centered planning would help residents to have a service more tailored to theirindividual needs. The home should include religious and spiritual needs of residents more prominently in care planning and reviews and to find out whether these issues are important to residents. Community activities could be improved and the home should try to support residents to develop a greater network of friends. The home needs to find out which residents are able to take their own medication, even with little help, and write this down so that residents will be helped to develop this skill. Some efforts should be made to improve the garden further, so that residents can enjoy it, and to get rid of unwanted pests in the area near the house.Staff need a bit more training about how to safely protect residents, and how to support residents with dementia support needs. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Charlton Road 30a Charlton Road Blackheath London SE3 8TY The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sean Healy Date: 2 9 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 40 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (20092008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 40 Information about the care home Name of care home: Address: Charlton Road 30a Charlton Road Blackheath London SE3 8TY 02083052425 02088585039 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : www.voyagecare.com Milbury Care Services Ltd care home 5 Number of places (if applicable): Under 65 Over 65 5 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection 3 0 0 4 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 40 A bit about the care home 30a Charlton Road is a registered care home providing accommodation and nursing care for four adults with a learning disability. It is situated near to Blackheath Standard a local shopping centre and has access to good public transport links. The home is one of a group of six homes for adults with learning disabilities situated in the London Borough of Greenwich and managed by Milbury Community Services Ltd. The property is a detached bungalow which provides four single bedrooms, a lounge/dining room, kitchen, laundry room, toilet and bathing facilities. The property has small gardens to the front and rear. The home has links with the Care Homes for Adults (18-65 years) Page 5 of 40 Greenwich Community Learning Disabilities Team (CLDT) to provide a multidisciplinary service. Members of the CLDT are involved in placements in the home, monitoring resident care and progress and provide day care services and links to specialist health care. The manager confirmed that the current fees were #1438.22 per week. Residents paid privately for personal clothing and toiletries, holidays and some leisure outings. Care Homes for Adults (18-65 years) Page 6 of 40 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 Care Homes for Adults (18-65 years) Page 7 of 40 How we did our inspection: This is what the inspector did when they were at the care home The quality Rating for this service is 2 Star. This means that the people who use this service experience Good quality outcomes. The site visit for this unannounced inspection was undertaken on 29th April 2009. The acting manager was on duty and she together with the area manager and staff assisted with the inspection. One resident was in the home with others returning from the day centre at lunchtime. The other residents were attending day centres. No relatives were seen during the visit. The service was last inspected on the 30th April 2007. The inspection included a review of information held by the Commission Care Homes for Adults (18-65 years) Page 8 of 40 since the last inspection, viewing the premises, an inspection of care records and records that must be maintained to comply with regulation, talking to and observing residents and staff and contacting relatives and other professionals to get their views of the service. An Annual Quality Audit Assessment was also provided by the registered provider for the purposes of the inspection. What the care home does well To staff are well trained and provide a sensitive and respectful service to residents. The residents families and health care professionals who visit the home said that staff are very good and very good job in providing care. Page 9 of 40 Care Homes for Adults (18-65 years) Health care needs and are well managed. The home is well decorated and well maintained, and fits the needs of residents well. The home is well managed, and staff and others say that management is very supportive, and that good quality training is provided for staff. What has got better from the last inspection The garden has been improved and is now more usable by residents, but further improvements are needed. Policies and procedures had been updated to help staff to be clear Care Homes for Adults (18-65 years) Page 10 of 40 about how to do their jobs. While the homes manager has temporarily become unavailable the provider has provided good support and direction for staff in his absence. What the care home could do better The home needs to improve the information provided for residents in their contracts, to show that service costs and how costs such as transport and food are paid for. Care plans could be improved by the use of pictures which would help residents to better understand their plans. Person centered planning would help residents to have a service more tailored to their Care Homes for Adults (18-65 years) Page 11 of 40 individual needs. The home should include religious and spiritual needs of residents more prominently in care planning and reviews and to find out whether these issues are important to residents. Community activities could be improved and the home should try to support residents to develop a greater network of friends. The home needs to find out which residents are able to take their own medication, even with little help, and write this down so that residents will be helped to develop this skill. Some efforts should be made to improve the garden further, so that residents can enjoy it, and to get rid of unwanted pests in the area near the house. Care Homes for Adults (18-65 years) Page 12 of 40 Staff need a bit more training about how to safely protect residents, and how to support residents with dementia support needs. