Care Home: Esplanade House

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What the care home does well The people who live at Esplanade House all appeared happy and relaxed. Both comment cards received from external professionals were positive about the home, the registered manager and staff. Interactions observed between people who live at the home and care staff and the registered manager were warm and positive with a team of care staff having a good knowledge of everyone and their individual needs. The home provides a range of in-house and community activities. These provide leisure and social opportunities that people enjoy. A holiday is being planned for later in the year. People are provided with choice about most aspects of their lives. The people who live at Esplanade House stated they were happy, one adding in their comment card `I am happy the way it is and I like living here`. Records viewed were generally well maintained and stored appropriately to ensure the confidentiality of information. Care staff are provided in sufficient numbers to meet people`s needs and the home has good recruitment procedures. What has improved since the last inspection? This was the first inspection since the service was registered in January 2009. What the care home could do better: Five requirements are made following this inspection. Some sections of care plans had not been updated for up to four years going back to November 2005. This places people at risk that their needs will not be met. The registered persons must ensure that care plans accurately reflect all a person`s current needs. Reviews of care plans must cover all parts of the care plan so that people`s changing needs are identified and responded to. Some risk assessments were in place however not all activities that people take part in had been risk assessed and the one person who requires a hoist did not have a moving and handling risk assessment or management guidelines. Risk assessments are necessary to ensure that risks are appropriately managed and people are not placed at unnecessary risk. The registered persons must ensure that full risk assessments are in place and that these are kept under review. The registered persons must ensure that there are guidelines for when staff should administer `as required` medication. This will ensure that people receive medication when they need it. The registered persons must ensure that all staff have completed all mandatory and service specific training to meet the needs of the people who live at the home. The responsible person must be able to evidence that this training has occurred. This is to ensure that staff have the necessary training to ensure that people`s needs are met and they are safe. The registered persons must ensure that a visit to the home is undertaken unannounced on a monthly basis and a report provided to the registered manager. This is to ensure that the provider can monitor the quality of the service provided and ensure that people are safe. There are some additional areas that the home could improve identified in the relevant sections of the report. Key inspection report Care homes for adults (18-65 years) Name: Address: Esplanade House 19-20 The Strand Ryde Isle Of Wight PO331JE     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: Janet Ktomi     Date: 2 2 0 6 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 35 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 35 Information about the care home Name of care home: Address: Esplanade House 19-20 The Strand Ryde Isle Of Wight PO331JE 01983616683 01983616683 esplanade1@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): First For Care Ltd Name of registered manager (if applicable) Mr John Powe care home 12 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 12. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Esplanade House is registered to provide care and accommodation for up to twelve people who have a learning disability. The home is located in a residential area close to the seafront at Ryde with easy walking distance to local public transport and the town centre shops of Ryde. The home is located on several floors and access to the home is via steps. Therefore people must be mobile, the home is not suitable for wheelchair users. All bedrooms are for Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 0 Brief description of the care home single occupancy many with ensuite facilities and those facing the sea having views over the Solent to Portsmouth. Communal rooms are located on the ground floor having a lounge and kitchen dining room. Appropriate bathing facilities are provided. The home is owned by First for care Ltd and managed by registered manager Mr Powe. Fees are individually determined based on the assessed needs of the person. Care Homes for Adults (18-65 years) Page 5 of 35 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: This report contains information gained prior to and during a visit to the home undertaken on the 22nd June 2009. All core standards and some additional standards were assessed. This was the first inspection of the home that was registered in January 2009 by the current provider. The home has been rated as providing for people who live there. The visit to the home was undertaken by one inspector and lasted approximately seven hours commencing at 10 am and being completed at 5 p.m The inspector was able to spend time with the registered manager and staff on duty and was provided with free access to all communal areas of the home, documentation requested and people who live at the home. Information from the Annual Quality Assurance Assessment (AQAA) completed by the registered manager and surveys Care Homes for Adults (18-65 years) Page 6 of 35 onsidered During the visit to the home the inspector was able to meet with and talk to people who live at the home. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Five requirements are made following this inspection. Some sections of care plans had not been updated for up to four years going back to November 2005. This places people at risk that their needs will not be met. The registered persons must ensure that care plans accurately reflect all a persons current needs. Reviews of care plans must cover all parts of the care plan so that peoples changing needs are identified and responded to. Some risk assessments were in place however not all activities that people take part in had been risk assessed and the one person who requires a hoist did not have a moving and handling risk assessment or management guidelines. Risk assessments are necessary to ensure that risks are appropriately managed and people are not placed at unnecessary risk. The registered persons must ensure that full risk assessments are in place and that these are kept under review. The registered persons must ensure that there are guidelines for when staff should administer as required medication. This will ensure that people receive medication when they need it. The registered persons must ensure that all staff have completed all mandatory and service specific training to meet the needs of the people who live at the home. The responsible person must be able to evidence that this training has occurred. This is to ensure that staff have the necessary training to ensure that peoples needs are met and they are safe. The registered persons must ensure that a visit to the home is undertaken unannounced on a monthly basis and a report provided to the registered manager. This Care Homes for Adults (18-65 years) Page 8 of 35 is to ensure that the provider can monitor the quality of the service provided and ensure that people are safe. There are some additional areas that the home could improve identified in the relevant sections of the report. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 35 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 35 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. The home would only admit people whose needs could be met at the home and who were compatible with the people already living there. Evidence: The inspector discussed the homes admission procedure with the registered manager and viewed one completed pre-admission assessment. The inspector also spoke with care staff and a person who lives at the home about new service users and the admission process. Information from two comment cards from care managers is also considered. None of the people living at the home are self funding. The inspector observed copies of contracts provided to their funding authorities. The fees for the home vary depending on the level of a persons assessed needs. Some people receive additional 1-1 support. The inspector also viewed the homes service users guide and statement of purpose. Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: Care staff confirmed that they had received enough information about new people moving into the home. The registered manager stated that consideration was given as to compatibility with existing people when considering whether to offer a home to a new person. One person has been admitted since the current provider purchased the home in January 2009. The registered manager explained the homes admission procedures which was also described in the homes AQAA. The pre-admission assessment for the new person was viewed. The registered manager had visited the person and completed a comprehensive assessment of their needs. Information had also been gained from professionals involved in their care including care managers, community nurses and the persons previous residential home. Copies of care manager assessment were also seen. The inspector spoke with people who lived at the home and they confirmed that the person recently admitted had visited the home prior to moving in, additionally many of the people knew the person from various social and leisure activities and clubs they attend. Comment cards were received from two care manages who stated that the homes assessment arrangements ensure that accurate information is gathered to plan the correct service for people. Information gained during assessment had been used to formulate care/support plans. The person had only been living at the home for a few weeks and the registered manager stated that a review would be held after one month. Information in the care plan and daily records would indicate that the person was settling into the home and that their needs were being met. Care Homes for Adults (18-65 years) Page 12 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have care plans however some of the information on these has not been updated for a number of years and therefore does not meet peoples current needs. Some risk assessments are in place however these are not present for all risks placing people at harm. Moving and handling guidelines are not in place putting the person at risk of not being moved safely. People are encouraged to participate in the home and to make decisions about their lives. Evidence: Three care plans were viewed. Risk assessments and the ways in which risks should be managed were seen in care plans. The inspector spoke with staff and the people who live at the home about care plans. The inspector also discussed how decisions are made and observed how people who live at the home are encouraged and supported to be active and participate in the home. Information from comment cards and the homes AQAA are also considered. The AQAA stated that the home uses a computerized care planning system which was Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: viewed with the registered manager during the inspection visit. Care staff were observed inputting information at the end of their shifts and stated that the system was easy to use. Care plans contained information about health care needs and risk assessments and management plans. The home uses a key worker system. Although care plans stated that they had been reviewed, in one instance by the registered manager in February 2009, parts of the care plan contained information that had not been updated for several years. One plan