Care Home: Elizabeth House

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What the care home does well There is a pre assessment process that allows the service users to visit and spend time at the home and make an informed choice prior to moving into the home. The service users are provided with a homely and clean environment that meets their needs. The meals are well managed and meet with the service users` satisfaction. People are supported to maintain contact with their friends and family and be part of the local community. The access to healthcare including the local primary trust and support is well managed. The service users made positive comments about the care and support that they are receiving at the service. What has improved since the last inspection? The service users have been provided with the facility that enable them to make hot drinks when they wish. Some parts of the service have been renovated. What the care home could do better: Further developments in risk assessments and care plans would ensure that all identified needs are appropriately met. Medication management need to be reviewed to ensure that this is managed safely at all times. Training in safeguarding for staff and their management should be developed further to ensure that the service users` welfare is protected. Key inspection report Care homes for adults (18-65 years) Name: Address: Elizabeth House 59/61 St Ronans Road Southsea Hampshire PO4 0PP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Anita Tengnah     Date: 2 3 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 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 32 Information about the care home Name of care home: Address: Elizabeth House 59/61 St Ronans Road Southsea Hampshire PO4 0PP 02392733044 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr M Khoyratty,Mrs M Khoyratty care home 20 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: 20 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: Mental Disorder, excluding learning disability or dementia - MD Learning disability - LD Date of last inspection Brief description of the care home Elizabeth House is registered with the Care Quality Commission as a care home for younger adults. The service has been converted from two large houses and is situated in a pleasant residential area of Southsea, close to shops and other amenities. The current registered providers have owned and managed the home for nearly 20 years and live close by. Because many of the residents have lived in the home for some years, the residents are in the forty to seventy year age groups and although the home is registered for younger adults aged 18 - 65 years. The home is registered to provide care for service users with a learning disability or mental illness or service users with a Care Homes for Adults (18-65 years) Page 4 of 32 20 20 Over 65 0 0 Brief description of the care home dual diagnosis. The home offers a good choice of communal space, with two good sized sitting rooms, a large dining room, a separate smoking area, hairdressing room, small conservatory and a paved and sunny garden area that residents have access to. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced visit was undertaken on 23 October 2009 as part of our inspection process. The evidence used to write this report was gained from a review of all the information we have received about the service since the last inspection and a visit to the home. The visit was carried out over a day and lasted six hours. During the visit we spoke with people who live in the home, staff on duty, the manager and the co owner of the service Documents relating to the running of the home were inspected that included care plans, assessments records, staff and the service users records. We looked at some of the service users bedrooms with their consents and the communal areas around the home. We sent out our Annual Quality Assurance Assessment ( AQAA) to the service. The AQAA is a self assessment that focuses on how well outcomes are being met for people Care Homes for Adults (18-65 years) Page 6 of 32 using the service. It also gave us some numerical information about the service. We received the completed AQAA and this gave us good information about the service. This is included in this report, as was information gathered by the Commission since the last inspection to contribute in assessing judgements in this report. We also sent out surveys to the people living at the home, the staff and external health and social care professionals. We received a good response and positive comments were received about the care and facilities available to them. The comments would be reflected in the sections of this report as appropriate. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 32 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. There is a satisfactory pre admission process in place and people are able to visit and meet the other service users prior to admission. Evidence: The record of a recently admitted service user was looked at as part of this visit. The manager stated that this person was admitted as en emergency placement and the home did not complete their own assessment . However information was not available from the service where this person was being admitted from and should have been sought by the staff prior to admission. The manager stated that information was sought from the care manager prior to this person moving in. Assessment and agreement were put in place three days following their admission in conjunction with the placing authority. The service has a statement of purpose and service users guide that also contained the complaint procedure as required and this is available to the service users. Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: The service users were provided with a written contract giving the terms and conditions for living at the home. The admission process includes a settling in period following admission and the home offers the prospective service users the opportunity to visit and spend time at the home and meet the other people living at the service. Staff reported that consideration is also given about how the new person will fit in with others already living at the home. The surveys that we carried out and seven service users who responded said that they were asked about moving into the service and six of them said that they received enough information about the home before they moved in. One of the service users we spoke to said that they visited another person at the home and comments were I knew that this was the right place for me and I am very happy living here. Comment from a care professional was the staff have been helpful and supportive in the transfer process. Information that we have received from our surveys indicated that that a more detailed assessment form and more thorough assessment would be beneficial prior to accepting clients. Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a process where the service users are involved in their care planning and are supported to make their own decisions. However the care plans and assessments do not cover all identified risks and further developments are needed to ensure that care is provided safely ant all times. Evidence: The care records for three service users were looked at and these showed that following assessments care plans were developed. The home has a key worker system and two people said that they were aware of their plan of care and they discussed these with the staff. Care plans contained details such as support needed with personal hygiene, assistance with meals and medication, emotional needs and communication and also specific needs . The care plan for a service user contained details about recurrent urinary tract infection and action required such as referral. Risk assessment for a specific need such as epilepsy was available in another record Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: that we looked at in order to inform staffs prcatice. There was evidence that the care plans were reviewed regularly, however information following review did not always correlate with the care plans in place. Further developments of assessments and care plans are needed for risks such as falls, support and action plans as these were lacking. The records showed that one person was prone to falls and another person had two recent falls. Risk assessments and care plans were not available for these as required. The lack of assessments and care plans put the service users at risk of their needs not being met in a consistent manner. Care plans for continence management needed more details about the type of pads and frequency of change and maintaining skin integrity as these were lacking. Another person was requiring support with their mobility and had a splint and care plans were lacking in relation to their management. The home has a different system of care planning in place since the last visit, information was at times difficult to find and some of them lacked details of action needed in order to meet the assessed needs of people. The manager confirmed that this would be reviewed and appropriate action taken. The AQAA states that the management keeps documentation to a minimum as the inspectors can seek information by interviewing the residents. However the manager must ensure that information in relation to the assessed needs of people are clearly documented in order that this does not impinge on the care that people receive. We have received positive comments from people we surveyed and those we spoke on the day of the visit. People tell us that they receive the support as needed by the staff and they are treated with respect. Comments from the service users included: The manager and staff look after me well. I am happy living here, everybody is kind and treat me well. Staff are very good, they always knock on the door and treat me with dignity. Staff are always kind to me. One person said that they were not always happy to live there, he manager was aware Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: of their concerns as these had been previously raised with the home and care managers. Risk assessments were available in the care plans including those for going out including road safety. Care Homes for Adults (18-65 years) Page 14 of 32 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. The provision of social activities, access to the community and meals are good and meet with the satisfaction of the service users. Evidence: The service user are supported to be part of the local community and some of them go out independently as they are able. Care plans showed that risk assessments had been developed in relation to accessing transport, road safety. The service user enjoyed a variety of activities in the community and three service users spoken with said that there is no restriction about going out and they enjoyed frequent trips to the shops and having coffee/lunch. The AQAA states that the manager has started working with an external agency to provide one to one recreational facilities for the service users. There are two service users who have the support of befrienders,which is a voluntary organisation that support the service Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: users and have one to one time and go out. Keep fit exercises were provided from an external person twice weekly. The manager stated that bingo game has been suspended at the moment due to a lack of interest. There are four people who are planning to go in holiday to Scotland in November. Two of them we met on the day said that they were looking forward to their holiday. The surveys from external professionals on what the service does well included social interaction and holiday arrangements for the service users. Offer opportunities for the residents outside the home. One of the service users attended a railway club, and another person attended the day centre twice a week. Four of the service users went to creative advances classes a few times a week. Another person undertook voluntary work through the lunch time in the local community. One of the service