Care Home: Chatterley House

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What the care home does well The manager sent us the AQAA when we asked for it and it had data information about how the service supports people who use the service, how it has improved since the last key inspection and what is needs to do to improve further. We saw that the service assesses prospective users of the service to ensure that it can meet their needs. We saw that the service is developing the model of Person Centred Planning that it had discussed with us at the last key inspection. People said in surveys, "Staff look after me well." "I like living here and don`t want to move." Staff said in surveys, "We work well as a team and provide good quality care." Relatives said, "I can`t think of anything Chatterley house could do better." A health professional said, "My impression is that the staff know the needs of people they care for and act promptly if there`s a problem." We saw that staff make sure that people using the service have regular health checks with their doctor and attend the dentist, sight tests, hearing tests and chiropody services as their appointments become due. People using the service told us they enjoy their food. They plan the menus for the coming week, and make individual choices about what meals that they want. We saw that Chatterley House is comfortable, homely and well maintained. There are spacious grounds. We saw that medication records are properly and accurately maintained. People told us that they know how to complain and who to go to if they have any concerns. What has improved since the last inspection? We saw that the service has recruited some new staff and has few vacancies. We saw that recruitment procedures have improved. The manager has now been allocated additional management hours. What the care home could do better: The manager sent us the AQAA when we asked for it. The information was not detailed and some areas of the assessment have not been completed fully. All care and support records should be produced in formats that people using the service can easily understand, and they should be supported to be involved in all aspects of planning and reviewing their care and goals. There have been concerns that the service does not sustain the improvements it makes, we found further evidence of this in relation to staff supervision and training, quality monitoring, care planning and goal setting. We have asked the manager to address our concerns promptly and will be asking for an improvement plan to be completed outlining how she intends to address the concerns we have raised. Where we have made a requirement of the home we also intend to undertake a random (follow up) inspection to ensure that the service has complied. Staff have said in surveys, "We could do with more staff to people out on more activities." "Staff could be better paid." People using the service said, "I`d like to go out a bit more." Staff should receive training about the Mental Capacity Act 2005 and Deprivation Of Liberties, so that they can properly support people who may not be able to make a decision for themselves. And recognise when they should refer to the appropriate agency to assist with making decisions in the best interest of people. The manager needs to implement the staff supervision and appraisal programme as identified in the AQAA. So that staff can be confident that they are being supported. The manager needs to ensure that all staff are nominated and receive updates in mandatory training, within the time scales we have agreed. The service needs a quality assurance and monitoring system, so that it can demonstrate how it monitors the quality of the service it provides and improves upon it. Key inspection report Care homes for adults (18-65 years) Name: Address: Chatterley House Chatterley Road Tunstall Stoke on Trent Staffordshire ST6 4PX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Wendy Jones     Date: 2 2 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 31 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 31 Information about the care home Name of care home: Address: Chatterley House Chatterley Road Tunstall Stoke on Trent Staffordshire ST6 4PX 01782834354 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Alice Clarke care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 11 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) 1 Learning disability (LD) 11 Date of last inspection Brief description of the care home Chatterley House is a care home registered for 11 people. The home can accept people over the age of 18 years and above that have a learning disability. They are registered for one place for a person who has a mental disorder that does not include a learning disability or dementia. Nine gentlemen and two ladies currently live at the home, which is a detached property set in its own grounds. The proprietors house is situated next door. The home is situated just outside Tunstall, which is one of the towns that make up the city of Stoke-on-Trent. It has good access by road, but although there is public Care Homes for Adults (18-65 years) Page 4 of 31 1 6 0 2 2 0 0 9 11 1 Over 65 0 0 Brief description of the care home transport from other areas to Tunstall itself, bus routes do not extend to the homes location. The home has a mini bus to assist the people using the service to have access to community facilities. There are few local facilities in very close proximity to the home, although a pub is within walking distance which one or two people use. Tunstall, however, has the range of shops that you would expect of a small town. Chatterley House has been extended with the addition of two en suite bedrooms. This means that the home now has two en-suite bedrooms, five further single bedrooms that are not en-suite, and two double bedrooms. There are spacious communal rooms that are attractively furnished. All areas of the home are generally well maintained. The grounds have attractive gardens and adequate space for car parking. There are links with local colleges and day services to provide individuals with the opportunity for personal development. People using the service purchase their own items, such as personal toiletries, newspapers and magazines. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We carried out an unannounced key inspection visit over two days. The focus of our inspections is upon outcomes for people who live in the home and their views of the service they receive. This process also considers the homes capacity to meet regulatory requirements, national minimum standards of practise and focuses on aspects of the service that may need further development. To prepare for the visit we looked at the last inspection report and our records of the information we have received about the service since the last inspection visit. Each year the service has to complete and return an Annual Quality Assurance Assessment (AQAA) to tell us how they meet the needs of the people who use, or may Care Homes for Adults (18-65 years) Page 6 of 31 use the service. This focuses on what they do well, how they evidence this, and any areas they feel are in need of improvement. Before key inspections we send out surveys to people using the service, staff, relatives and anyone else who has involvement with people who live there. We have used the information in the 7 service user surveys, 3 staff, 4 relatives and 3 others we received, to help us make a judgement about how the service supports people living at the home. When we were at the home we focused on a small number of people who use the service. This involves discovering individual experiences of living at the home by meeting and talking with them, discussing their care with staff, looking at medication and care files and reviewing areas of the home relevant to these people. This helps us to understand the experiences of people who use the service. We looked around the home to make sure it is safe, clean and comfortable and we looked to see whether people who use the service are being protected, and the arrangements the service has for listening to what people think about living at Chatterley House. We have made 2 requirements and 15 recommendations as a result of this visit and have asked the service to provide an improvement plan telling us how it intends to address the matters we have raised. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The manager sent us the AQAA when we asked for it. The information was not detailed and some areas of the assessment have not been completed fully. All care and support records should be produced in formats that people using the Care Homes for Adults (18-65 years) Page 8 of 31 service can easily understand, and they should be supported to be involved in all aspects of planning and reviewing their care and goals. There have been concerns that the service does not sustain the improvements it makes, we found further evidence of this in relation to staff supervision and training, quality monitoring, care planning and goal setting. We have asked the manager to address our concerns promptly and will be asking for an improvement plan to be completed outlining how she intends to address the concerns we have raised. Where we have made a requirement of the home we also intend to undertake a random (follow up) inspection to ensure that the service has complied. Staff have said in surveys, We could do with more staff to people out on more activities. Staff could be better paid. People using the service said, Id like to go out a bit more. Staff should receive training about the Mental Capacity Act 2005 and Deprivation Of Liberties, so that they can properly support people who may not be able to make a decision for themselves. And recognise when they should refer to the appropriate agency to assist with making decisions in the best interest of people. The manager needs to implement the staff supervision and appraisal programme as identified in the AQAA. So that staff can be confident that they are being supported. The manager needs to ensure that all staff are nominated and receive updates in mandatory training, within the time scales we have agreed. The service needs a quality assurance and monitoring system, so that it can demonstrate how it monitors the quality of the service it provides and improves upon it. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service have an assessment of need prior to moving into the home, but cannot be confident that they have sufficient information about the service to make a decision about the home. Evidence: The service told us in the AQAA that, People who may want to move in can visit the home many times before they decide they would like to live here. Support plans are agreed based upon the assessment of the individuals needs. People using the service said in surveys that they had enough information about the service to help them make a decision about moving in and were asked if they wanted to. We spoke to one person who has been admitted to the service since the last key inspection, who confirmed this. He said he was supported by his social worker and visited the home before his admission. The manager said that they had an assessment for the individual from the social worker. We asked the manager if we could see the Statement of Purpose, but she couldnt find Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: it, we saw a sample Statement of Purpose in the homes policy file, but it wasnt specific to the home. We asked if people using the service have access to a Service user Guide and have been told that each person has a copy in the rooms. We spoke to one person about this, they knew what the guide was and showed that they had a copy. The guide has been produced in simple language and pictures to make it more user friendly but didnt give specific information about the fees and charges they can expect to pay. We saw that people have a copy of their local authority contract in their care records. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have care plans and risk assessments in place but need to be involved in the implementation and evaluation of them. Evidence: The service told us in the AQAA that, Care plans are drawn up with the individual, their relatives and social worker, advocate or specialist. It is done in appropriate manner to ensure that the service user understands. We looked at 2 care files during this visit. We saw that one newly admitted person has a care plan in place. The manager said, we are working from the social workers assessment until the service user has settled in, then we intend to implement a PCP with the individual. We looked at another persons care records and saw that there is a basic assessment of need and care plan where a need has been identified. The records show that reviews of the plans have been carried out approximately twice since the last key Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: inspection visit. But we could not see any evidence that the individual had been involved in the implementation of the plans or their review. We spoke to people using the service about care plans but couldnt be sure that they had access to them or knew what their plans said. We saw that risk assessments are in place and have also been reviewed. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are able to make choices about their lifestyle and are usually supported to access community activities. Evidence: The service told us in the AQAA that, Where possible service users are encouraged to be involved in voluntary work in the community we support them to access amenities in the community to socialise, to access entertainment. We encourage them to maintain friendships and family contact. People using the service told us in surveys that, they can choose what they want to do during the day and evening. One person said, I like going for walks and love football. We asked if he is able to do these things regularly, staff said, that he had joined a rambling club but that hadnt worked out. Since that time we were told that he does go out for walks with staff when the weather is good. We looked at the Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: records of the persons activities for a 3 month period and couldnt evidence this. The person told us that he used to go to football matches with another person, but hasnt been for awhile. We asked another person what sort of things they did during the day, she told us she likes to watch the TV, I like the soaps, and play games with some others, such as dominos and cards, Im retired now so I dont want to go out to work or anything like that, I go to the shops when I want to go and do my own jobs like washing and ironing my own clothes. We asked people how they choose what they do, we have been told that they have a weekly meeting to decide on the meal choices for the following week. But an alternative isnt shown on the menu, however people told us that they could choose something else. People using the service dont have an opportunity to be involved in cooking their own meals, but do have opportunities to be involved in baking occasionally. One person goes to day services, some people have access to college placements. We have been told that one person used to go to horse riding, but doesnt now because of the costs. All of the people spoken to talked about the holidays they have been on, some have been abroad to Turkey and others have been to Wales. There are photographs displayed in the home of the holidays they have taken. Staff said in surveys that, We need more staff to be able to take people out more often. A relative said, The service covers all of my relatives needs admirably. A very caring home, good food, a very good team. The staff have passion about how they conduct themselves there. Full marks to them. Treat all persons in their care equally. Take them out and give them a good quality of life that they may not have had. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that they will be supported to have their health needs met and their medication is managed safely. Evidence: The service told us in the AQAA that, Staff provide sensitive and flexible support to ensure privacy, dignity and independence. A health professional said, My impression of Chatterley House is that staff are always well informed about the patients conditions and concerns. Also very aware of their moods and needs as mostly long term clients. Another said, The care given appears to be of a high standard and the clients all appear happy and comfortable in their surroundings. We looked at a sample of two care files to ensure that people are receiving the health support they require. We were able to evidence good standards of support and record keeping relating to this. The service has demonstrated that it liaises closely with health professionals, supports individuals to keep appointments and acts to ensure Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: any health advice is implemented. We looked at how the service manages, stores and administers medication. We saw that medication records are accurately maintained, we were able to carry out an audit trail of medication to confirm this. The service has a suitable storage facility, but does not have a controlled medication cupboard. We saw that when medication is prescribed occasionally, that the service has agreed with the GP the circumstances under which that medication can be administered. The manager told us that all staff who administer medication have received training to do so. We talked to her about competency assessments and have been told that this has not yet been done. We have made this a recommendation of this report. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported to express their concerns and feel confident that they will be listened to. Evidence: The service told us in the AQAA that, All people using the service and their relatives know how to make a complaint and we have a complaints procedure on display in the home. People who use the service have told us in surveys that they know how to complain and who to go to if they have any concerns. 