viewed was for a person whose needs had changed considerably, however their likes and dislikes and social and leisure interests had not been updated since November 2005. The registered manager agreed that these were no longer reflective of the persons care needs or interests. The person had a risk assessment for making tea and coffee however they were no longer able to mobilize independently and this risk assessment was no longer relevant. The person now required moving and handling via a hoist and there was no risk assessment or moving and handling guidelines for this person. Other care plans viewed also contained sections, primarily those relating to social and leisure interest, likes and dislikes and spirituality that had not been updated for a similar number of years as the one detailed above. Risk assessments were present in other care plans viewed however these did not cover all activities that the person might participate in within the home. No risk assessments were seen for service users helping in the kitchen or with cleaning their bedrooms and the use of cleaning products. Most people are independently mobile and one risk assessment was seen for a person who had moving and handling needs in relation to getting up and down the steps leading to the home. The failure to ensure that care plans contained accurate and up to date information and risk assessments relevant to the persons needs places people at risk of not having their care needs met. A requirement is made that care plans must be reviewed and updated so that they reflect peoples current needs and that risk assessments must be in place for all activities that people may participate in. Four of the people who live at the home completed comment cards and two stated always and two usually they are able to make decisions about what they do each day. Discussions with people during the inspection visit indicated that they were included in discussions and decisions about the home. People confirmed that they are involved in cooking and kitchen duties including washing up. People were observed making themselves hot and cold drinks and information about menu planning was seen in the minutes of service user meetings. People living at the home vary in the level of support they require in respect of their Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: personal finances. The home does not act as appointee for anyone with either a family member or the local social services receiving officer fulfilling this role. The registered manager explained the homes procedures for supporting people with smaller amounts of personal money. . The records for and indicated appropriate spending on personal Care Homes for Adults (18-65 years) Page 15 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to live the lifestyle they choose however the failure to update care plans may mean that activities do not reflect peoples current interests. There are not risk assessments for some activities to ensure that people are able to participate safely. Evidence: Information in care plans, comment cards and other records viewed is considered along with discussions held during the inspection with care staff, the registered manager and with people who live at the home. As identified in the previous outcome group care plans require updating to accurately reflect the current information relating to people living at the home. Sections of the care plan relating to likes and dislikes, spirituality and social and leisure had not been reviewed and updated for up to four years going back to November 2005. Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: Everybody has an individual weekly programme of activities that includes a variety of day services, college and leisure activities, intended to help develop and maintain life skills and provides opportunities for socialization away from the home. A list of regular weekly activities was seen on the office wall. Daily records contained records of what activities, either in the home or in the community, people had participated in. Discussions with care staff and people who live at the home confirmed that they enjoy these activities and had been involved in the development of their individual activity plans. During the unannounced visit by the inspector to the home most people were not at home and arrived later in the afternoon. People had been out at day services or on individual activities with care staff. Comment cards were returned from four service users who said they could do what they wanted during the day, evening and at weekends. The manager stated in the homes AQAA that he felt the home had improved in that more individual activities are now provided. An additional comment on a staff comment card stated that the home could do better by having more staff in the evenings so that residents can go out more and another that the home does well with house activities, outings and holidays. The registered manager showed the inspector the holiday information for a planned holiday for later in the year. The decision as to whether to go on holiday has been individual with some people choosing not to go away this year. The home has its own transport with all costs relating to this being covered by the home. The registered manager stated that staff costs relating to outings such as refreshments are covered by the home with service users only paying for themselves. Within their bedrooms people have a variety of home entertainment equipment such as TVs and music systems. During the inspection visit people were noted to be able to spend their time as they wished, most moving about the home independently. The home is located in a residential area with easy access to local services, public transport and leisure amenities. Staffing levels are sufficient to enable people to access community activities. Whilst viewing financial records the inspector saw evidence of money spent on outings and personal items. People are involved in assisting care staff with food shopping in the local shops, use local leisure centres, beach and use local health facilities. The home has a good sized rear garden with BBQs and other social events planned for the summer. Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: The homes routines tend to be organised around the people who live there with meal times flexible to meet peoples individual preferences and routines. Discussions with the people who live at the home confirmed that all had done different activities on the day of the inspection visit. As well as external activities people are encourage to undertake domestic tasks and the home has a range of craft and activities equipment which was shown to the inspector. The home does not employ separate catering staff so care staff take turns to cook each day. An additional comment from a care staff comment card stated that there needed to be stricter conduct of hygiene in the kitchen. Staff training records showed that not all staff had completed food hygiene courses or updates. People who live at the home are encouraged to participate in food preparation although risk assessments were not in place in care plans viewed for this activity. Some service users prepare their own meals on an individual basis. Service user meeting minutes showed that people who live at the home have been involved in discussions about menus. Records showed that meals are varied and that alternatives are available. People stated that they liked the meals at the home. The home has a good sized kitchen/dining room where most people were observed to be eating their evening meal when the inspector was leaving the home. Care Homes for Adults (18-65 years) Page 18 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the care and support including health care they require however the home must ensure that risk assessments are in place for all people who require assistance with moving and handling so they are safe. Peoples dignity is generally protected. The home generally has safe procedures in respect of medication Although some records do not give clear guidance to make sure that people receive their medicines safely. Evidence: Information about personal and health care needs and that provided was viewed in care plans and daily records. Comment cards and discussions were held with the people who live at the home and staff. Comment cards from care managers are also considered. The arrangements for the storage and administration of medication were viewed with any related records. The registered manager stated in the homes AQAA that there has been alot of involvement from the local health team in respect of two of the people who live at the home and that all staff have undertaken manual handling and many have attended training to manage challenging behavior. Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: Two care managers completed comment cards both stating that usually social and health care needs properly monitored and reviewed and the care service acts to meet peoples health care needs. Care managers raised no issues about health care or medication and confirmed that privacy and dignity are usually respected. An additional comment being that the service seeks advice and acts on recommendations and the other that some staff do not always appear to understand or follow guidelines in place for specific service users. The home operates a key worker system. Male and female staff are employed so choice would be available if support were required. The home has appropriate bathing facilities with some rooms having en suite facilities. Care staff stated that the bathing facilities were appropriate for the people living at the home. People living at the home are registered with local GPs and support is provided from care staff to make and attend appointments. Care plans contained records that indicated that people are able to see chiropodists, Dentists, opticians and doctors when required. The home also has involvement form community learning disability nurses and twice daily visits from district nurses to met one persons health needs. At the time of this unannounced inspection all medication was found to be stored correctly. The medication administration records were viewed and these had been fully completed. Medication coming into the home is recorded on the Medication Administration Records. The home uses a predispensed system for tablets with liquid medication dispensed at the time of administration. Some people are prescribed medication to be given on an as required basis. Some of the people living at the home would be able to request this when needed however others would be unable to request medication. The home did not have guidelines for care staff as to when as required medication should be given. The inspector noted that the medication administration records showed that an additional dose of an inhaler had been given when this was only prescribed twice daily with no as required option. There was no record available either on the Medication Administration Records or elsewhere as to why this had been given. The registered manager stated that he would investigate this. The home has some medications that must be kept at cooler temperatures in a fridge. The home has been recording the fridge temperatures on a daily basis however this is only the temperature when recorded and the home does not have a maximum/minimum thermometer to record the highest and lowest temperatures of the fridge. No specific concerns about privacy were identified during the inspection however it Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: was noted that one person was sitting in the lounge with a pair of socks on their hands. This was discussed with the registered manager who stated that it was to prevent the person scratching themselves. The use of socks in this way does not promote the dignity of an adult. The registered manager stated that he would investigate alternatives to promote the dignity of the person. Care Homes for Adults (18-65 years) Page 21 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home are able to complain and should be protected