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sean Healy Finsbury Tower 103 – 105 Bunhill Row London EC1Y 8TG Telephone: 0207 448 9299 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 13 of 40 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 14 of 40 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 15 of 40 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. Quality in this outcome area is good.This judgement has been made using available evidence including a visit to this service. Prospective residents do not have all the information they need to make a choice about whether to live in the home. Residents individual care needs are fully assessed, but written contracts regarding the care provided and the cost of this care is not yet sufficient. Evidence: The home is long established, and has a permanent registered care manager supported by an assistant team manager and 10 female staff. Currently four residents live at the home all of whom have Learning Disability support needs, and the majority of whom have full personal care support needs and physical disabilities. One of the current residents also has dementia support needs. There is the Statement of Purpose and Service Users Guide in place which provide a broad range of information to inform residents have the home is run in what they can expect. As a home for people with learning disabilities that should be fully functional arrangements in place for Person Centred Planning for residents. However discussion with the homes management and staff, and the residents files showed this is not yet fully operational. The statement of purpose should show more clearly how the home is Care Homes for Adults (18-65 years) Page 16 of 40 Evidence: going to ensure that Person Centred Planning will be applied for each resident, including issues such as training for staff and timescales following a move into the home. The homes medication administration is the responsibility of registered learning disability nurses who are shift leaders. This also needs to be reflected in the Statement of Purpose. The current Statement of Purpose and Service Users Guide does not have a date of the review. The homes management need to ensure that these documents are updated to include this information. (Refer to Requirement YA1) Of the three files examined all had adequate information to showed that care needs, including health and social care, and leisure, relationships and personal development care needs were being assessed. There is a contract in place between the home and each resident, that these do not contain adequate information as follows. There are no mention of the fees for the cost of support for each individual resident, there is no mention of room numbers or rooms to be occupied by each individual resident, there is no mention of reasons for individual residents costs being higher than that of other residents, and contracts have not been signed and dated by residents of the representatives. The whole must ensure that residents contracts are updated to include all of the above issues. (Referred to Requirement YA5) Care Homes for Adults (18-65 years) Page 17 of 40 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans were prepared to show how residents care needs were to be met and how risks were managed. As far as practical care plans were prepared with involvement from residents. Evidence: Residents primarily have learning disability support needs, with all of the residents needing support in washing, personal care, shopping, cooking, and calling out in the community. Three of the residents have significant physical support needs also. I examined him three residents care plans, and found all of them to reflect in good detail their assess need, including health, personal care, and social and leisure care needs. All employs qualified learning disability nursing staff, and there is one of them in charge on each shift during the day, who also manage medication for residents. While there is generally a good care planning system in place, currently there is not a person centered planning system in place for each resident, as is now recommended an expected for people with learning disabilities. The home needs to introduce person Care Homes for Adults (18-65 years) Page 18 of 40 Evidence: centered planning for each resident, (Referred to Recommendation YA6) Comment from visiting professionals and residents suggest that staff are very sensitive and supportive, and are very respectful in the way the to provide care and communicate were residents. Residents care plans would benefit greatly from the use of pictures to enable residents to understand them better, as none of the residents currently are able to read their care plans. (Refer to Recommendation YA6) The care plans I had seen did show whether residents religious and spiritual needs were being considered planned and reviewed, although all of the residents are described as being of the Christian faith. It is recommended that this issue be raised individually with residents and their families, and where appropriate be included in care plans and care reviews for residents. Where residents say they have no interest in having these issues included in care plans a note should be made to reflect this in the care plans. (Refer to Recommendation YA6) A number of surveys received from health care professionals, residents and their families state that the whole could outdoor activities for residents. (see also Standard 12 of this report) There is currently no system in place for formerly planning how the work is to be divided during shifts, or for recording the activities that residents have taken part in, for the purposes of monitoring the quality and frequency of activities provided. It is recommended that the home consider introducing weekly plans and shift plans, and a simple system for monitoring were activities