Care Home: Elmers End Road

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What the care home does well The homes long established ethos of care for a vulnerable group in society is clearly one of its strengths. 23, Elmers End Road is an ordinary, although enlarged, family house and this provides a community based home like resource. This is clearly another of the homes strengths. The residents who spoke to us said that they are very happy with the home and like living there. What has improved since the last inspection? At the last inspection a large number of issues were raised to do with the environment and the need for urgent repairs, redecoration and refurbishment. Since the last inspection in May 2009 all these works have been carried out and completed. The Manager told us that Hyde Housing had carried out the works given that they are the landlords for the building. Specifically a new kitchen has been installed. It is of a high standard and meets the requirements. Bathrooms have been completely overhauled with new floors and tiling where required. All requirements have been met. The areas that required painting and redecoration have all been completed and the garden has also been upgraded to a good standard. There are no outstanding requirements from the last key standards inspection. What the care home could do better: Specific areas that require improvement and that have been referred to in this key standards inspection report are as follows: Standard 2 It is a requirement that the Manager ensures that a full and comprehensive needs assessment is carried out for each of the 5 residents. This should be done in partnership with each of the residents and where appropriate their families or representatives such as the Care Managers from the Local Authority. The needs assessment should form the basis for the care plans. The needs assessments should be reviewed every 6 months or earlier if the residents needs change sooner. Standard 6 We recommend that there should be a single care plan format that is used for all the residents and that covers both health and social care needs. It is recommended that at each care plan review the care objectives are considered individually and reported on at the review with minutes provided that cover the discussion and progress made. It is required that the Manager ensures that all residents care plans are reviewed at least every 6 months (or earlier if their needs change) together with the resident and other key parties. Standard 9 It is required that the Manager ensures that all residents have an individualised risk assessment that is linked to the needs assessment and care planning process. Standard 19 It is recommended that the Manager establishes in the residents files a section where visits to healthcare professionals are logged. This should identify the reason for the visit and the outcome of the visit. Standard 20 It is a requirement that the Manager ensures that all residents Medical Administration Record sheets are completed appropriately and that staff receive up to date training (from an external and appropriately authorised trainer) on the safe administration of medicines within the home. Standard 23 It is recommended that the Manager ensures that all staff receive POVA training from an outside and recognised trainer at least once every 3 years. Standard 24 It is recommended that the Manager puts in place a maintenance book that identifies works needed to be done. Standard 34 It is recommended that the Manager ensures that all CRB checks be renewed every 3 years. Standard 35 It is recommended that the Manager draws up a single training matrix for the whole staff group as this will identify in an at a glance fashion what training the entire staff team have covered. Standard 36 It is recommended to the Manager that the discussions had in staff supervision are expanded to include discussion on specific resident`s issues and the key working process, monthly reports on progress being made by residents and key workers with care plan objectives. It is recommended that the supervision records should be improved by being more detailed to include all the issues discussed and that any agreed actions are included in the records. Standard 39 It is required that the Manager ensures the homes quality assurance process be fully developed as discussed. Key inspection report Care homes for adults (18-65 years) Name: Address: Elmers End Road 23 Elmers End Road Anerley London SE20 7ST     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: David Halliwell     Date: 0 4 0 6 2 0 1 0 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 37 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: Elmers End Road 23 Elmers End Road Anerley London SE20 7ST 02087766564 F/P02087766564 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.lcdisability.org Leonard Cheshire Disability Name of registered manager (if applicable) Mr Lindon Philander Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home Elmers End is home for five young adults who have a learning disability. It is maintained in a domestic style and is located in a residential area of Penge, close to local shops. The home has three floors and the stairs to the two top floors are steep, there is no lift so Elmers End would not be suitable for persons with significant mobility difficulties. It is part of the Leonard Cheshire Foundation. Service users in this home are encouraged and enabled to be as independent as possible. Each service user attends the local day centres five days a week. Visits to their families are encouraged, Care Homes for Adults (18-65 years) Page 4 of 37 Over 65 0 5 1 2 0 5 2 0 0 9 Brief description of the care home including overnight stays. Leisure facilities in the local community are also accessed. Group holidays are organised by the home and staff accompany service users as appropriate. There is a staff team of five, including the Manager. Staff members in the home are recruited and trained through the Leonard Cheshire Foundation. Staff covers the house 24 hours a day. All local health provision is accessed. Specialist support is offered via staff at day centres . Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The stars quality rating for this service is adequate. This means that people who use these services experience adequate quality outcomes. They said that they like to be called residents. No enforcement activity has occurred since the last inspection. This was an unannounced inspection visit and was carried out over 1 day. The Inspection covered all the key standards in the National Minimum Standards for Younger Adults. The inspection involved a tour of the home, a review of all the homes records and formal interviews with 2 staff as well as the Manager. 4 residents were spoken with formally. 4 staff and 3 residents files were inspected as was the policies and procedures manual for the home. Care Homes for Adults (18-65 years) Page 6 of 37 5 requirements have been made as a result of this inspection and 9 recommendations have been made. Feedback on the requirements and recommendations was given verbally to the Manager at the end of the inspection visit. The residents and staff were very helpful and they are to be thanked for their assistance over the course of this inspection visit. The agencies Registration Certificate with the Commission for Social Care Inspection was seen displayed appropriately in the hall just outside the main office. There have not been any changes in the ownership of 23, Elmers End Road since the last inspection in May 2009. Care Homes for Adults (18-65 years) Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: Specific areas that require improvement and that have been referred to in this key standards inspection report are as follows: Standard 2 It is a requirement that the Manager ensures that a full and comprehensive needs assessment is carried out for each of the 5 residents. This should be done in partnership with each of the residents and where appropriate their families or representatives such as the Care Managers from the Local Authority. The needs assessment should form the basis for the care plans. The needs assessments should be reviewed every 6 months or earlier if the residents needs change sooner. Standard 6 We recommend that there should be a single care plan format that is used for all the residents and that covers both health and social care needs. It is recommended that at each care plan review the care objectives are considered individually and reported on at the review with minutes provided that cover the discussion and progress made. It is required that the Manager ensures that all residents care plans are reviewed at least every 6 months (or earlier if their needs change) together with the resident and other key parties. Standard 9 It is required that the Manager ensures that all residents have an individualised risk assessment that is linked to the needs assessment and care planning process. Standard 19 It is recommended that the Manager establishes in the residents files a Care Homes for Adults (18-65 years) Page 8 of 37 section where visits to healthcare professionals are logged. This should identify the reason for the visit and the outcome of the visit. Standard 20 It is a requirement that the Manager ensures that all residents Medical Administration Record sheets are completed appropriately and that staff receive up to date training (from an external and appropriately authorised trainer) on the safe administration of medicines within the home. Standard 23 It is recommended that the Manager ensures that all staff receive POVA training from an outside and recognised trainer at least once every 3 years. Standard 24 It is recommended that the Manager puts in place a maintenance book that identifies works needed to be done. Standard 34 It is recommended that the Manager ensures that all CRB checks be renewed every 3 years. Standard 35 It is recommended that the Manager draws up a single training matrix for the whole staff group as this will identify in an at a glance fashion what training the entire staff team have covered. Standard 36 It is recommended to the Manager that the discussions had in staff supervision are expanded to include discussion on specific residents issues and the key working process, monthly reports on progress being made by residents and key workers with care plan objectives. It is recommended that the supervision records should be improved by being more detailed to include all the issues discussed and that any agreed actions are included in the records. Standard 39 It is required that the Manager ensures the homes quality assurance process be fully developed as discussed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 37 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 37 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. Standards 2 & 5. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Prospective service users cannot at present be assured that their needs are being re assessed or that their individual aspirations and wishes are being taken into account in the assessment process. Each service user had a written contract. Evidence: Standard 2 We inspected 3 of the 5 residents files, randomly chosen. All 3 of these residents have lived at 23, Elmers End Road for more than 10 years. The Manager provided us with all the residents files and other relevant documentation for the residents. We were unable to find a comprehensive needs assessment for each person that covered the whole range of their health and social care needs. We saw Care Homes for Adults (18-65 years) Page 11 of 37 Evidence: some assessments that covered some of the social care needs of the residents and some that covered some of their health care needs. There was a health action plan format on 1 of the files however this had not been fully completed. We could not find a health action plan for the other 2 residents. The Manager told us that these plans had not been used for all the residents. The layout of the residents files that we inspected was inconsistent and different formats that have been developed by The Leonard Cheshire Society over the last few years had been used by staff for different residents. Each resident did have a service user plan or care plan. These were given a variety