Care Home: Fair Bungalows Nursing Home

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What the care home does well The home has information it can give people before they move in.Each person has a plan to tell staff what help they need. Their plans are kept up to dateStaff support people to do activities they like. There is a minibus to take people on trips and to their activitiesThe home makes sure people stay healthy and get the help and treatments they needPeople`s complaints are taken seriously and acted uponStaff are trained about protecting people from abuse.Fair Bungalows is a clean, comfortable and homely place to liveThere are enough staff to make sure people get the support they need What has improved since the last inspection? Information about people is kept more secureStaff and the manager are making sure that people get the treatments they needThere is a safer system for helping people with their medicinesSome hazards around the home have been made safe.The manager is working well with other people to make improvements in the home What the care home could do better: All staff need to be aware of important things in people`s plansAlthough the help with medicines is much better, a bit more improvement is needed.Some staff need to be reminded about who to tell if someone is being harmedRecords about staff need to be properly kept so that they can be checked by inspectorsThe manager needs to be registered with the Care Quality Commission. Key inspection report Care homes for adults (18-65 years) Name: Address: Fair Bungalows Nursing Home Franklyn Drive Cowick Lane St Thomas Exeter Devon EX2 9HS 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: Graham Thomas Date: 0 3 1 2 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 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 © (2010) 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 37 Information about the care home Name of care home: Address: Fair Bungalows Nursing Home Franklyn Drive Cowick Lane St Thomas Exeter Devon EX2 9HS 01392438430 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Fair.bungalows@guinness.org.uk Guinness Care and Support Ltd care home 7 Number of places (if applicable): Under 65 Over 65 7 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is 7. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection 1 2 0 6 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 37 A bit about the care home Fair Bungalows gives nursing support for up to seven people with a learning disability. People may also have a physical disability or difficulties with seeing or hearing. There are two bungalows. Three people live in Fair Winds and four in Fair Crest. The bungalows are Both bungalows have an adapted bathroom. There are gardens at the front and back. There is also a safe area in the back garden. Care Homes for Adults (18-65 years) Page 5 of 37 Care Homes for Adults (18-65 years) Page 6 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 Care Homes for Adults (18-65 years) Page 7 of 37 How we did our inspection: This is what the inspector did when they were at the care home Before we visited Fair Bungalows, the manager filled in a form to tell us about the home. We looked at our records about fair bungalows. This included records about a visit we made in October 2009 called a random inspection. Care Homes for Adults (18-65 years) Page 8 of 37 We visited Fair Bungalows and looked around we spoke with staff. While we were there we saw staff helping people. We looked at peoples plans and other records about them We also looked at records about staff and the running of the home Care Homes for Adults (18-65 years) Page 9 of 37 What the care home does well The home has information it can give people before they move in. Each person has a plan to tell staff what help they need. Their plans are kept up to date Care Homes for Adults (18-65 years) Page 10 of 37 Staff support people to do activities they like. There is a minibus to take people on trips and to their activities The home makes sure people stay healthy and get the help and treatments they need Peoples complaints are taken seriously and acted upon Care Homes for Adults (18-65 years) Page 11 of 37 Staff are trained about protecting people from abuse. Fair Bungalows is a clean, comfortable and homely place to live There are enough staff to make sure people get the support they need Care Homes for Adults (18-65 years) Page 12 of 37 What has got better from the last inspection Information about people is kept more secure Staff and the manager are making sure that people get the treatments they need There is a safer system for helping people with their medicines Care Homes for Adults (18-65 years) Page 13 of 37 Some hazards around the home have been made safe. The manager is working well with other people to make improvements in the home What the care home could do better Care Homes for Adults (18-65 years) Page 14 of 37 All staff need to be aware of important things in peoples plans Although the help with medicines is much better, a bit more improvement is needed. Some staff need to be reminded about who to tell if someone is being harmed Care Homes for Adults (18-65 years) Page 15 of 37 Records about staff need to be properly kept so that they can be checked by inspectors The manager needs to be registered with the Care Quality Commission. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 16 of 37 If you want to speak to the inspector please contact Graham Thomas CQC South West Citygate Gallowgate Newcastle upon Tyne NE1 4PA 03000 616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 17 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 18 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 1 and 2 There is sufficient information for people who are considering a placement in the home. Although no people have recently moved into the home, the manager is appropriately aware of the requirement to assess their needs before they move in. Evidence: At our last key inspection in June 2009, we recommended that the information for people considering moving into the home should be updated. In October 2009 we made a random inspection visit to the home and found that this had been done. The homes Statement of Purpose and Service Users Guide are available in large print format. Since our last key inspection in June 2009 there have been no new admissions to the home. However, in discussion the manager has demonstrated her awareness of the need to assess peoples needs thoroughly before they move into the home. Care Homes for Adults (18-65 years) Page 19 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 adequate 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 and 10 The way in which peoples individual needs and choices are identified and recorded has improved since our last inspection. However further improvement is needed to ensure that individual