Care Home: Eaton Lodge

Similar services:

• Insight - Eastchurch
• Southfields
• Thorndene
• Magenta
• Seabourne House
• 33 St John`s Church Road
• Dovedale Court
• Lyncol House

What the care home does well The admission process ensures that only residents whose needs can be met are admitted to the home. Care staff demonstrated an understanding of the individual needs of residents and was attentive to them on the day of the site visit. Residents make decisions about their lives and are consulted on aspects of life in the home to ensure choice and preferences are accounted for. Residents` are provided with opportunities to participate in appropriate activities and to be part of the community. The routine of daily living was observed to be within the individual`s choice and preference. Visitors are welcomed at the home. Residents receive personal support in the way they prefer. The provision of food is good. Complaints are dealt with appropriately, reassuring those involved that they are being listened to and that action will be taken, if necessary. Safeguarding Adults investigations are dealt with appropriately by the home and action is taken, when needed, to further safeguard residents. Improvements in procedures ensure residents` monies are better safeguarded. Residents live in a clean and homely environment and are provided with suitable facilities to meet their needs. Residents` needs are currently being met with skill mix of staff on duty and are safeguarded by the recruitment procedures in place. Some written comments from staff on what the home does well were: `staff work really well as a team`, `office door is always open to help and listen and willing to try new ideas`, `provide staff regular training`, `care about all residents equally` and `taking into account service users` individual needs, preferences, likings`. What has improved since the last inspection? The random unannounced inspection undertaken in August 2008 identified action had been taken to ensure that sufficient checks were in place where information had been provided by the Criminal Record Bureau (CRB) regarding an individual. This was better managed and promoted residents` safety. A Pharmacist Inspector visited the home and identified that it was an outstanding requirement that a suitable controlled drugs cabinet be provided and installed in line with current legislation. This has since been complied with. The AQAA identifies areas that they have improved in the last 12 months and some examples given as changes they have made as a result of listening to residents are: changed the menu and introduced more variety and have introduced weekly activity schedules. What the care home could do better: The home must obtain a copy of terms and conditions/contracts for all residents to ensure that they are providing the services they are contracted for and resident/representative expectations are met. Terms and conditions of residency need to be available to each resident in a way they can understand, to ensure that residents have information about their rights available to them in a way they can comprehend.That residents` personal goals are reflected in their plan of care to promote selfdevelopment and ensure aspirations are fulfilled. Guidance must be provided for staff on how to assist residents to achieve their personal goals. That clear information is provided in regards to prescribed medication to ensure that residents receive the care they require. Management must ensure that services advertised in their Statement of Purpose and Service User`s Guide are provided, ensuring that service users/representatives expectations are met. When asked what the home could do better, some written comments from staff were: `outings and holidays to residents`, `more money so staff can provide better in house and outside activities`, `have more staff` (reflecting also to have a chef and cleaner) and to `have better communication between office and staff regarding residents appointments`. Any minor shortfalls noted at the site visit, of which no requirement or recommendation has been made have been highlighted throughout the report. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Eaton Care 14 Eaton Gardens Hove East Sussex BN3 3TP     The quality rating for this care home is:   one star adequate 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: Jennie Williams     Date: 0 1 0 5 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. 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. 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 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) 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. 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 33 Information about the care home Name of care home: Address: Eaton Care 14 Eaton Gardens Hove East Sussex BN3 3TP 01273777911 01273777948 eaton@vigcare.com 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) : Southern Primecare Ltd care home 10 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 10 The maximum number of service users to be accommodated is 10. The registered person may provide the following category/ies of service only: Care home only- (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disabilities (LD) Date of last inspection Brief description of the care home Eaton Care is a care home registered for ten (10) places for service users, of either gender, aged between eighteen (18) and sixty-five (65) years of age on admission, who have a learning disability. The home is not registered to provide nursing care. District nurses will supply nursing input when needed. The home is located in a quiet residential area of Hove. The Registered Providers own eight care homes throughout the South of England, predominantly older people services The home was previously a nursing home and has been renovated for its current use. All rooms are for single occupancy and are located on the ground and first floor. All Care Homes for Adults (18-65 years) Page 4 of 33 Brief description of the care home rooms are provided with a toilet and shower en suite facilities. There is a lounge room, dining area and activities room located on the lower ground floor. There is a garden area located at the rear of the home. In addition