of named headers. We refer to this under Standard 6 later in this report. We interviewed 3 of the residents and we asked them if they had been a part of the needs assessment process. They told us that they had and that they had been able to express their views, preferences and wishes. This all means that although the residents have been involved in a needs assessment process, the process itself does not appear to have been comprehensive in its coverage of the full range of health and social care needs. It would be helpful to staff concerned if the same needs assessment tool was used for all the residents. It is a requirement that the Manager ensures that a full and comprehensive needs assessment is carried out for each of the 5 residents. This should be done in partnership with each of the residents and where appropriate their families or representatives such as the Care Managers from the Local Authority. The needs assessment should form the basis for the care plans. The needs assessments should be reviewed every 6 months or earlier if the residents needs change sooner. Standard 5 The 3 residents files that we inspected did have a written and costed contract or statement of terms and conditions. These contracts specified all the appropriate elements expected in such contracts. They had been signed by the residents. Care Homes for Adults (18-65 years) Page 12 of 37 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 6, 7 & 9. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the inspection visit to this service. The individual residents care plans seen on the residents files does not reflect the assessed and changing needs and personal goals of the residents. Therefore they may not be assured that they will be supported to make decisions about their lives with assistance as needed. Risk assessments need to be developed to help to ensure that the residents will be supported to take risks as part of an independent lifestyle. The risk assessments should be integrated with care plans. Evidence: Standard 6 We found on each of the 3 residents files a photograph of the resident concerned. We also found the other information that is required under Schedule 3. Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: Each resident has a care plan although these plans have a variety of named headers such as: the progression record, the individual service plan, the health action plan, the support plan or the action plan. This makes it rather confusing for any new member of staff or an agency member of staff who wished to find the comprehensive care plan for that resident. Inspection of the care plans in the 3 files revealed that some social care objectives and personal care objectives are detailed. However the care plan objectives that we saw did not comprehensively cover all a persons likely needs. This may be in part due to the fact that we were unable to find comprehensive needs assessments for the residents. We would therefore recommend that there should be a single care plan format that is used for all the residents and that covers both health and social care needs. This would provide a single document that sets out clearly for staff, residents and others to see the complete scope of a residents care plan. This should assist staff to provide the full range of identified support that the resident needs. On 1 of the files inspected we saw that personal support needs had been identified for the resident that covered areas such as support with bathing, dressing, preparing food and going out. When we looked at the action plan for the same person there was no reference to these needs and how they will be met. The Manager told us that all care plans are reviewed annually. Inspection of the files showed us that 2 of the 3 residents care plans had been reviewed in April 2010. There was no evidence to show that the other residents care plan had been reviewed in the last year. The reviews were seen to have involved all the relevant people including the residents. Review papers that we saw did not include commentary on any progression or otherwise of the stated care plan objectives for the residents. When we asked the Manager about this he told us that where this is the case it is because the care plan remains the same with no changes. It is recommended that at each care plan review the care objectives are considered individually and reported on at the review with minutes provided that cover the discussion and progress made. Where progress has not been made the care plan objective should be looked at by the review team to consider if it is still pertinent for the residents concerned. It is required that the Manager ensures that all residents care plans are reviewed at least every 6 months (or earlier if their needs change) together with the resident and other key parties. What this all means is that residents cannot be assured that all their needs are reflected in their care plans or that as their needs change they will be incorporated in revised care planning as a part of the review process. Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: Standard 7 Residents interviewed by us confirmed that the staff at Elmers End Road do respect their rights to make their own decisions where appropriate. Care staff also made it clear that they involve the residents wherever possible in making their own decisions in order to assist in supporting them to fulfil their preferences and wishes. The Manager told us that residents meetings are now held regularly and they involve the residents as much as is possible, to make decisions about different aspects of their lives. This includes menu planning and daily activities as well as planning the routine maintenance tasks that have to be undertaken every day and which involves the residents. Residents confirmed with us that they attend these meetings. We saw minutes of these meetings that confirm they have been held and the issues that were discussed. This all means that residents are assisted to make decisions about their lives with assistance as it is needed. Standard 9 As we have already indicated we inspected 3 of the 5 residents files. On these files we found