3 out of 4 relatives confirmed that they know what the procedure is for making a complaint. We saw that a complaints procedure is displayed in the home and each person has a copy of it in their care files. We would recommend that the service produces the procedure in a more user friendly format. We spoke to two people who confirmed that they are happy with the service they receive and felt able to raise any concerns. One person said, when we have meetings on a Sunday we can talk about any thing. We spoke to another person, and noted that her bedroom was quite cool, the radiator wasnt very warm to the touch. We asked her what she wanted to do about it she replied, Ill go and tell the staff, they will sort it out for me. This happened. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: We havent received any complaints about this service since the last key inspection visit and are not aware of any safeguarding referrals. We saw that staff have received training in the protection of vulnerable people and how to recognise and report abuse. The manager said she has received training on the Mental Capacity Act 2005 and Deprivation of Liberty but other staff havent. We recommend that all staff receive guidance and that the service looks at individual circumstances to ensure that people are not at risk of having their liberty deprived. We saw that the recruitment procedures at the home have improved and all pre employment checks are now carried out. We checked the records of peoples finances to ensure they are being managed and recorded properly. We noted that some people occasionally have large amounts of cash kept on their behalf, we have asked the manager to review this in line with the insurance limits for cash. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have a comfortable and well maintained home. Evidence: The service told us in the AQAA that, We provide a clean and well maintained home. We found the home to be comfortably furnished and well maintained. People using the service said they are happy with the home and have free access to all areas of it. We were disappointed to note that the service hasnt acted upon the recommendation of the last inspection report regarding heating in the conservatory. The current heating system is insufficient to heat the room in the cold weather, therefore restricting access in the winter months. We spoke to the manager about this and have been told that the provider is planning to upgrade the heating for the home, this will hopefully resolve this problem. We looked at a sample of bedrooms with the kind co-operation of people living at the home. Two bedrooms are doubles, we spoke to two people who share a room, they confirmed that they are happy to do so. We saw that a privacy curtain is provided around the washbasin area. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: We are also surprised that three bedrooms dont have a wash hand basin. The manager stated that the bedrooms are located in close proximity to a bathroom and toilet. We have been told that two bedroom have en-suite facilities. We noted that the service has an assisted bath on the ground floor and separate shower room. There is also a bathroom and shower on the first floor, additional toilets are located on both floors. The kitchen is spacious and well equipped, people using the service have access to it, we observed people making their own drinks throughout the day. Care Homes for Adults (18-65 years) Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service, need to be sure that staff responsible for supporting them are supervised, well trained and their practise is monitored to be confident that they have the skills they need. Evidence: The service told us in the aqaa that, We do well with NVQ, mandatory training staff supervision and appraisal. Relatives told us in surveys, that, We are very satisfied with the care and support my relative receives, the staff are very good and keep in touch with me regularly. We think the staff are dedicated and care for the people they look after. Another said, It would be difficult to improve on Chatterley House the staff take pride and have a passion about how they work an conduct themselves. Full Marks to them. All of the people who returned a survey said that staff treat them well. We observed good interactions between staff and people using the service during our visit, confirming the information we have received. Staffing levels are being maintained at 2 for a day shift and 1 waking night staff. The manager reported that she has been provided with some additional management Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: hours in addition to the care staff hours. A domestic has been employed to ensure that care staff can concentrate on supporting people using the service, rather than on domestic chores. We saw that the number of staff trained to National Vocational Qualification at level 2 is good, but we are concerned that some staff have not received updates for their mandatory training such as manual handling. This was identified as a concern at the last inspection and has not been satisfactorily addressed. Similarly we continue to have concerns that staff are not receiving supervision sessions with the manager and are not meeting regularly as a team. The manager said that she had supervision and appraisal documentation but has not been able to start the supervising due to staffing difficulties toward the end of last year. She also said that updates for mandatory training have now been planned and that staff meetings are held approximately every 3 months, but the records are not up to date. Since the last inspection the service has become involved with a training and recruitment agency to support it, we saw that recruitment records are now up to date and new staff are now provided with their mandatory training before they commence their employment at the home. Also a senior support worker has been nominated to support the manager. We spoke to three members of staff during the visit they said, It would be better if we werent on the minimum wage. Another said, I feel Im supported, when I started I received a good induction and have been put forward for my NVQ. Staff said in surveys that, We keep service users well feed and have a clean home. We ensure they attend appointments