to en suite facilities there is; one communal bathroom with an assisted bath and toilet facilities. There are a number of disabled toilets located throughout the home. Weekly fees range from 900 pounds to 1269 pounds. There are additional fees; hairdressing, chiropody, physiotherapy, dry cleaning, personal clothing/toiletries. A full list of what is not included in the fees can be found in the Service Users Guide. This information was provided to us on the 23 May 2009. Care Homes for Adults (18-65 years) Page 5 of 33 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: It has been identified that service users prefer to be called people who use services. People living at this service are called residents. For the purpose of this report, people who use the service will be referred to as residents. This unannounced key site visit took place for nine hours over two days, 23 April and 1 May 2009. Evidence obtained at this site visit and information that we have received since the last inspection forms this key inspection report. An annual quality assurance assessment (AQAA) was sent to us by the service, completed by the home on the 17 February 2009. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave Care Homes for Adults (18-65 years) Page 6 of 33 us some numerical information about the service. The last key inspection was undertaken on the 24 April 2008. A random unannounced inspection was undertaken on the 21 August 2008 to monitor compliance with requirements made at the previous key inspection and to ensure suitable management arrangement were in place. Three residents were spoken with. Due to the disability of some of the residents the Inspector had limited communication contact with them. Two care plans were viewed and specific areas of care were looked at in other care plans. Ten staff surveys were sent to the service prior to the site visit, of which three were returned. Four staff were spoken with during the site visit. Five staff files were viewed, along with training records. A brief tour of the environment was undertaken and some individual rooms were viewed. Medication procedures were inspected. The quality assurance system was discussed and recent results viewed. Procedures for dealing with complaints and Safeguarding Adults were viewed. Procedures for dealing with residents monies were assessed. There were four residents residing at the home on the day of the site visit. What the care home does well: What has improved since the last inspection? What they could do better: The home must obtain a copy of terms and conditions/contracts for all residents to ensure that they are providing the services they are contracted for and resident/representative expectations are met. Terms and conditions of residency need to be available to each resident in a way they can understand, to ensure that residents have information about their rights available to them in a way they can comprehend. Care Homes for Adults (18-65 years) Page 8 of 33 That residents personal goals are reflected in their plan of care to promote selfdevelopment and ensure aspirations are fulfilled. Guidance must be provided for staff on how to assist residents to achieve their personal goals. That clear information is provided in regards to prescribed medication to ensure that residents receive the care they require. Management must ensure that services advertised in their Statement of Purpose and Service Users Guide are provided, ensuring that service users/representatives expectations are met. When asked what the home could do better, some written comments from staff were: outings and holidays to residents, more money so staff can provide better in house and outside activities, have more staff (reflecting also to have a chef and cleaner) and to have better communication between office and staff regarding residents appointments. Any minor shortfalls noted at the site visit, of which no requirement or recommendation has been made have been highlighted throughout the report. 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. 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 33 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 33 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. Residents/representatives expectations are not being fully met, as advertised in the Statement of Purpose/Service Users Guide. The admission process ensures that only residents whose needs can be met are admitted to the home. Evidence: The home has a Statement of Purpose and Service Users Guide to advise prospective resident about the services and facilities provided at the home. The home has developed an easy read format Service Users Guide. These documents need to be updated to reflect our new details and to ensure current management arrangements at the home are reflected. Some services advertised are not being provided. Some examples are: monthly resident meetings and personal goal setting for individuals. The easy read Service Users Guide stated that the manager or senior will make sure that your medication is ordered each month. This does not evidence that people are provided with choice or their independence encouraged. Two residents spoken with confirmed that they were involved with the choice to live at Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: the home. There is no resident at the home from any minor ethnic community, social/cultural or religious groups with any specific needs or preferences. The appointed manager undertakes an assessment of all prospective residents. She discussed the admission process with us which demonstrated that the transition into the home is designed to suit the needs of the prospective resident. Pre visits to the home are encouraged and trial overnight stays/weekends are available. There was evidence of a pre admission assessment having been undertaken prior to an individuals admission into the home. The appointed manager identified that they were in the process of assessing some prospective residents. Two of the care plans provided to the home from social services regarding individual needs were over a year old. The appointed manager assured us that she will undertake her own assessment to ascertain current needs. The AQAA identifies that the pre admission assessment form in