risk assessments had been carried out for the residents however these had not been updated since December 2008. The risk assessments that had been carried out in 2008 covered a standard set of risks for each of the residents. They did not in all cases cover risks associated with some identified care plan objectives. It is required that the Manager ensures that all residents have an individualised risk assessment that is linked to the needs assessment and care planning process. This will help to ensure that residents are supported to take risks as part of an individual lifestyle. It will also assist staff in providing appropriate levels of support to the residents. Care Homes for Adults (18-65 years) Page 15 of 37 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. Standard 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Residents are able to take part in appropriate activities and are to a reasonable extent involved in local activities. Residents have appropriate relationships and their rights and responsibilities in their daily lives are recognised and respected by the staff in the unit. Residents are offered a healthy diet and they are assisted in learning cooking and food preparation skills. Evidence: Standard 12 We found evidence that care staff do encourage the residents to keep Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: their relationships with family and friends if residents wish to do so. The Manager told us that visitors to the home are encouraged and that they use the visitors book to sign in. The visitors book that was seen in the front entrance hall was evidently in regular use. The Manager also said that residents are enabled to take part in appropriate activities by the care staff. We were told in interviews with 3 residents and 2 staff that outside services and activities are used to enhance the life experiences of the residents. We were told by the Manager that each resident has a weekly activities timetable that helps them to remember what has been planned with them each week. Evidence of this was seen on residents files. Residents told us that they believe they have good access to a range of activities that they enjoy. The Manager told us that information is provided to residents by staff about local activities that residents say they are interested in. This all means that residents are able to take part in appropriate activities that they feel enhances their lives. Standard 13 Some of the residents that we spoke to told us that they do attend some local community events. Information is made available and staff do encourage residents to be involved as much as possible in local activities. Some residents told us that they like to go to the shops. Residents make full use of local public transport facilities in order to get out and about and to see friends and family. 1 resident who was interviewed said, the bus service is not bad and there is a bus stop just down the road here. All residents living at Elmers End Road are registered to vote in elections and are supported by staff to do so if they wish. We saw that some information is made available within the home about local activities for residents to take up if they wish. This means that wherever possible residents are a part of the local community. Standard 15 Some of the residents we interviewed told us that they do keep in regular contact with their families and friends and that staff assist them to do so. Staff were seen to encourage the residents to keep and maintain contacts with family and friends Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: so that they benefit from having appropriate relationships. We did not see anybody else in this home during the course of the inspection however the visitors book demonstrated that a steady floe of visitors come to the home. This all means that residents do have appropriate relationships and that there are no apparent restrictions for visits by family or friends to see residents. Standard 16 Residents confirmed to us that the homes policy on privacy is upheld appropriately within the home. Residents have keys to their own rooms and to the front door, they are able to see their GP when they need to and to choose their GPs. Staff were seen by us to knock on residents doors before entering and service users were seen to have the opportunity to spend time in their own company as and when they wish. Some residents participate in household chores and those that we interviewed said that they enjoyed these responsibilities and were all very clear as to when and what they have to do. Residents can be assured that their rights and responsibilities are respected in their daily lives. Standard 17 A member of staff told us that there is a weekly menu and that there are always 2 choices of meals for the residents. Residents are enabled to make choices at the menu planning stage and special needs are catered for. 3 residents we interviewed said that they have been asked about what food they would like to see on the menu and what they wish to eat on a daily basis. Menus that were seen were varied and nutritious in the food being provided. Residents confirmed that they all enjoy the food they receive at Elmers End Road. Cultural needs and wishes of the residents are also taken into account with the provision of appropriate foods, which meets their stated needs. Residents can therefore be assured that they will be offered a healthy diet and that they should enjoy their meals and mealtimes. Care Homes for Adults (18-65 years) Page 18 of 37 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. Standards 18, 19 & 20. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Personal and healthcare is provided according to service users individual needs. Clinical support for specific health care is provided by General Practitioners, District Nurses and by the psychiatric multi disciplinary teams as well as other specialist services such as chiropody, sight and hearing services thus ensuring that residents do have a good quality of life. Procedures for the administration of medication need to be reviewed so as to avoid errors. Evidence: Standard 18 The Manager told us that residents have the choice of when they get up, when they go to bed and what they do during the day. The residents we interviewed at this inspection also said that they choose when to go to bed, when to have a bath, what they wish to wear and what activities they do during the day. Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: Residents did not raise any concerns with us about their key workers. The Manager told us that residents at 23, Elmers End Road continue to receive regular input from their Consultant Psychiatrist, Community Psychiatric Nurses and from other professionals in their clinical teams. This means that residents do receive support in the way they prefer. Standard 19 With regards to the health care of the residents the Manager informed us that all residents are supported to keep well through accessing appropriate healthcare and associated mental health care support. All residents are signed up with local GP surgeries and some are registered with local dentists. The Manager told us that annual health checks take place at the GP surgeries. The Manager said that whether or not a resident uses the dentist is left up to the residents own decision but staff will encourage residents to use this service if required. Residents who we spoke to said that they go to see their GPs as and when necessary. When we inspected the residents files it was difficult to see which healthcare professionals the residents had seen and when. The Manager told us that this information could be found in the daily diary sheets. However these records are lengthy and short of reading every entry it was difficult to see the pattern of care and support that residents are receiving from external healthcare professionals such as the GP, dentist, chiropodist, optician etc. For this reason it is recommended that the Manager establishes in the residents files a section where visits to healthcare professionals are logged. This should identify the reason for the visit and the outcome of the visit. This will assist in being clear about the levels of healthcare support the residents are receiving and in ensuring that the residents physical and healthcare needs are being met. Standard 20 The Manager told us that he is responsible for the medication practices carried out within the home. We were told that only those care staff who have received appropriate training are allowed to administer medication to the residents. The homes policies and procedures manual was inspected and was seen to contain appropriate policies for the control of medication. We reviewed the records for the administration of medication to residents and these were seen to be appropriately completed and in line with the homes policies and procedures. The Manager told us that none of the current residents are prescribed any controlled drugs. Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: A stock take check was also carried out by us together with the Manager. The levels of medication held within the home did match the MAR sheet records. Records were inspected for 3 different residents and a number of unexplained errors were found on each of the 3 residents records. This is a serious breach of the homes policy and procedures. It was agreed with the Manager that this would be investigated immediately and that the procedures will be completely reviewed to ensure no further mistakes are made in this area. It is a requirement that the Manager ensures that all residents MAR sheets are completed appropriately and that staff receive up to date training (from an external and appropriately authorised trainer) on the safe administration of medicines within the home. Inspection of the staff training records for 5 staff members showed us that only 2 staff have received this training and for 1 of these staff that training was received by them in 2006. Training in this area should be received by all those staff who administer medication and this should be regularly updated. The Manager assured us that he will ensure that all staff are booked on to a training course in order to receive medication training and to be fully briefed as to how the new procedures work. We were told that the Boots Pharmacy do a regular inspection of the homes procedures. The Manager told us that residents are all unable to administer their own medication. This all means that is difficult to say if residents are being protected by the homes policies and procedures for dealing with medications. Care Homes for Adults (18-65 years) Page 21 of 37 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. Standards 22 & 23. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Residents may be assured that their views will be listened to and acted upon appropriately. They may also be assured that they will be protected from abuse, neglect and self-harm. Evidence: Standard 22 Residents told us that they feel their views are listened to and acted upon. They also all said that if they had a complaint they know the procedure to be followed and would do so if they needed to. Staff interviewed confirmed with us that the residents are all aware of the complaints process and that the whole staff group took any issues raised by residents seriously. The Manager provided us with the homes complaints leaflet that he told us is given to the residents. This contains all the relevant information needed to make a complaint. The complaints record was reviewed, no complaints had been made since the last inspection visit. The Manager told us that no complaints had been received since the last inspection. The Manager also told us that a quarterly complaints record is returned to Leonard Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: Cheshire Headquarters by him. We saw these returns for the last year, no records of any complaints had been entered here. This all means that residents feel their views are listened to and acted upon appropriately. Standard 23 The home has an adult protection policy (POVA) and the Manager informed us that staff receive POVA training. Review of the staff training records showed us that 3 of the 4 staff files inspected contained information that these staff had received POVA training. 