from abuse. Evidence: Information in comment cards, from discussions with staff and people who live at the home and records viewed are considered. The homes service users guide contains information as to the homes complaints procedure. The registered manager stated in the AQAA that no complaints had been received since the home was purchased by the current provider. During the inspection visit this was clarified and the registered manager stated that since completing the AQAA the home received one complaint and this was discussed. The registered manager has investigated the complaint and stated that he intends to write to the complainant stating the outcome of the investigation. The home has regular service user meetings which also provide an opportunity for people who live at the home to raise issues. The minutes of these were seen and people did appear able to express their views based on the minutes seen. The inspector was able to talk with people who live at the home who stated that if they had any concerns or complaints they would raise these with the staff or manager. Two care managers completed comment cards and both stated that the home responds to concerns that have been raised. Comment cards were received from four Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: people who live at the home and all stated that they knew who to speak to if they were unhappy and that they knew how to make a complaint. Ten staff completed comment cards and all stated that they knew what to do if someone had a concern about the home. Throughout the inspectors visit people who live at the home were seen responding verbally and non-verbally to staff, making requests and appeared comfortable around staff. Staff have a good understanding of the people who live at the home and should be in a position to realise if people were unhappy. Staff spoken with were aware of the procedure they should follow should a person or their representative make a complaint. The home has a safeguarding policy and the registered manager was aware of the local procedures for safeguarding. Staff spoken with during the inspection were aware of the adult protection policy and procedures and clear about their responsibilities to report issues of concern without delay. The manager and staff confirmed that they have received safeguarding training. No concerns in respect of safeguarding were raised in any comment cards received from people who live at the home, staff, or care managers. A senior person at the home has completed safeguarding train the trainer and stated that update safeguarding training would be provided to staff. The home has reported safeguarding concerns to the local safeguarding team. These have been around the behaviour of a person who previously lived at the home. Staff have attended training to help them manage people who may present challenging behaviour. Information received at the commission indicates that the home has acted appropriately when peoples behaviour has placed others at risk and has sought advice and guidance from external social and health care professionals. The homes recruitment procedures and those relating to the management of service users personal finances should ensure people are safe in these respects. The home has however placed people at risk in that care plans have not been fully updated and all risk assessments were not in place. Care Homes for Adults (18-65 years) Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable homely house suitable for their individual and collective needs. Evidence: The inspector viewed the communal areas of the home and some bedrooms. Information in the AQAA and registration report completed in 2009 are also considered. People and staff talked about the home and comments in comment cards received are also considered. The home is located in a property which comprises two four storey detached houses converted to a single large home and situated on the main Esplanade in Ryde, close to the beach. It offers views of local beaches, the Solent and the mainland from windows at the rear. It is within half a mile of the main shopping area of Ryde town, main bus station and passenger ferries/hovercraft to the mainland. All rooms are for single occupancy and have been furnished and decorated to peoples individual tastes. Some bedrooms have en suite facilities. Bathrooms and WC are located around the home. The home has the necessary equipment to assist people with their mobility needs. Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: The home has a communal lounge and kitchen/dining room. The home has a large garden at the rear and at the front there is room for off road parking for approximately six cars. There is restricted parking in the roads around the home and a pay and display car park on the sea front. The home appeared to be safe, well maintained and at the time of the unannounced inspection clean and free from any unpleasant odours. The home employs a cleaner weekdays for the communal areas and care staff undertake other cleaning tasks and encourage the people who live at the home to participate. The home meets peoples needs in a homely and domestic way. Access to the home is via steps from the front of the home and most bedrooms are located either up or down stairs. The home is not suitable for people with very restricted mobility who are unable to negotiate steps or stairs. The homes laundry is situated in a small external room with access via the front steps or via the basement. The laundry is appropriate for the size of the home. Care staff confirmed that they have adequate supplies of disposable gloves, aprons and any other infection control equipment required. Substances hazardous to health and items hazardous to health were stored securely although some toiletries were located in a communal bathroom on the ground floor. Certificates were viewed for servicing of equipment in the home. The records of the checks weekly checks of the homes fire detection equipment were viewed and evidenced that these had not been undertaken every