use is more person centred as an area they have improved in the last 12 months. All residents were residing at the home prior to the newly appointed manager commencing employment. There was no evidence that a letter is provided to prospective residents, confirming that following an assessment the care home is suitable for the purpose of meeting their needs in respect of their health and welfare. The appointed manager will address this. There were no copies of contracts in place for residents whose placement is funded. The appointed manager needs to obtain a copy of these to ensure that they are providing the care and services they are contracted for. The home had got one resident to sign their terms and conditions without any evidence that the individual fully understands what they have signed. The AQAA identifies that all residents have signed terms and conditions or contracts on file. Care Homes for Adults (18-65 years) Page 12 of 33 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. Resident personal goals are not identified and no guidance is provided to staff on how to assist individuals achieving their goals. Residents make decisions about their lives and are consulted on aspects of life in the home to ensure choice and preferences are accounted for. Evidence: There was evidence of care plans being in place that provided staff with guidance on how to meet the health and social needs of the individual residents. Specific areas of care for individuals were also reflected in the care plans. There were some minor shortfalls noted in the care plans that were either addressed on the day or confirmed will be addressed. The staff member spoken with about care plans was enthusiastic and will share areas of improvements with other staff. Staff demonstrated an understanding of residents needs and staff surveys reflected that they are always given up to date information about the needs of the people they support and care for. Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: Care plans are written in the first person and are devised with the input from the individual and/or representative. Care plans are reviewed at least every six weeks or earlier if the needs of an individual changes. If a key worker is on holiday, it is important that other staff still ensure information is up to date. The last two visits to the service identified that training on person centred care was going to be provided to staff. This still has not been accessed. The newly appointed manager will continue to pursue this. This will assist in staff better understanding person centred care and provide a service in line with Valuing People. It was observed that some improvements can be made in relation to daily notes. Staff were commenting about an individual resident who may at times become noisy and when other residents become upset, this individual is taken to their room. Due to the category of registration for this service, staff need to be encouraged to document incidents in more detail such as time, place, what were they doing, who was present etc to see if there are triggers/patterns to their noisy periods. If so, productive action can be taken instead of having to remove the resident from the area every time. A resident confirmed that staff discuss their care with them and they have been involved in devising and reviewing their care plan. Not all residents have personal goals identified. The appointed manager confirmed that they are currently developing these. Some residents have resided at the home for some months and staff must be pro active in ensuring that action is taken to document and access whatever resources are necessary to assist individuals to achieve their goals. The AQAA also identifies that the home identifies setting personal goals is an area in which they could do better. Residents are involved in decision making about aspects of their lives. This was evident throughout the site visit with staff discussing options with residents. No resident is currently managing their own finances. The appointed manager confirmed that the home keeps the money safely in agreement with the individuals. The appointed manager confirmed that residents are consulted and are provided with opportunities to participate in the running of the home. Examples are: devising weekly menus, regular resident meetings, choosing activities and are responsible for maintaining the cleanliness in their own rooms with support from staff where needed. This was confirmed by a resident and staff. Risk assessments are implemented and are reviewed with care plans to ensure residents remain safe. No shortfalls were identified at the last inspection and it was Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: confirmed that the same process is still in place. Action has been taken to ensure that information pertaining to individuals are kept secure and promote confidentiality. Care Homes for Adults (18-65 years) Page 15 of 33 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. Residents are provided with opportunities to participate in appropriate activities and to be part of the community. The provision of food is good. Evidence: The appointed manager confirmed that no resident is currently involved in any education or occupation. They are trying to encourage a resident to return to college again. They advised that this individual did not wish to travel to college when the weather is poor. A resident was attending a day centre at the time of the first site visit and a resident was looking forward to attending a disco that evening. Residents are encouraged to maintain contact with friends/social groups they are involved in prior to admission to the home. Two residents attend a weekly church service. Residents are taken out into Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: the community on a one to one basis with staff. The appointed manager will be looking into accessing a mini van bus so that group outings can be arranged. Only local outings are currently arranged within walking distance or by accessing public transport. It was observed at the site visit that resident independence is encouraged and daily routines were to the individuals choice. There was clear, personalised information within care plans about the preferred daily routine for individuals. Staff were observed to knock on resident doors prior to entering. Residents are provided with a key to their room if they wish and it is safe for them to have one. Menus are devised on a weekly basis by the residents with assistance from staff. A resident confirmed the food was good. The homes own quality monitoring survey identified that 75 percent of residents said they liked the meals. 