have taken place, so it is more easily possible to plan activities for residents and to record when they have happened. (Refer to RecommendationYA6) Residents are allowed and enabled by staff to make this the decisions about their dayto-day activities and are given choices about what they would like to do in the home, and generally how they would like to spend their time. Comments received from residents families and from visiting health professionals reflected that staff are very good at communicating well with residents, and that they speak with them and include them, and are very respectful in their approach. The registered provider has a corporate appointee for all of the residents, for their benefits and finances. Each resident has their own bank account. While it is good that the registered provider helps to protect residents interests in this way, there is no formal agreement for them to do so recorded on each residents file. The registered provider must ensure that a formal agreement is in place on residents files authorising them to be appointee for their DSS benefits. This should be done in late liaison with residents, social services and appropriate family members. (Refer to Requirement YA7) The home provides transport for residents but it was not possible to clarify how this is paid for currently, of whether residents are making any payments towards this transport. A weekly charge of £69.90 is also being paid by each resident, but the files that the home do not clarify what it is for. Neither is it absolutely clear as to how a residents food is being paid for. The home must ensure that these issues are clarified in writing in each residents care plan. (Refer to Requirement YA7) Care Homes for Adults (18-65 years) Page 19 of 40 Evidence: Residents files contain a range of appropriate risk assessments which are now regularly reviewed. Without the risk is assessments are in the form of directions for staff in how to support residents, but do not show the process for carrying out each risk assessment or who was involved in the assessment. Given the proximity of the residents home to a very busy road it is recommended that a risk assessment be in place for each resident in relation to wandering from the premises through the front door. (Refer to Recommendations YA9) Care Homes for Adults (18-65 years) Page 20 of 40 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents had the opportunity to enjoy leisure activities of their choice both in and out of the home, were treated respectfully and had their dietary needs met. Evidence: Historically this home is provided a good level of activities for residents, with good opportunities to go out in the community. Three residents attend a day centre between three and four days a week, where they meet people they have known for a long time, and take part in range of recreational activities. Staff from the day centre are invited to attend review meetings at the home, and the staff of the home attend meetings at least once a year at the day centre, to ensure that there is good awareness of residents care needs. In response to the inspection surveys residents and their families said they are happy with these arrangements. One resident has a friend of longstanding from school days, who sees them regularly, but otherwise there are few activities for residents with friends outside of the day centre arrangements. Social Care Homes for Adults (18-65 years) Page 21 of 40 Evidence: clubs activities which were previously in place have now stopped, and at least one resident who enjoyed swimming no longer does this activity. In the homes feed back provided in their Annual Quality Assurance Audit , there is an objective to improve and increase advocacy support for residents. Comments received from a number of visiting health professionals and families suggest that the home needs to focus on improving the level of leisure activities outside of the home. There are a few drivers currently available to drive the vehicle which is fully available for use. The home needs to review swimming activities for at least one resident and explore options for increasing the level of leisure activities outside the home such as outings to parks, bowling, and weekend outings. Further effort also need to be made to identify acquaintances residents may have built up at the day centre or in other areas, with a view to building relationships and friendships with them. (Refer to Recommendations YA12,YA13 andYA15) Comments received from three residents, two family members and several health professional who visit the home state that staff are a very respectful of residents, and always treat residents with great respect offering them choices. They say that there is a very friendly atmosphere in the home and residents families and other people are encouraged to visit. Residents and their families say that the food provided by the home is very good. Care Homes for Adults (18-65 years) Page 22 of 40 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents personal and healthcare needs were met and medicines were safely managed. Evidence: As at the last inspection all bedrooms in the home were for single occupancy which provided privacy for the residents. Care plans seen showed how personal hygiene needs were to be met. It was not possible for all residents to comment on whether this suited them or not. However residents seen were well presented and feedback from relatives and visiting healthcare professionals showed they were happy with how care was provided. Most of the residents in the home were unable to give feedback about any aspect of the service. Daily records were kept to show the care provided and any changes in support needed. All residents were registered with a GP and staff supported them to access other medical services such as dental and optical care. Residents paid privately for chiropody treatment. Links were maintained with the community learning disability team to support staff with meeting resident needs. The care records inspected had evidence to show that the resident had received good levels of care