plans are well orgasnised and clear for carers. Evidence: When we made a key inspection visit to the home in June 2009, a number of shortfalls were identified concerning the storage of confidential information, the absence of risk assessments and the quality of care planning. When we visited in October 2009, we saw that records were stored in the homes office which was kept locked when not in use. Peoples assessments and plans were being updated. For example, the files we examined all contained health assessments and person-centred health action plans. In the files we examined, we saw that risk assessments had been updated. These included, for example, risk management protocols regarding best interests assessments and decision making in compliance with Mental Capacity Act. At this time the Manager told us about ongoing work with the local Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: Citizenship Team to develop person-centred plans. We saw an example of one such plan. Though this work was not yet complete, there was evidence at this stage that the home was working towards compliance with our requirements and recommendations. During this key inspection visit, we looked the care plans of all the people living in the home and paid particular attention to two. The plans continued to show evidence of the improvements we had seen at our last visit in October 2009. For example, we saw that the plans and risk assessments had recently been reviewed and updated and that there were records of regular monitoring such as nutrition and skin condition. The organisation of the plans needed further refinement as not all the key information was immediately evident. For example, in one plan we found an assessment by a Speech and Language Therapist which identified certain foods that posed a high risk of choking for one person. When we discussed these with staff, they appeared unaware of the particular risks. However, we watched the person being fed and saw that this was being done in accordance with their assessed need and the risk assessment. The manager subsequently told us that the information about risks for this person was available to staff in the kitchen area. Since our last key inspection staff have been trained in Total Communication. Staff we spoke with talked about how they were able to use this approach to communicate more effectively with people. This included, for instance, the use of objects of reference. These are objects familiar to the person such as care keys that they associate with particular activities like going for a drive. During this visit we saw staff offering people choices about what they wanted to eat, and activities they might want to do. In one persons file we saw that the Registered Provider was acting as a appointee for the person. Although this is not prohibited, it is not best practice and should be seen as a last resort where no other person or agency is able to take on the role. Care Homes for Adults (18-65 years) Page 21 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. Standards 12, 13, 15, 16 and 17 There is sufficient, flexible support for people to enjoy day-to-day activities and contact with people important to them. Meals and mealtimes are sufficiently flexible to meet peoples individual needs. Evidence: We looked at the homes records concerning activities and discussed these with the staff. The range of activities was similar to those available during our last visit. The activities timetable was seen in the office included, for example, reiki, music, rebound therapy, and horse riding. Some activities such as evening walks, shopping and trips to the pub, included people in the wider community. Care plans included details of the activities enjoyed by individuals. For example, one person was supported to attend horse riding twice per week , reiki, massage and bus trips (for which a bus pass had been obtained). The level of activity for this person had incresed since our last visit. Another person enjoyed music sessions and attended magic carpet, a sensory activity session. While we were visiting, a musical entertainer attended the home and we saw people going out in Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: the homes minibus for a planned activity. Staff responded flexibly to one persons needs and withdrew them from the activity when they showed signs of distress. We looked at how people are supported to maintain contact with people who are important to them. Records and photographs around the home showed that people living there were in regular contact with their families. Visiting arrangements appeared to be sufficiently flexible to support this contact and there was evidence that families have been actively involved in the life of the home. We heard for example, that since our last visit, a planned meeting with relatives had taken place. Access to the garden had previously been restricted by a lack of maintenance. At the time of this visit, the season and poor weather meant that external areas were not in use. However, we saw that the maintenance these areas of the home had improved. During our visit we saw that people were taking meals according to their individual needs and routines. We saw menus for four weeks which represented a varied and nutritious diet. No menus were available in an accessible format for people using the service though some specific communication aids had been developed for individuals. We saw one person receiving help eating breakfast. The person was receiving soft food in keeping with their individual need. The pace of feeding was unhurried and the specific aids identified in the persons plan were in use. Individual plans we examined showed evidence of nutritional screening and monitoring. One persons plan described a risk of weight loss. We saw weight records that showed attention to this persons dietary needs and an an increase their weight. Care Homes for Adults (18-65 years) Page 23 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. People living at Fair Bungalows are benefitting from improvements in the arrangements for health and personal care. Evidence: During this visit we saw that people were clean, well groomed and dressed in individual styles. Routines appeared flexible and were suited to each persons needs and preferences. At our Key inspection in June 2009, significant shortfalls were identified in this area. However, improvements were noted in our random inspection of the home in October 2009. For example, there had previously been no evidence of recommended Physiotherapy treatment regimes were being followed. When we visited in October we found specific written and pictorial guidance for staff in the persons plan and records of when the treatment had been applied. The recording and monitoring of this treatment was being followed up by key workers who had been allocated to each individual. During this visit, we found person-centred health plans in peoples files and saw that people had attended routine appointments such as annual health checks and had received more specialist treatments. Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: The home had worked closely with visiting healthcare specialists to bring about improvements. In one plan we saw evidence that the home had worked closely with local agencies to meet the persons complex needs. This had resulted in positive outcomes for the persons physical health, mood and behaviour. We saw evidence of these improvements in our own observations of the person who we had seen on previous visits to the home. We saw that there had been regular monitoring and recording of peoples weight skin condition and continence where this was required. These showed, for example, that action had been taken about one persons weight which had been below average. This had increased by 6 kilograms at the time of our visit. One persons file contained an assessment by a Speech and Language Therapist that listed foods that could present the person with a high risk of choking. Staff with whom we spoke were not apparently aware of this list. However, when we observed the person being assisted to eat, this was being done in accordance with the care plan and risk assessment. The Manager subsequently told us that the list was available in the kitchen for staff reference. Since our last key inspection, there has been a marked improvement in the homes administration of medicines. This was noted in our random inspection visit in October 2009. During this visit we found that the improvements had been largely sustained, though there were some shortfalls. Medicines are now stored in a dedicated medicines trolley chained to the office wall when not in use. There is also a separate secure storage cabinet for controlled drugs. Information was available for staff about allergies, specific medications and their purpose. Protocols were in place for the use of rescue medication used for prolonged epileptic seizures. Staff had also received training in the use of this medication. Guidance was available for staff regarding the administration of medicine with food. We examined the medicines administration records for two people and found that these were largely up to date and in good order. Prescribed skin creams were being signed for separately with a C for carer. These should be signed for with the persons signature so that a clear audit trail is available for the use of this treatment. We saw that one person was receiving paracetamol as required. There was no protocol in place as to the circumsatances in which this should be given. Such a perotocol is important so that all staff understand the exact circumstances under which the medicine is to be give and the maximum dosages that can be used. Care Homes for Adults (18-65 years) Page 25 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 and 23 There are robust systems in place to address any concerns and complaints raised by the representatives of people living at Fair Bungalows. The home has worked well with external agencies to address safeguarding concerns Evidence: At our last Key inspection we found that the homes complaints records were unavailable for inspection On this occasion we found that a complaints record was in place and that complaints were recorded together with the action taken and outcomes. At the time of this visit, an ongoing programme of training for staff in safeguarding vulnerable adults from abuse was in progress. The staff with whom we spoke were aware of their responsibilities in protecting people from abuse. Although they were not able to identify external agencies to whom they might report suspected or actual abuse, this information was available for staff Training regarding the Mental Capacity Act and deprivation of Liberty Safeguards had been arranged and there was some evidence in individual files of consideration of peoples mental capacity. Serious safeguarding concerns had been raised at the time of our last key inspection. The evidence from our Random inspection visit in October 2009 and this visit indicate that the manager and staff have worked co-operatively with other agencies to bring about Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: improvements to address the concerns raised. Care Homes for Adults (18-65 years) Page 27 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 and 30 The home is sufficiently comfortable, clean and sdafe to meet the needs of people living there. Evidence: The home comprises two bungalows which are connected by a corridor in which there is a nurses station and laundry. Each bungalow has individual bedrooms as well as its own kitchen and bathroom. The staff office is sited in one of the bungalows. When we looked around the home we saw that the standard of decoration had improved since our last key inspection. We also saw evidence of ongoing decorative work in one persons bedroom. Screws had been left protruding from the walls of this room while the work was taking place. This was drawn to the attention of the homes staff and these were removed immediately. A new flat screen television was being fitted in the lounge of one bungalow during our visit. We noticed that peoples own rooms contained their possessions and were decorated according to individual tastes. Communal lounges were comfortably furnished. Half glazed entrance doors to both bungalows which had presented a potential hazard had been removed. We saw that hot water to hand basins and baths had been regulated to prevent scalding. Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: Hot surfaces on radiators had been covered. Cupboards containing hot water tanks and exposed hot pipes had been fitted with locks since our last key inspection, removing a potential hazard. During this visit we noted that the kitchen doors were kept closed when the kitchen was not in use and that this hazard was better managed. Bathrooms contained baths adapted to the needs of people using the service. Storage arrangements for hazardous substances and other required materials had been improved since our last visit. Outside, the bungalows are surrounded by level gardens. Due to the season and poor weather, the outside areas were not in use at the time of our visit. However, we could see evidence of better maintenance of these areas to make them more accessible to people living in the home. We looked at the measures in place to control the potential spread of infections. during our visit we noted that the home was sufficiently clean throughout and there were no unpleasant odours. A cleaner was working in the home during our visit. At wash hand basins we saw that there was liquid soap and paper towels. We saw that staff wore aprons and gloves for personal care tasks and handling potentially infected materials. The laundry area