1 of these staff members had this training in 2006. It is recommended that the Manager ensures that all staff receive POVA training from an outside and recognised trainer at least once every 3 years. Regular training in this area should mean that staff are better aware of what abuse is and the safeguards in place for the protection of the residents should they need them. Certificates of staff attendance at this training will be inspected. We saw the allegation of abuse record and 1 allegation had been made in 2009 since the last inspection. Evidence was seen by us that the correct procedures have been followed. The appropriate authorities were informed and an action plan implemented. A vulnerable adults conference was held with the appropriate parties including the referring local authority. All the agreed actions were taken appropriately except that the Commission was not informed of the event via a Section 37 report. We told the Manager that in future the Commission should be informed and the Manager confirmed that this would be done. The policies and procedures manual for the home includes a whistle blowing policy and a policy on dealing with violence and aggression. Understanding the policies and procedures is a part of the staff induction process and staff are asked to sign to say that they have read and understood the policies and procedures. A review of staffing records held on staff files confirmed that all staff had signed such an agreement. The Manager said that the home does look after some residents money. We reviewed the financial records for these transactions that all were in order. All transactions are dated and signed for by both staff and residents to confirm satisfaction by all parties. We found no anomalies. This all means that residents are being protected from abuse, neglect and self harm. Care Homes for Adults (18-65 years) Page 23 of 37 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. Standards 24 & 30 were inspected at this inspection.Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users at 23, Elmers End Road are able to live in a homely, comfortable and safe environment. The home is also clean and hygienic and well looked after by staff. Evidence: Standard 24 Together with the Manager we reviewed all areas of the home to assess the quality of the environment and decor. Generally the home was found to be clean and hygienic. No areas were identified that need repair or improvement. We were told by the Manager that the building is owned by Hyde Housing and that all maintenance and renovation works are carried out by that Company. He told us that Hyde Housing visit the home every 3 months to assess what work is required to be done. The Manager told us that a handyman comes monthly to the home to carry out identified work. It is recommended that the Manager puts in place a maintenance book that identifies works needed to be done, this should help ensure that ongoing maintenance is targeted and that a backlog does not occur as it had done by the last inspection. Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: At the last key standards inspection a good deal of work to be done was identified. Major refurbishments were identified as being needed in the home, mainly in the kitchen and bathrooms but also in the garden. This work has since been carried out and all the required work has been completed to a good standard. 3 residents bedrooms were inspected with the permission of those residents. When we spoke to them they told us that they are happy with their rooms. We asked to see the records for checks on water temperatures and the Manager provided the homes records for this. They revealed that these tests have been carried out each week as is required. Tests carried out all indicated that the hot water temperatures were within the prescribed limits. This all means that residents live in safe, comfortable accommodation. Standard 30 The Manager showed us the homes infection control procedure, which seems to be working effectively. This means that the residents live in a clean and hygienic home. The laundry area is well laid out and there is an impermeable floor laid down to prevent water ingress and easy cleaning. Care Homes for Adults (18-65 years) Page 25 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 32, 34, 35 & 36. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users do benefit from clarity of staff roles and responsibilities but service users cannot be fully assured that they are supported by a competent and qualified staff team given the lack of documentary evidence on staff files. An appropriate recruitment policy and induction process helps protects residents and ensure that they are supported appropriately. However until regular and formal 1:1 supervision is provided to all staff, service users cannot be assured that they will benefit from well-supported and supervised staff. Evidence: Standard 32 The Manager informed us that no new staff have been recruited to the home since the last inspection. It was reported by the Manager that most of the staff group have now achieved their NVQ level 2 or 3 qualifications and this was confirmed by the staff who we spoke to at this inspection. However certificated evidence of these qualifications was not available Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: for inspection and a requirement is made with reference to this under Standard 35. Residents interviewed told us that staff are approachable and we saw staff taking time to deal with residents questions. Standard 34 The Manager told us that the home does have a recruitment policy and procedure and that all staffing posts are filled by application and interview. Evidence of these processes being used was seen when we inspected the staffing files. A review of 4 of the staffing files evidenced 1. That suitable application forms are completed as a part of the process. 2. Usually 2 references are obtained including one from the last employer, however 2 staff files had no references in them. 3. All staff files reviewed had proper CRB checks that had been carried out for staff employed within this home. However it is recommended that the Manager ensures that all CRB checks be renewed every 3 years. On all 4 files those CRB checks had been carried out in 2003, 2004 and 2005 need now to be renewed. 