week. Care Homes for Adults (18-65 years) Page 25 of 35 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. People are supported by a consistent staff team, provided in sufficient numbers. Staff do not have all the necessary training to ensure that they are able to meet the needs of the people who live at the home. Staff have not all completed manual handling and food hygiene training putting people at risk of harm. Evidence: The inspector viewed information in staff files about recruitment, staff training and supervision. Information from comment cards from people who live at the home, staff and external professionals is also considered. Observations and discussions with people, the registered manager and staff during the inspection are also included. Interactions observed during the visit indicated that people who live a the home and staff have a warm friendly relationship with people feeling able to express themselves. Comment cards received from the people who live at the home stated that staff treat them well and act on what they say. An additional comment on a service user comment card being most staff are very approachable and a few could do with being a bit better. Ten comment cards were completed by care staff, all were positive confirming that training is provided, that there are generally enough staff to meet peoples needs and Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: that communication between staff is good. Additional comments on staff comment cards stated that staff work well as a team and that staff are very happy working at Esplanade House and believe they provide a good service. Two care managers completed comment cards and stated that staff usually have the necessary skills and experience to met peoples health and social care needs. Some people living at the home are funded for one to one care at specific times and days. Duty rotas seen correlated to the number of staff on duty at the time of the inspection. Staff spoken with felt that the staffing levels and arrangements were appropriate to meet the peoples needs and that activities relating to social and leisure are possible during the evenings and weekends. Evidence in peoples files confirmed that people are able to enjoy a variety of external activities with the current staffing levels. People who live at the home confirmed to the inspector and on comment cards that they are able to do what they want at evenings and weekends. The home has not needed to use agency staff as staff cover each others annual leave and sickness. The registered manager described the homes recruitment procedures and records for two staff recorded since the home was purchased by the current provider were viewed. The procedures in place and records seen would indicate that a thorough recruitment and checking process is in place that should ensure that unsuitable people are not employed at the home. Discussions with the registered manager and people who live at the home showed that people who live at the home are not involved in the recruitment of new staff although as interviews are held at the home people would have the opportunity to meet applicants if they were at home at the time of interviews. Ten staff returned comment cards and all confirmed that all pre-employment checks had been carried out before commencing employment. They all also confirmed they had received an induction which covered everything they needed to know the job when they started. Discussions with care staff confirmed that new staff work supernumerary for the first few shifts until they feel confident. The registered manager was unable to evidence that care staff had completed an induction as care staff keep the induction books once completed. The registered manager stated that he would in future photocopy induction books and keep with staff files as evidence of induction. The registered manager stated that seventeen of the twenty-eight care staff have at least an NVQ level 2 in care and two further care staff are undertaking this qualification at level 2. Three staff who already have an NVQ level 2 are now doing a Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: level 3 qualification. Care staff confirmed to the inspector that they have undertaken mandatory and service specific training. Comment cards returned by care staff stated that they received all the necessary training and that they felt they had the necessary skills and experience to meet peoples needs. The inspector viewed the homes training matrix and this showed that not all staff have completed all mandatory training including food hygiene (staff prepare meals for service users) and manual handling. There was also no evidence that staff had undertaken specific training to meet the health needs of people living at the home such as PEG feeding, diabetes and epilepsy. The inspector was informed that the local district nurse had undertaken this training but hat no certificates had been provided. The registered manager is to consider how training that has been undertaken can be evidenced however all staff must have the necessary training to meet the needs of the people who live at the home and the home must be able to evidence this. Care staff confirmed that they felt well supervised by the registered manager and that they regularly had opportunities for supervision. Staff comment cards also identified that staff meetings are held and minutes were seen during the inspection visit. Care Homes for Adults (18-65 years) Page 28 of 35 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. There has been a failure to provide effective management. This means that care plans and risk assessments are not always in place to support people and ensure all their needs are met. There has been a failure to ensure full safe practice in relation to medication and to identify when peoples dignity is comprised and staff have not undertaken all the necessary training to ensure that people are safe. The management of the home does not currently ensure that the service fully protects the best interests and