which are usually doctors, chiropodists, opticians etc. But we could do with more staff so more things can be done to meet all peoples needs, also give staff more money then staff might not keep leaving. Care Homes for Adults (18-65 years) Page 24 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service cannot be confident that the the quality of the service is monitored this means that they cannot be sure that the management of the service knows what needs to improve or how to go about it. Evidence: The manager told us in the AQAA that, I ensure that the health and safety of service users is met and keep the records, policies and procedures up to date. I keep up to date with changes and attend training. The service has met the requirement of the previous key inspection visit relating to the overall management of the home, but there are a number of recommendations that have not been acted upon as we would expect them to be. We have previously asked the service to ensure staff appraisal and supervision is carried out regularly and that staff training and records are up to date. We have asked that the service has effective quality monitoring and assurance systems in place, but this has not happened. We spoke to the manager about this, she said, I have started Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: to review all the policies and procedures, starting with the ones that directly service users but am not sure what else or how to go about monitoring the quality of other things. I have received some training and guidance from the training agency we use. Since the last inspection the manager stated that she has recently been allocated some additional management hours to allow her to address some of the deficits we have identified at previous inspection visits. But due to staffing problems in recent weeks she has not been able to take advantage of these. We have also been told that equipment in the home has been checked and serviced in the last 12 months. We could not tell from the AQAA if policies and procedures are up to date although the manager stated that she has started to review them. We saw that risk assessments are in place and are being reviewed regularly. The manager has started to introduce Person Centred Planning (PCP)and has arranged for staff to have training. The person centred plans have yet to be fully implemented. The manager stated that she has not had time to discuss PCP in detail and may need to arrange updates for staff. We are concerned that the service has not developed a system of monitoring the quality of the service provided. The manager stated that she has received some support from the training agency they used but has yet put this into practise. Care Homes for Adults (18-65 years) Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 31 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 32 13 The service must ensure that staff have received up to date manual handling training. To be sure that they have the skills they need to support people using the service. 25/03/2010 2 39 18 The manager must ensure 25/03/2010 that staff receive supervision and support on a regular basis. To be sure that they have the skills they need to support people using the service. 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 1 The service user should ensure that people using the service know what the fees and charges they can expect to Care Homes for Adults (18-65 years) Page 28 of 31 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 pay. 2 1 The service should ensure that the Statement of Purpose is available and specific to the home, to be confident that prospective users of the service and their supporters have the information they need to make a choice about moving in. The service should ensure that care plans and other care records are produced in a format that people using the service can easily understand. The service should ensure that people using the service are involved in the implementation and evaluation of their care plans. People using the service need further support to ensure that they can access the community based activities they would like to be involved in. The service should ensure that staff who have been trained to administer medication have assessments of competency, to be sure that they are able to put theory in to practise. The service should provide a controlled drugs cupboard, so that any controlled medication that is prescribed can be stored safely. The service should provide the complaints procedure in a format that people using the service can more easily understand. The service should ensure that cash kept in the home on behalf of people who use the is covered by the homes insurance limit, or evidence that if it isnt, people have the capacity to agree to have it stored in the home on their behalf. The service should ensure that all staff have received training on the Mental Capacity Act 2005 and Deprivation of Liberty. The service should take action to ensure that the conservatory is adequately heated, so that people using the service can access it all year round. Where wash hand basins have not been provided in bedrooms the service should include fitting these in any development plan for the service. 3 6 4 6 5 12 6 20 7 20 8 22 9 23 10 23 11 24 12 26 Care Homes for Adults (18-65 years) Page 29 of 31 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 13 32 Staffing levels should be continually reviewed to ensure that people using the service and supported by sufficient staff to meet their needs. Provide all staff with an annual appraisal of their work, which gives both the manager and staff the opportunity to think about their practise and the training needed for their further development. The service should review the quality of care provided at the home, and produce a report detailing what action is to be taken on the outcome of the review, and provide a copy to the commission. So that people using the service can be sure that the service is continually improving. 14 36 15 39 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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