has an impermeable floor and arrangements are in place for managing infected laundry. Care Homes for Adults (18-65 years) Page 29 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 and 35 People living in the home cannot be assured that staff recruitment procedures are robust enough to protect them from potential harm. There have been significant improvements in the provision of training for staff though further specific training is needed. Evidence: We looked at staffing arrangements for the home. Rotas showed that the usual staffing complement comprises the manager, a qualified nurse, three carers, a part-time cleaner and a driver. At night there are two waking staff on duty one of whom is a qualified nurse. Our observations during the inspection suggested that this staffing complement was sufficient to meet the care needs of people living in the home and support them to attend and participate in activities. Since our last key inspection, the manager has reduced the homes reliance on agency staff, thereby increasing the consistency of peoples care and support. The staff with whom we spoke were generally aware of peoples immediate care needs such as handling and communication though there were evident gaps in knowledge and understanding of the specific needs of people with a learning disability. We looked at recruitment procedures. The assistant manager told us that a staff member had been recruited about three months prior to our visit. The recruitment records for this Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: person had not been returned from the Providers head office. It was therefore not possible to check whether a robust recruitment procedure was in operation. This is poor practice as it is a legal requirement for such records to be available for inspection. This issue has arisen in previous inspections. Much recent work has been done to improve staff training. Our examination of staff files and training records showed that training had been organised to meet the most obvious shortfalls such as epilepsy awareness and the administration of rescue medication. We also confirmed training in health and safety subjects. This included, for example, topics such as food hygiene and safeguarding vulnerable adults from abuse. Further training specific to the particular needs of people with learning disabilities is recommended. Care Homes for Adults (18-65 years) Page 31 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. People living at fair bungalows have benefitted from a more stable and consistent managment arrangement and improvements to the service. However, the continued lack of a registered manager remains a cuase for concern. Evidence: Fair Bungalows does not have a manager registered with the Care Quality Commission and has not had a registered manager for a considerable time. The current manager is a Registered General Nurse who has previously worked in homes for older people run by the same provider. Although she has no specific training in learning disability she has many years nursing experience and has completed the Registered Managers Award. Since her recent appointment she has attended courses relevant to the needs of people living in the home such as epilepsy awareness, the administration of rescue medication and total communication. Since the managers appointment, she has worked well with other agencies to improve standards in the home. Our previous random inspection in October 2009 and this inspection have revealed that, whilst there remain issues to be addressed, there is an overall pattern of improvement. One external professional has remarked on the Care Homes for Adults (18-65 years) Page 32 of 37 Evidence: improvements for one person now that the management and staffing of the home have stabilised. We also saw comments from relatives in questionnaires sent by the home commenting on improvements in the service. We looked at the arrangements for maintaining the health and safety of people using the service and staff. As described in previous sections of this report training in health and safety topics has been updated and improved. This includes topics such as moving and handling, infection control, fire safety and food hygiene. Records showed up to date safety and maintenance checks of fittings, equipment and services. For example, we saw a service report for the Arjo bath in August 2009 and a controlled waste transfer note from October 2009. The manager had also completed a property checklist. Care Homes for Adults (18-65 years) Page 33 of 37 Are there any outstanding requirements from the last inspection? Yes  No  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 1 24 13 A risk assessment must be 13/07/2009 produced concerning access to the homes kitchens and a copy supplied to the Commission. This is to ensure that people are not put at unnecessary risk 2 34 19 The registered person must 13/07/2009 ensure that there is a robust recruitment procedure in place. This includes the supervision by a named, experienced colleague of any staff member who commences duties before the completion of a criminal records check This is so that people living in the home are safeguarded from potentially unsuitable staff Care Homes for Adults (18-65 years) Page 34 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 Description Timescale for action 1 20 13 A protocol must be produced 31/01/2010 for all medicines prescribed as required (PRN) This is to ensure people receive medicines when they need them and reduce the possibility of error 2 34 17 Records concerning staff 31/01/2010 recruitment must be available for inspection at all times. This is to ensure that checks can be made on the robustness of recruitment procedures for the protection of people using the service 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 Description Timescale for action 1 6 13 The Registered person must 31/01/2010 ensure that care plans are organised in such a way as to make obvious any high risks to people using the service and how these are to be avoided. All staff must be Care Homes for Adults (18-65 years) Page 35 of 37 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 Description Timescale for action aware of such risks. This is to prevent people using the service from coming to harm 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 7 The Registered Provider should review its role as appointee for people using the service and seek alternative arrangements wherever possible The records of the use of prescribed creams should include the signature of the person applying the cream rather than a generic C. Staff should be reminded as to which external agencies are available to report actual or suspected abuse 2 20 3 23 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2010) 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. 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