from other professionals such Care Homes for Adults (18-65 years) Page 23 of 40 Evidence: as a dentist chiropodist mental health review and physiotherapist. The residents life plan was up to date. Residents enjoyed treatment the received from an aroma therapist who visited the home on a private basis. Medicines were well managed and records and medicines checked for two residents were found to be correct. The medicine policy and procedure had not been updated as required at the last inspection to reflect changes to medicine disposal. A requirement was made to have this done. This requirement is now met as the home has since reviewed the policy and included the necessary information. Medicines are no longer being returned to the pharmacy for disposal but were disposed of under contract by a waste disposal company. The home had a stock of homely remedies which was agreed with the GP. Records were kept for receipt and administration of these. Comments received from residents and their families and from two healthcare professionals suggest that one or more of the current residents are capable of selfmedicating at least partially with support from staff. The home has a self-medication policy but residents care plans do not reflect that they have been assessed regarding their ability to self-medication. The home must ensure that all residents are assessed in this regard and that a clear note of this assessment is placed on their care plans and that residents who can are supported formally to develop their abilities regarding selfmedication. (Refer to Requirement YA20) Care Homes for Adults (18-65 years) Page 24 of 40 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory procedures were in place to manage complaints and to ensure residents protection and safety. Evidence: Policies and procedures were provided in relation to complaint management. A system was in place to record complaints made about the service. No complaints had been made to the provider or the Commission since the last inspection. Relatives contacted said they were aware of the complaints procedure and added that if they had any concerns they would see the manager or a member of staff to resolve the issue. Policies and procedures in relation to safeguarding adults were provided. No allegations of abuse had been made to the provider or the Commission since the last inspection. The home had copies of Greenwich adult protection procedures, a whistleblowing policy and a copy of the Department of Health document No Secrets. A number of staff were interviewed and although generally showed a good understanding of safeguarding adults adult protection, but were inclined to suggest they might investigate initially first themselves in relation to a theoritical allegation of theft, before reporting to management. Evidence suggests that some staff need current training in safeguarding procedures as at least one has not had this training in about four years. It is Required that the home provide this training for any staff who have not had it in more than 2 years and also ensure that staff are fully aware of their responsibilities. (Refer to Requirement YA22) Care Homes for Adults (18-65 years) Page 25 of 40 Evidence: Care Homes for Adults (18-65 years) Page 26 of 40 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home meets the needs of the residents and is comfortasble, clean and personal to the residents own taste. Evidence: All areas of the home seen were clean, tidy and free of unpleasant odours. Bedrooms were clean, tidy and personalised to reflect the interest of the resident. Personal clothing was neatly arranged and laundered. All bedrooms and the bathroom had ceiling hoists provided which were serviced in 2008. One shower room which is available to residents but which the manager said is not usually used by them has water temperatures which seem excessively high. The manager must investigate this and ensure that it is regulated to a safe temperature. (Refer to Requirement YA42) One resident had been supported to buy a personal computer. Comments from relatives and visiting care professionals said they found the home comfortable, clean and fitting the needs of the residents. Residents capacity to comment is limited. Two residents had their own armchairs to ensure they were comfortable and properly supported. The property was satisfactorily maintained and there was a requirement made at the last inspection to repair the garden fence and maintain the garden. This requirement was met as a new fence was erected and some work on the garden had been done. New seating and tables have also been provided. However the garden still needs further improvements and the manager has been negotiating with the housing association to have this work completed so that the garden is more pleasant. (Refer to Care Homes for Adults (18-65 years) Page 27 of 40 Evidence: Recommendations YA24) In view of the location of the property the home got a lot of heavy traffic noise especially when the windows were open or when sitting in the garden. One shower and one assisted bath were provided for residents to use. Residents were supported to make a choice as to which they preferred to use. These bathing facilities were in good condition and were kept clean and fresh. Hand washing facilities were provided where waste was handled and staff were provided with adequate supplies of protective clothing. Sluice facilities were provided for washing clothes and linen. The staff had access to policies and procedures on infection control. However there is an ongoing problem with pest control which may be due to the location of the home near a grassy area to the side of a busy road. The home has taken steps to sort out this problem but there is a need to look into ot further to ensure the home and garden is free from unwanted pests. (Refer to Requirement YA24) Care Homes for Adults (18-65 years) Page 28 of 40 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were cared for by a committed, appropriately trained staff team. Regularity of staff appraisal and supervision needs to be improved. Evidence: The staff team comprised of a full time manager, trained nurses and support workers. Currently the home had three permanent care staff and used regular bank staff to cover shifts. 