well being of the people living there and regulation 26 reports have not always been completed to monitor the quality of the service and support good outcomes for people. Evidence: Information form the homes AQAA, comment cards received, records viewed and discussions with the registered manager, staff and people who live at the home are considered. Relevant information from previous outcome groups is also included. The homes registered manager confirmed that he has an NVQ level 4 in Care and the Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: Registered Managers Award. The manager also stated that he has attended a range of other relevant training. The manager was registered as the homes manager in October 2008 when it was owned by the previous provider. The manager has many years experience managing residential services and working with people with learning disabilities. Two care managers completed comment cards and one added communication with the manager is good and he is always keen to meet to resolve and discuss concerns. Additional comments were also included on some service users comment cards including I am happy the way the home is and I like living here. Service users did not identify anything the home could do better and responded to the question what does the home do well lots of stuff. Comment cards were received from ten care staff. These were positive about the management of the home management are very approachable, residents seem to be fully aware that they may come and talk to staff and management at any time and they take full advantage of this. Also residents comments and opinions are taken into consideration and acted upon. Staff comment cards also confirmed that service user and staff meetings occur. Minutes of these were viewed during the inspection visit. The most recent service users meeting having been held in January 2009. During the inspection visit service users were seen making suggestions and expressing opinions to staff and the manager. The registered manager stated that he sends a weekly report to the provider and these were viewed. The provider should visit the home unannounced at least once a month and provide a report of the visit to the registered manager. These are called Regulation 26 visits and reports. The registered manager stated that the provider visits the home on a monthly basis however only one regulation 26 report completed on the 21st May 2009 was present. The registered manager stated that he is aware when the provider is due to visit the home. The provider must ensure that visits and reports about the home are undertaken as stipulated under Regulation 26. Five requirements have been made concerning care plans, risk assessments, medication, staff training and the monitoring of the service by the responsible individual. There has also been a failure to ensure that peoples dignity is fully protected as evidenced by a person wearing socks on their hands in a communal area and that staff did not appear to consider that this was inappropriate. Throughout the inspection visit a number of records were viewed. These have been identified in the relevant section of this report. Most but not all records had been well maintained. Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: Generally the homes environment is safe for people who live there however the inspector noted in a ground floor bathroom which was accessible to all that toiletries and some old toothbrushes had been left where people could get them. The toiletries present a COSHH risk if ingested and should people use the toothbrushes then an infection risk is also present. The registered manager has been unaware re these items however staff appeared to be aware of whose they were and that they were left in the bathroom. The registered manager agreed to arrange for a cupboard to be provided to secure the items. One person has also been placed at risk due to there being no manual handling assessment and plan for the use of a hoist. Risk assessments were also not in place for all activities that people undertaken. Other people have been placed at risk as all staff have not had food hygiene training and the training matrix identified that not all staff had undertaken all mandatory training. The weekly checks of the fire detection equipment had not occurred every week. Care Homes for Adults (18-65 years) Page 31 of 35 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 32 of 35 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 6 15 The responsible person must 01/08/2009 ensure that care plans acurately reflect all a persons current needs. Reviews of care plans must cover all parts of the care plan. So that peoples needs will be met and they are not placed at risk. 2 9 13 The responsible person must 01/08/2009 ensure that full risk assessments are inplace and that these are kept under review. So that risks are appropraitley managed and people are not placed at unecessary risk. 3 20 13 The responsible person must 01/08/2009 ensure that there are guidelines for when staff should administer as required medication. Care Homes for Adults (18-65 years) Page 33 of 35 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 So that people are safe and receive medication when they need it. 4 35 18 The responsible person must 01/09/2009 ensure that all staff have completed all mandatory and service specific training to meet the needs of the people who live at the home. The responsible person must be able to evidence that this training has occurred. So that staff have the necessary training to ensure that peoples needs are met and they are safe. 5 39 26 The responsible person must 01/08/2009 ensure that a visit to the home is undertaken unannounced on a monthly basis and a report provided to the registered manager. So that the provider can monitor the quality of the service provided and ensure that people are safe. 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 34 of 35 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. 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