50 percent of residents thought they could make the meals better. The home identified that they have changed the main meal to lunch time as a result of listening to residents. There is no cook employed at the home and it was confirmed that staff who undertake these duties have all attended food and hygiene training. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive personal support in the way they prefer. Residents are not always safeguarded by the medication practices within the home. Evidence: Care plans are written in the first person and provide guidance on their preferred way of being assisted. There was evidence that routines are flexible to allow time for residents to maintain independence. There was information in place for one resident who wished to be supported with personal care from the same sex care worker. This is respected by the home. The homes quality monitoring surveys identified that 100 percent of residents said that they get choices in relation to bed times, meal times, what they want to do and bathing preferences. 25 percent identified that the home could change something to make it better for them. There was evidence at the site visit that a resident was able to eat their lunch when they wanted to and at a pace that suited them. The appointed manager confirmed that no specialist equipment has needed to be purchased for any individual. Where it was identified that someone may be at risk of Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: developing pressure area, a pressure relieving mattress was borrowed from a sister home owned by the same providers. The home is in the process of purchasing a mattress for this individual. An assessment should be undertaken to ensure the appropriate mattress is purchased. Records are maintained of any professional health visitor visits. The appointed manager confirmed that residents have access to a GP, dentist and other health professionals as required. There is information within care plans regarding health needs. There was evidence that resources are accessed for the individual who requires a specialist diet. Guidance provided by the district nurse for one resident had not been incorporated into the individuals care plans, however a staff member confirmed that the care is being provided. The staff member confirmed they will address this. It was observed that staff were monitoring the intake of a resident. There was no information in the care plan to identify that this is being done, or why. This was addressed on the day of the site visit. A staff member confirmed that there are policies and procedures in place for all aspects of dealing with medications. No resident is currently self-medicating. The home needs to ensure that documentation is in place to identify why the home controls medication and assess if with training and support, some residents may be able to achieve independence. All staff who administer medicines have received training for this. New Medication Administration Records (MAR) charts were in place so there were limited entries to view. The appointed manager confirmed that the person in charge checks medication every day to ensure correct procedures are followed. It was observed that on one occasion, medication had been signed for but not given. The home has notified us of medication errors and identified that appropriate action was taken to ensure safety measures were put in place. One incident impacted on the well being of an individual. Where a prescription identified that a cream/tablet should be administered regularly, this was not being done. The staff member confirmed that they were not required. There was no evidence to identify this. Action must be taken to ensure clear information is provided on the MAR chart prescriptions. There were some guidelines in place for when needed (PRN) medications are needed to be given and staff are double signing any hand written prescriptions to safeguard resident and staff. There is now a suitable controlled drugs cabinet installed as previously required to ensure compliance with current legislation. Records and medicines viewed identified that accurate records are maintained of controlled drugs. Additional training is arranged for staff in the safe administration of a medication used for people who may suffer a seizure. Care Homes for Adults (18-65 years) Page 19 of 33 Care Homes for Adults (18-65 years) Page 20 of 33 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. Complaints are dealt with appropriately, reassuring those involved that they are being listened to and that action will be taken, if necessary. Safeguarding Adults investigations are dealt with appropriately by the home and action is taken, when needed, to further safeguard residents. Improvements in procedures ensure residents monies are better safeguarded. Evidence: The home has a complaints procedure in place that people have access to should they need to raise concerns regarding the home. A copy of this was noted to be located at the entrance of the home. The AQAA identifies that there have been three complaints raised with the home in the last 12 months, of which none were upheld. Of the records that were available for viewing, there was evidence that the home takes appropriate action to address any concerns raised. The easy read Service Users Guide advises residents they can contact us if they wish to raise concerns, however no contact details are provided to enable residents to contact us independently if they wish. The homes quality monitoring system identified that 100 percent of residents feel they can talk to the staff if they are unhappy or upset. Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: Concerns expressed to us were referred to the Safeguarding Adults team and dealt with through the Safeguarding Adults procedures. There have been five Safeguarding Adults alerts raised since the last key inspection. These had been referred back to the home for investigation. Three related to missing money at the home, one relating to medication administration and one relating to care provided at the home. Two were substantiated, one inconclusive and two were unsubstantiated. There was evidence that the home is co-operative with the local authority with any investigations and no concerns have been raised with us regarding the way the home has conducted their own investigations. Suitable action is taken by the home to reduce the risk of incidents occurring again. Information has been shared with us since the site visit that another alert was raised that was substantiated, relating to neglect and a further incident is currently being dealt with by the Safeguarding Adults team. This investigation is currently ongoing. The home has been informing us of allegations made within the service. The appointed manager confirmed that she is familiar with Safeguarding Adults procedures and will be undertaking this training designed for managers with the local authority in the near future. There was evidence that staff receive training in Safeguarding Adults procedures. Feedback from staff identified that individuals know what to do if someone has concerns about the home, are familiar with Safeguarding Adults procedures and would feel comfortable to whistle blow. Procedures have been implemented to ensure residents monies are better safeguarded, following money going missing within the service. Money for residents is kept securely within the home and receipts and records maintained. Monies checked identified that accurate records are being maintained of residents personal allowances. Limited staff have access to the money and regular checking of the money further protects residents. Care Homes for Adults (18-65 years) Page 22 of 33 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. Residents live in a clean and homely environment and are provided with suitable facilities to meet their needs. Evidence: The environment was only briefly viewed due to no shortfalls being noted at the last inspection and no major changes have been made. Work continues to be done to redecorate areas within the home the appointed manager advised that resident will have a choice in the colours of redecorating bedrooms. All rooms are for single occupancy and are located over the ground and first floor. They are all provided with en suite facilities that consist of a hand basin, toilet and showers (wet rooms). There is a passenger shaft lift available to assist service users to access all areas of the home. Rooms were observed to be personalised to reflect individual choice and character. There is a dining room, lounge room, activities and quiet room provided on the lower ground floor. There is one communal bathroom with an assisted bath and disabled toilet. There are a number of communal disabled toilets throughout the home. Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: Residents have access to a garden area and it was confirmed that they have enjoyed being involved in the gardening. The laundry and kitchen are located on the lower ground floor of the home. The washing machine has a sluice cycle. Care staff are currently undertaking the washing and cleaning duties with residents assisting within their own rooms wherever possible. The home appeared clean on the day of the site visit and there were no offensive odours noted. The home is currently advertising for a cleaner. Care Homes for Adults (18-65 years) Page 24 of 33 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. Residents needs are currently being met with skill mix of staff on duty and are safeguarded by the recruitment procedures in place. Evidence: Feedback from staff identified that there are usually enough staff on duty to meet the needs of residents. The appointed manager is aware of the need to keep staffing levels under review if more residents are admitted into the home. Staff expressed scenarios when they thought they may become short staff, however these incidents have not occurred to date. Concerns expressed to us were relayed to the appointed manager to address with staff. An example was: that if someone needed two carers to provide personal support in the evenings, this would leave other residents unattended. A staff member confirmed one resident needs to be always supervised as they wander around the house and pose a risk to themselves by accessing food or stairs. They would take this individual to their room whilst they attended to another resident. This scenario was discussed with the appointed manager. No resident is on one to one funding, no information was recorded and the appointed manager confirmed the individual does not need constant supervision. It was discussed that if residents are not able to wander freely within the Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: service, then an assessment needs to be undertaken to ensure residents are living in the right home for them and is the environment a safe place to live for the individual. This scenario identified the need for further training for staff and the need for person centred care. The appointed manager currently lives on site and confirmed that she is available to assist staff should an emergency arise. This procedure should be formalised. One carer works a waking night and there is always another carer sleeping on site to provide assistance when needed. Ten carers are currently employed at the home, of which six have National Vocational Qualification (NVQ) level 2 or above. A further three carers have commenced undertaking NVQ level 2 studies. Feedback from staff identified that they felt their induction covered everything they needed to know to do the job when they started. There was evidence of induction being provided in a new staff members file. Staff files viewed identified that robust recruitment procedures are being followed, ensuring residents are safeguarded. Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks, application forms and references were seen to be in place. Feedback from staff identified that they felt their recruitment was done fairly. There was evidence within the service that staff receive training relevant to their roles. The appointed manager has a training matrix in place and where it has been identified that updated training is required, she is addressing this. There was evidence at the home of future dates for training planned on different topics. Feedback from staff reflect that they are provided with enough training for them to understand and meet the individual needs of people and relevant to their roles. Care Homes for Adults (18-65 years) Page 26 of 33 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. Residents benefit from a newly appointed manager that will assist in ensuring the home provides the services it advertises. In order to secure good outcomes the home must now seek to achieve a period of stability and concentrate on future development. Evidence: The home has been without a Registered Manager since June 2008. Whilst people have been appointed to manage the service, no person has completed the registration process with us. Due to regular changes in management and previous regulatory input, there is no evidence on sustainability of improvements. A newly appointed manager commenced working at the home in February 2009. She informed us that she has previous management experience in different settings within the care industry and will be applying for registration with us. She confirmed that she has the relevant skills, qualifications and experience to manage the service. Staff were complimentary about the newly appointed manager and felt that there are clear roles and responsibilities within the service. Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: Management must ensure that the services they advertise in their Statement of Purpose/Service Users Guide are provided. The Service Users Guide states assist residents to focus on their individual short and long term goals. As identified earlier, some residents have resided at the home for months and no goals were reflected. The Statement of Purpose advises that resident meetings are held monthly. It was confirmed that resident meetings occur every six to eight weeks. The full format Service Users Guide needs to be amended to reflect the current management arrangements. The appointed manager needs to assure herself that the terms and conditions for residents are being fulfilled. It is required that management and staff undertake training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS) to ensure residents are safeguarded and care provided is in line with current good practice guidelines and legislation. The appointed manager confirmed that she has a small understanding of DOLS and is currently covering this subject in a course she is undertaking. By the second visit, the home had obtained copies of information brochures for the staff in relation to DOLS. Feedback from staff identified that they had no understanding of the newly implemented legislation in relation to DOLS. There was currently no application for authorisation being processed. There is a quality monitoring and quality assurance system in place to assist in ensuring the home is ran in the best interest of residents. Surveys are sent to residents, representatives, and staff every three months. The appointed manager plans to send surveys to health professionals every six months. A brief summary of the quality assurance surveys returned from residents was provided to us, which was overall positive. A representative for the providers undertakes an analysis of feedback provided and identifies any action to be taken to improve the outcome for residents. The AQAA (completed by the previous appointed manager) identified areas that they have improved in the last 12 months, what they could do better and what their plans for improvements are in the next 12 months. Their progress on improvements they have identified will continue to be assessed throughout the inspection process. Two hot water taps sampled demonstrated that water was being dispensed over the recommended 43 degrees Celsius. Written confirmation was received that this had been addressed. At the second visit, these taps were still dispensing water above 43 degrees. Written confirmation was received to identify that action is being taken to safeguard residents and temperatures are being checked daily. Incident forms identified that the home could be more proactive at taking action to Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: ensure a similar incident does not occur again. It was confirmed that staff receive relevant health and safety training. The fire risk assessment was last done in November 2007. The appointed manager confirmed that she will be reviewing and updating this. She has familiarised herself with the safety procedures within the home. The AQAA identifies that equipments, as applicable, has been serviced or tested as recommended by the manufacturer or other regulatory body. Care Homes for Adults (18-65 years) Page 29 of 33 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 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 5 5 That the home has a copy of 30/06/2009 terms and conditions/contracts for all service users. That the terms and conditions of residency are available to each service user in a way they can understand. To ensure that they are providing the services they are contracted for and service users/representative expectations are met. To ensure that service users have information about their rights available to them in a way they can comprehend. 2 6 15 That service users personal 30/06/2009 goals are reflected in their plan of care and guidance be provided for staff on how to assist service users to achieve their personal goals. This will ensure selfdevelopment is promoted and aspirations be fulfilled. Care Homes for Adults (18-65 years) Page 31 of 33 3 20 13 That clear information be provided on correct administration of prescribed medicines. To ensure that service users receive the health care they require. 15/06/2009 4 37 5 That management ensure 30/06/2009 that services advertised in their Statement of Purpose and Service Users Guide are provided. To ensure that service users/representatives expectations are met. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 32 of 33 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!