users was independent and attended weekly mass at the local church. Comments we have received included holidays are no longer available to me from one of the service users as this was due to restriction of fee available from the County. There is a planned menu that the staff stated is rotated on a four weekly basis. Concerns were shared with us regarding access to hot drinks previously. The provider has taken positive steps and hot water facility and a fridge has been put inn place. The service users said that this was very good as they are able to help themselves to hot drinks at any time. The service users provided their own tea/ coffee and milk was provided by the home. Lunchtime meal on the day offered the service users with two choices of main meal. The people who responded to our surveys and those we spoke to all expressed a high degree of satisfaction with the meals that were provided. The lunchtime meals on the day of the visit looked well presented, balanced and appetising. Comments from the service users about the food provided were : Good food. Food very good. Food very good and especially roast lamb. There is always plenty to eat. You get a choice and the food is good. Provide food that the residents like from a care professional Care Homes for Adults (18-65 years) Page 16 of 32 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. The service users receive the support they need and are treated with respect. There are records maintained of medicines administered to the service users. However further developments are needed as they pose some elements of risks to the service users. Evidence: The service users are provided with flexible personal support that takes into account their wishes and preferences. The service users we spoke to and the surveys showed that there is no restriction with their activities of daily living. They told us that they are able to go to bed and get up at their preferred times. Comments were that they are treated with dignity and the staff knocked prior to entering their rooms. We also observed that the staff asked their permission prior to entering the bedroom during our visit. The home has a couple who had recently married and they said that their privacy was always respected. Comments from external professional included that the home are Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: able to deal with the diverse needs of the service users. Another comment was the home meets the challenging needs of people well. We looked at the medicines management that the home undertook on behalf of the service users. The manager maintained records of medicines received into the service and their disposal as required. The home was using the dossett system and medicines were received weekly. The records of medicines administered were recorded on the Medication Administration Record ( MAR ) charts. These were maintained with no gaps were seen in a sample of the records that we looked at. There was also good record such as when the medicines were started in order to inform practice. There was one service user who was administering their own medicines at the time of the visit. There was evidence that the manager had sought consent from the GP and a record of this was available. There was no procedure in place to guide staff regarding the self -administration process and management of medicines in the home and this should be developed. A record of medicines given to a self- administering service user must be maintained to include the date and signature of the responsible care worker as this was not available. This will assist the staff to monitor compliance with their medicines. Lockable facilities should be available to people who are self administering their medicines to ensure that this is managed safely at all times. The service user said that they hid their medicines in their bedroom and this was all right. The manager stated that the service user kept their bedroom door locked. All other medicines were maintained safely and securely at the time of the visit. The manager stated that he dispensed the service users medicines and a carer administered these to the service users who may be anywhere in the service. The manager does not witness the administration,however signs the MAR charts records to show that these have been administered. This is not good practise and has the potential of people not receiving the correct medicines, or medicines being administered to the wrong person. The home did not have printed MAR charts and the manager kept handwritten records of medicines prescribed on the MAR charts. It is strongly recommended that medicines that are transcribed are checked/ signed for by a second person and referenced back to the original prescriptions to eliminate any risks of error as this was not available. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: The manager reported that they did not have a copy of the prescriptions and this should be reviewed to ensure all necessary records are available, in order to promote safe practice. The manager confirmed that none of the service users were currently receiving any controlled medication at the time of the visit. The controlled medicines cupboard does not meet with the current regulation. There was one medicine that must be stored as a controlled medicine at the time of the visit. The manager must ensure that controlled medication are stored appropriately and in accordance with the safe management of medicines. The manager must ensure that arrangements are in place and procedures developed for the safe management of medicines at all times. Following our visit the manager has sought the advice of the Commissions pharmacy inspector in respect of controlled medicines management/storage . Care Homes for Adults (18-65 years) Page 19 of 32 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. The service user are confident that their concerns would be dealt with by the staff. There are processes in place and action taken following allegations of abuse. However there is a lack of up to date guidance to ensure that all