4. Other official documentary evidence confirming the identification of staff either in the form of a passport, birth or marriage certificate was seen on the files inspected. 5. Training certificates and other evidence of qualifications gained by the staff member should also be held on the staffing files such as that for NVQ training. Evidence of NVQ qualifications was not on the files. 6. Staff files were seen to include signed and dated copies of their contracts. This means that residents are supported and protected by the homes recruitment policy and practices. Standard 35 It was clear from the inspection of the 4 staffing files and from what the Manager had told us that no new staff had been employed since the last inspection. Although this has not been used for some time the Manager informed us that a structured induction programme is offered to new staff. Documentary evidence of this was however not seen on the staffing files. This may be because none of the staff whose files we reviewed had been employed after 2006. We were told by the Manager that Leonard Cheshire do offer a comprehensive training plan for staff that covers the essential and priority training needs for staff. The Manager informed us that staff may attend as many internally provided training courses as they are assessed to need in order to carry out their job appropriately. The Manager showed us an individual staff training list that he calls a matrix. This identifies all the training undertaken by the staff concerned. However it is recommended that the Manager draws up a training matrix for the whole staff group Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: as this will identify in an at a glance fashion what training the entire staff team have covered. It would also usefully highlight the gaps where staff need to undertake further training. This is a useful management tool and should assist greatly with ensuring that all staff are sufficiently well trained to meet the needs of the residents. Training for staff has included Fire prevention POVA 1st Aid Health and Safety Manual Handling Infection control Medication Food hygiene Additional training for staff is also provided that helps to expand the scope and range of the existing in house training packages and is a useful addition to the staff training package. This includes important key areas for staff skills and knowledge including: Communication skills Keyworking Empowering service users Health and safety. Individual service planning. The Manager is reminded that all core training should be refreshed every 3 years and that all staff should complete the core training areas. Standard 36 From discussions with the Manager and from interviews with 2 staff it is clear that at present staff receive ongoing supervision and support in the work they undertake and a supervision record is maintained that is signed by both parties. However the record made of key areas of discussion or of all the decisions and agreements made falls short of what is required. The supervision notes we inspected did not contain enough detail to be a useful record either for the Manager or for the supervisee. Areas of discussion have been recorded briefly however it is recommended that these records could be considerably improved by being more detailed to include all the issues discussed and that any agreed actions are included in the records. The Manager told us that staff all receive a copy of their supervision notes. This was confirmed by those members of staff who were interviewed as a part of the inspection. It is also recommended to the Manager that the discussions had in staff supervision are expanded to include discussion on specific residents issues and the key working process, monthly reports on progress being made by residents and key workers with care plan objectives. The Manager agreed that there is work to be done in improving the quality of staff supervision in the home. Annual appraisals need to be carried out and copies held on file. Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: This will mean that all the key and important areas for the review and monitoring of the work being done in the home to meet the needs of both the residents and the staff groups will then be properly met. Care Homes for Adults (18-65 years) Page 29 of 37 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. Standards 37, 39 & 42. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users can be confident that they benefit from a well run home. With the developing quality assurance system they may be confident that their views underpin monitoring and review of the homes developments. Service users may also be confident that their rights and best interests are safeguarded by the homes record keeping policies and procedures. Evidence: Standard 37 The Manager has 8 years overall experience of management experience at 23, Elmers End Road. He holds the Registered Managers Award at NVQ level 4 and a Diploma in Management. The residents spoken to by us felt that the home is being satisfactorily run and Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: evidence seen supports this view. The homes records and administration systems were seen to be in reasonable order. Interviews with staff reflected a positive and caring approach towards the residents. Residents can therefore be assured that they are benefiting from a well run home although improvements need to be achieved in the needs assessment, risk assessment and care planning areas of the work. Standard 39 We spoke with the Manager about the homes quality assurance programme. He told us that the central headquarters (HQ) organisation of Leonard Cheshire carry out quality assurance surveys with the service users. They also undertake internal audits and together with Section 37 visits this constitutes the homes process for quality assurance of services being provided at 23, Elmers End Road. Some further discussion was had with the Manager as to what other