50 of care staff had achieved NVQ level 2 or above. From the rotas inspected adequate staffing levels were maintained. One to one care was provided to one resident and was funded by social services. Relatives contacted did not raise any concerns about the staffing levels. Feedback from relatives and visiting professionals was complimentary in relation to the staff team. Comments made included statements that staff were very good, very friendly, offered residents choices and were respectful at all times. They also said that staff know the residents well and are able to care for their health and other care needs competently. Currently there are only a small number of drivers available to drive the Echo which is an important aspect of taking residents out in the community. It is recommended that a registered provider make additional effort during recruitment to find additional drivers. (Refer to Recommendation YA32) There is good information available regarding staff recruitment induction and training. Care Homes for Adults (18-65 years) Page 29 of 40 Evidence: All staff are fully CRB checked and references are checked before commencing employment. All staff files inspected showed they have contracts of employment in place. However there is no evidence that the registered provider is seeking evidence from staff regarding their fitness for work as part of the recruitment process. The registered provider must ensure that staff provide evidence of their fitness for work at the recruitment stage and that this is kept on file. (Refer to Requirement YA34) Staff who spoke to the inspector said they had access to training and support to ensure they fulfilled their role. The manager received notification of forthcoming training and identified staff to attend. Individual training records were kept and since the last inspection staff had access to training such as moving & handling, advanced medicine management, mentorship, fire safety mental health and learning disability and infection control. The manager had attended relevant and update training as needed. Discussion with staff and the manager and records inspected suggest that training and induction is good but that there is a need to ensure that all staff safeguarding training is up to date and that all staff now have dementia training included in their training plans. (Refer to Requirement YA35) Policies and procedures were provided on staff recruitment. Three staff files were inspected. These were well maintained and contained all the information required by regulation. Records seen also included evidence of induction, training and supervision. However inspection of thes files and discussion with staff and the acting manager reflect that staff are not reeiving formal one to one supervision as often as is required, six times a year. the rota shows the current acting manager is not able to do supernumery shifts to easily allow this supervision to happen. The registered provider and manager must ensure that both these issues are addressed, so that staff are properly supervised and the manager has adequate time available to perform management tasks. (Refer to Requirement YA 36) Care Homes for Adults (18-65 years) Page 30 of 40 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed with attention given to providing a safe environment for residents and others. Evidence: The home manager had completed the registered managers award and had the care skills needed to manage the service. He was registered with the Commission and ensured he attended training relevant to this role. Feedback from relatives and visiting professionals indicated satisfaction with how the service was managed. Staff interviewed commented they fell supported by the homes management, and that they had received good training in health and safety issues. The registered manager has been absent from work and the assistant manager is acting in the role of manager in his absence. She are supported by regular visits to the home by the area manager, who takes a hands-on approach to providing support and direction. Monthly visits are carried out and report is provided to enable the home to address any problems. Currently the acting manager does not have enough time available on the rota to carry out her full range of management duties but together with the area manager they have agreed that she will have more supernumery time Care Homes for Adults (18-65 years) Page 31 of 40 Evidence: available to her to fulfil her role. The provider completed an annual audit of the service and sent a copy of this to the Commission. Regulation 26 reports were sent to the Commission regularly. Staff meetings were held and minutes kept showed that staff had input to the meetings. A number of safety records were inspected. These included fire safety, gas, hot water temperature checks and electricity. Hot water temperatures were satisfactory but the shower temperatures were not monitored. The manager agreed to review this. Fire drills were practiced and at times to include night staff. The home manager had completed the fire marshal training and provided fire safety training for staff. Records were up to date and showed attention was given to providing a safe environment for residents and others. Two members of staff were trained to provide first aid and all staff received basic first aid training. There is the shower on the ground floor which is accessible by residents which seems to have an excessively of the high-temperature. The manager and staff confirmed that residents do not user shower. However in the interests of safety the home must ensure that this temperature is tested and regulated to a safe level. (Refer to RequirementsYA42) Care Homes for Adults (18-65 years) Page 32 of 40 Are there any outstanding requirements from the last inspection? Yes  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 Care Homes for Adults (18-65 years) Page 33 of 40 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 