allegations are reported, recorded and appropriate actions are taken. Evidence: The service has in place a complaint procedure and a log of complaints. The manager stated that the service had not received any complaints since the last visit. The service has an easy read version of the city Council complaint procedure that was also available to the service users. People we spoke to and the surveys we received indicated that people are able to approach the manager if they have any concerns. Response from the healthcare professionals were that the service usually responded appropriately if they or a person using the service have raised concerns. The staff that we spoke to said that they would report to the manager or the senior staff in charge of the service any allegations that are made to them. Comments that we have received from our surveys and people spoken with included: Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: I do not think the home could do better. I am completely satisfied. One person said that they do try and raise their concerns and get no results. The manager stated that they have contacted the care managers and they are aware of the residents concerns and they have been dealing with these. We looked at the process that the service must have in place to manage any allegations of abuse. The record showed that the safeguarding team had investigated an allegation last year and report of the outcome was available. However the manager reported that this investigation had been going for a long time and the home had written to social services on several occasions to seek an outcome. Record showed that there have been two recent allegations of abuse that included financial abuse .The record showed that two service users had made two recent allegations to a care professional and to a carer at the service. The carer had recorded/ compiled a statement of the allegations and reported to the manager. According to the manager both of these allegations had been reported to the care coordinator at social services. The manager stated that they were not allowed to make direct referral and the service had to report to the coordinators instead. This is contrary to safeguarding referral guidance that is available to all the providers. There were no record to demonstrate that the concerns have been investigated by the safeguarding team as required. We looked for the recent updated safeguarding referral procedures from the City Council that give clear information about making referrals to social services, as part of the prevention of abuse and safeguarding people living at the home. This was not available and the manager said that he would be accessing this for the home. There was a lack of clear process such as making referral/ reporting all allegations of abuse to the appropriate authority. There were inadequate records to show what action had been taken following investigation by the safeguarding team to ensure that people are safeguarded. These must be developed and must include staff training on the agency multi agency reporting procedures to ensure that people receive safe and effective care and their interests are protected. Care Homes for Adults (18-65 years) Page 21 of 32 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. The home is warm and homely and further refurbishment would ensure that this meets the needs of all people accommodated. Infection control procedures are not always adequate and should be improved to ensure that people are not put at risk to their health and safety. Evidence: We walked around the home and looked at some of the service users bedrooms, communal areas, bathrooms and kitchen as part of our visit. The service users we spoke to said they were satisfied with their bedrooms and their privacy was respected. They had keys to their bedrooms and some preferred to lock their rooms and staff were aware of this. The service users have unrestricted access to the communal areas of the home that includes two lounges, a large dining room, smoking room, small conservatory and the garden. The accommodation is provided in sixteen single and two shared rooms over three floors. There is no lift but a chair lift is provided for residents who have difficulty with the stairs. The manager reported that only those whose assessments showed that they are able Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: to access the bedrooms with steps would be accommodated in this area. The home was bright, homely and there was no adverse odour when we looked around. The AQAA states that there is an ongoing renovation of the service and recent work included the patio area, access to the laundry and repair to the chimney. Comment from a service user was thatrecently a hot water urn and a fridge has been installed in the dining room for use by the residents. The service users provided their own tea/coffee for the use of this facility as confirmed by the manager. We asked people we surveyed if the home was fresh and clean. All those who responded said always. Other comments included: Good cleaning and excellent washing. The home gave me the best place to stay. This is the best place I have lived. We observed that some parts of the home were in need of upgrading as wall papers looked tired and worn. One of the service users bedroom in particular had old water marks that we brought to the attention of the manager. Following the visit the manager reported that part of that bedroom had been renovated. The communal bathrooms and toilets would benefit to be included in the refurbishment programme in order that these are homely and comfortable. The AQAA has identified two bedrooms requiring renovation and the carpet on the landing and minor repair to some furnishing. As part of managing the health and safety risks to the service users, the ground floor cupboard as identified should be kept locked. The hand washing facilities in the communal toilets/ bathrooms were inadequate to ensure good infection control procedures are followed. This included lack of disposable towels, soap dispensers to promote effective infection control and reduce risks to staff and the service users. The home has a laundry and all the service users laundry was undertaken internally. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: The staff were aware of the access to the laundry and reported that they use a separate door. The laundry area was clean and well maintained and the manager stated that the present equipments such as washer and drier were appropriate for their current needs. Care Homes for Adults (18-65 years) Page 24 of 32 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. There is a good recruitment process in place that ensures that checks are completed prior to staffs employment. There is satisfactory staff training in mandatory health and safety. However further development in training is needed in order to meet the current needs of the service users safely. Evidence: The AQAA states that there is a recruitment process in place that includes all checks such as criminal record bureau (CRB) and POVA first checks are completed prior to employment. We looked at the records for two recently recruited staff and found that records of recruitment and necessary checks such as CRB , POVA and references were available as required, in order to minimise the risks to the service users. Staff and the service users we spoke to said they felt that there was enough staff and received assistance as required. The staff we spoke to and the surveys showed that the manager and his wife who are co owners were always at the home and provided very good support to the staff and the service users. The staff duty roster showed that there are two carers on the morning shifts, three Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: carers until five thirty on the afternoon shift and two carers until nine at night. Night duty has one awake carer and the manager is on call and lives next door to the service. The carers are responsible to carry out the services users laundry. There is a chef to assist with the lunchtime meal and the carers do the teas and suppers. People we spoke to and the service users stated that there is no restriction to the times that people got up or went to bed and their autonomy was respected. There is a staff training programme in place that included induction and mandatory training such as fire safety, food hygiene and moving and handling to support safe care practices. Records of training were maintained and a training matrix had been developed to monitor staff training requirements. Recent training included mental capacity and two staff have completed infection control and medications in July 2009. Further development of training such as deprivation of liberty, mental health and learning disability must be put in place as some of these have been identified in the last report. These are crucial in order to ensure that the staff have the skills and recognise the service users needs to deliver care effectively and safely and meet with current good practice guidelines. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a clear management structure and the registered manager has clear lines of accountability for the service. There are satisfactory arrangements in place for the promotion of health and safety at the home such maintenance of equipment as required. Evidence: The service has a registered manager who has experience in working with the current service users group and has managed the home for over twenty years. The manager is a registered nurse has an National Vocational Qualification(NVQ) at level 4. Mrs Khoyratty is the co owner and helps support the service users/ staff and is very involved in the service. The response from our surveys and interaction observed on the day showed that the manager/ provider, service users and staff have developed and maintained good relationship with each other. staff said that there was a supportive management that was available for advice. It was evident that the manager and provider were aware of the needs of the service users and showed mutual respect. Staff said that communication was good and complaints are sorted Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: out promptly. Information from the AQAA shows that the home has required policies and procedures in place. We noted that most of these have not been reviewed since 2007/ 2008. Regular reviews of these policies and procedures are needed to ensure that they reflect current good practice guidance and reflect any changes in regulations. The AQAA shows that there is an ongoing programme for the servicing of equipment that are in use such as fire safety, heating, chair lift, emergency lighting and call bell systems have all been completed in the last six months. Care Homes for Adults (18-65 years) Page 28 of 32 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 29 of 32 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 9 13 The registered person must 15/12/2009 ensure that risks assessments are developed to ensure that strategies are developed and care plans are in place to manage these. To ensure that the service users receive care safely and their assessed needs are met. 2 20 15 The registered person must ensure that arrangements are in place for the safe handling, safe administration and safe keeping of medicines received into the service. To ensure that people receive their medicines safely. 30/12/2009 3 23 12 The registered person must 30/12/2009 ensure that clear procedures are in place to deal with all allegations of abuse. Page 30 of 32 Care Homes for Adults (18-65 years) 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 To ensure that people are not put at unnecessary risks of harm and abuse. 4 35 18 The registered person must 30/12/2009 ensure staff receive the training they require to meet the current needs of people accommodated including the protection of vulnerable adults and learning disabilities awareness. So that care is provided in a safe manner and staff have the skills to deliver the care. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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