elements might be usefully included in order to ensure a complete approach to developing quality assurance processes. Some suggestions were: Questionnaires for relatives and referring professionals seeking their feedback on different aspects of the service. For instance professionals who have referred people to Elmers End Road could be asked about the effectiveness of the service in meeting the care plan objectives. Relatives and families could also be asked for their views on different elements of the service and how their relative is being served by it. A review of any accidents that have occurred. Issues raised by residents at their meetings. Issues raised by staff at staff meetings. A summary and analysis of the key points arising from these areas mentioned above could then be used to inform an annual development plan for the home. Different areas or themes could be targeted on an annual basis that over a longer period would inform all the key areas of service provision. It is required that the Manager ensures the homes quality assurance process be fully developed over the next year as discussed. Standard 42 We were shown information to do with relevant Health and Safety legislation. Policies and procedures were also seen for Health and Safety, risk assessment, moving and handling and fire. A fire risk assessment had been carried out in 2009 that identified a number of actions. The Manager said that these actions had been met but thought that a new fire Care Homes for Adults (18-65 years) Page 31 of 37 Evidence: risk assessment could be usefully carried out in 2010. This is supported and should be carried out as advised. Up to date and satisfactory pass certificates were seen for: Boiler & Gas 14.7.09 Electrical installation 27.2.06 Portable electrical appliances December 2009 Fire alarms 13.5.10 Fire equipment 11.09 Emergency lights 7.12.09 A water and legionnaires test was last carried out 28.8.09. Records were seen that confirmed regular tests had been carried out for the: Fire alarm regularly, last record seen 13.5.10 Accident records were checked. They had been completed appropriately however Regulation 37 notices had not been sent out as required. A visit from the Environmental Health Officer in November 2008 made a very positive report on conditions at Elmers End Road with no requirements or recommendations. At the time of this inspection no fire doors were seen to be wedged. Generally the building appeared to be secure. All of this means that the welfare, safety and health of the residents are being promoted and respected. Care Homes for Adults (18-65 years) Page 32 of 37 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 33 of 37 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 2 14 It is a requirement that the 01/08/2010 Manager ensures that a full and comprehensive needs assessment is carried out for each of the 5 residents. This should be done in partnership with each of the residents and where appropriate their families or representatives such as the Care Managers from the Local Authority. The needs assessment should form the basis for the care plans. The needs assessments should be reviewed every 6 months or earlier if the residents needs change sooner. In order to meet the NMS. 2 6 14 It is required that the 01/08/2010 Manager ensures that all residents care plans are reviewed at least every 6 months (or earlier if their needs change) together with the resident and other key Page 34 of 37 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 parties. In order to meet the NMS. 3 9 14 It is required that the Manager ensures that all residents have an individualised risk assessment that is linked to the needs assessment and care planning process. In order to meet the NMS. 4 20 13 It is a requirement that the Manager ensures that all residents Medical Administration Record sheets are completed appropriately and that staff receive up to date training (from an external and appropriately authorised trainer) on the safe administration of medicines within the home. In order to meet the NMS. 5 39 10 It is required that the 01/08/2010 Manager ensures the homes quality assurance process be fully developed over the next year as discussed. In order to meet the NMS. 01/07/2010 01/08/2010 Care Homes for Adults (18-65 years) Page 35 of 37 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 We recommend that there should be a single care plan format that is used for all the residents and that covers both health and social care needs. It is recommended that at each care plan review the care objectives are considered individually and reported on at the review with minutes provided that cover the discussion and progress made. It is recommended that the Manager establishes in the residents files a section where visits to healthcare professionals are logged. This should identify the reason for the visit and the outcome of the visit. It is recommended that the Manager ensures that all staff receive POVA training from an outside and recognised trainer at least once every 3 years. It is recommended that the Manager puts in place a maintenance book that identifies works needed to be done, this should help ensure that ongoing maintenance is targeted and that a backlog does not occur as it had done by the last inspection. It is recommended that the Manager ensures that all CRB checks be renewed every 3 years. It is recommended that the Manager draws up a single training matrix for the whole staff group as this will identify in an at a glance fashion what training the entire staff team have covered. It is recommended that the supervision records should be improved by being more detailed to include all the issues discussed and that any agreed actions are included in the records. It is recommended to the Manager that the discussions had in staff supervision are expanded to include discussion on specific residents issues and the key working process, monthly reports on progress being made by residents and key workers with care plan objectives. 2 6 3 19 4 23 5 24 6 7 34 35 8 36 9 36 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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