Description 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 Description Timescale for action 1 1 3 The registered provider must 30/09/2009 update the homes Statament of Purpose to include all of the required information as discussed especially regarding responsibilities for administration of medication, and clarifying the homes capabilities to provide Person Centred Planning for residents This is to ensure that all current and prospective residents are aware of the processes for Medication administration and Person Centred Planning 2 5 5A The registered provider must 30/09/2009 ensure that residents contracts are updated to reflect all of the information outlined in this report especially in relation to cost Care Homes for Adults (18-65 years) Page 34 of 40 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 Description Timescale for action of support. This is to ensure that residents are aware, and have agreed the cost of the service, and their rights while living in the home 3 7 12 The registered provider and manager must ensure that costs of transport and food and reasons for current weekly payments are clarified and agreed in writing in residents care plans 30/09/2009 This is to ensure that residents financial interests are best protected 4 7 20 The registered provider and 30/09/2009 manager must ensure that written authorisation is in place to allow the registered provider to act as appointee for residents DSS benefits as discussed in this report This is in order to ensure that relevant parties are consulted and agree as to the best means of protecting residents finances 5 20 12 The Registered provider and manager must ensure that all residents are assesed regarding their abilities to 30/09/2009 Care Homes for Adults (18-65 years) Page 35 of 40 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 Description Timescale for action self medicate and that a record of this is place on their care plans and appropriate action taken This is to ensure that residents are supported to retain administration and control of their own medication to reflect their own capabilities 6 23 13 The registered provider must 31/07/2009 ensure that all staff have upto-date training in current safeguarding procedures and are fully aware of their responsibilities This is to ensure that residents are safeguarded from all forms of abuse 7 24 13 The registered provider and manager must ensure that all available measures are taken to ensure the home is free from unwanted pests 30/06/2009 This is to ensure the health and safety of staff and residents 8 34 19 The registered provider and manager must ensure that there is evidence on file for each member of staff demonstrating that they are physically and mentally fit 31/07/2009 Care Homes for Adults (18-65 years) Page 36 of 40 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 Description Timescale for action the purpose of their work This is to protect the health and welfare of staff and residents 9 35 18 The registered provider and manager must ensure that care staff have up-to-date safeguarding adults training and dementia training as discussed in this report 30/09/2009 This is to ensure that residents are protected and receive support from welltrained staff 10 36 18 The registered provider and 31/07/2009 manager must ensure that all care staff receive formal supervision at least six times a year and formal appraisal annually This is to ensure that staff are adequately supported in doing their jobs and in personal development 11 42 13 The registered provider and 30/06/2009 manager must ensure that the water temperature in the shower mentioned in this report is regulated and maintained at a safe temperature Care Homes for Adults (18-65 years) Page 37 of 40 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 Description Timescale for action This is to ensure residents safety Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 The registered manager should consider the benefits of using weekly and daily plans for each resident so that goals regarding activities and development are reflected The registered manager should ensure that the religious and spiritual needs of residents are discussed and mentioned in each residents care plan and review meetings, and any appropriate action taken. The registered manager should introduce more widespread use of pictures in care planning for all residents who cannot read. The registered provider should ensure that Person Centred Planning processes are introduced for each resident, and that clear documentation of this is maintained. The registered manager should ensure that risk assessments clearly show the process and who was involved in accordance with the registered providers risk assessment policy. Carrying out a risk assessment for each resident in relation to wandering through the front door is also recommended. The registered manager should review swimming activities for one resident who previously enjoyed swimming, and enable them to do this again on a weekly basis with support from the home. The registered provider and manager should explore opportunities for residents to enjoy increased levels of leisure activities outside of the home as discussed in this report 2 6 3 6 4 6 5 9 6 12 7 12 Care Homes for Adults (18-65 years) Page 38 of 40 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 8 15 The registered provider a manager should develop further advocacy support opportunities for residents as stated in the development plan for the home. The registered provider and manager should further explore opportunities for residents to build friendships and relationships as discussed in this report. They registered provider a manager should ensure that works to the garden area are completed so that it is a comfortable and pleasant environment for residents The registered provider should include recruitment of drivers in the next recruitment drive for care staff for the home 9 15 10 24 11 32 Care Homes for Adults (18-65 years) Page 39 of 40 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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