Care Home: Fen House

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What the care home does well The assessment arrangements made for people to live at the home are carefully considered and are a process that assures people who live at the home they will be appropriately supported. The ongoing assessment and planning of care is thorough and is approached from a clinical medical model, as well as using a social functioning approach. Support is geared between these two elements of need and is fully understood by staff. Overall, care is individual and person centred and improved functioning and rehabilitation is acheived for many people living at the home. The home has a sound and preventative approach to safeguarding. They have always referred their concerns to the local authority to investigate. Staff are safely recruited. The management structure and personnel in place is extensive and consists of experienced staff. This is a strong resource the service is able to offer. When medicines are prescribed on a `when required` basis, for example to control a person`s behaviour, there are clear written guidelines on the circumstances such medicines are used and records show that these are followed. What has improved since the last inspection? The two requirements made at the last inspection on the 30th August 2007 had been met. Better methods to ensure consultation have been put in place. Staff training in safeguarding had been provided for all staff. The management structure has increased and additional staff have been recruited. Where agency staff are employed, the home has ensured that only staff who they have asssessed as competant and who can communicate effectively, are agreed. One to one support for people is provided and this variable demand is anticipated and well managed by employing additional agency staff who have been safely recruited and vetted and agreed in advance. What the care home could do better: Care plans could include more written detail of the current and topical social aspirations and goals that people are expressing and wanting to acheive. The induction arrangement for the brief and initial induction in the first 2-3 days when a new worker commences employment, should include safeguarding awareness and this brief induction should be fully recorded. Records made when medicines are received into the home, when they are given to people must be more accurate, so that all medicines can be accounted for and the home is able to demonstrate that people receive their medicines as prescribed. Handwritten changes or additions to medication records should be signed and dated by the person making the entry and checked for accuracy by a second person who should also sign the record. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Fen House 143 Lynn Road Ely Cambridgeshire CB6 1DG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Don Traylen     Date: 2 6 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Fen House 143 Lynn Road Ely Cambridgeshire CB6 1DG 01353667340 01353653155 fh@birt.co.uk www.birt.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Disabilities Trust care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is 25 The registered person may provide the following categories of service only: Care Home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Physical Disability - Code PD Date of last inspection Brief description of the care home Fen House is a purpose built home for people who have suffered a brain injury. Fen House is intended to be temporary accommodation for people who expect to be rehabilitated and not live permanently in a care home. The service started when the accommodation was opened in February 2005. The home is owned and managed by the Brain Injury Rehabilitation Trust, a division of the Disabilities Trust. The building is divided into two units. Each unit has its own front entrance from the car park at the front of the building. One unit has 10 places for short-term rehabilitation the other unit Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 25 Brief description of the care home has 15 places for people who need a longer period of rehabilitation. All bedrooms are single and have an en-suite toilet, washbasin and shower. The home has a clinical psychologist, a consultant psychologist, a psychology assistant and two occupational therapists and a speech and language therapist and physiotherapists who are linked to the Princess of Wales hospital, Ely. Fees range from £1350 per week to £1905 per week. Copies of CQC inspection reports are available at the home, or can be accessd from the CQC webpage. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support peterchart Concerns, complaints and protection Environment Staffing Conduct and management of the home Poor Adequate Good Excellent How we did our inspection: The inspection started at 9:30 am on 26/08/2009. Two inspectors carried out this inspection one of whom was a specialist pharmacist inspector. The inspection finished at 6pm. We assessed two peoples care plans and read part of one other persons care plan. The assessmenst process and the process of care planning, reviewing care plans and recording the rehabilitative progress were assessed. Six people were asked about the suppoprt they received and whether they like living at Fen House. We ascertained peoples daily routines and their preferences and choices. We saw lunch being served to some people. The management and administration of medication was assessed. The recruitmenmt of staff was assesssed and the recruitment records for one new member of staff were inspected. Induction arrangements for new staff were read and discussed with the manager. The training records and arrangemenst for staff were also assessed. The management of complaints and the management of issues relating to safeguarding were assessed. The homes policies and their quality assurance arrangements were Care Homes for Adults (18-65 years) Page 6 of 32 seen and were explained by the manager. The home sent us an Annual Quality Assurance Assessment prior to the inspection. 10 surveys were sent to people living at the home to complete. What the care home does well: What has improved since the last inspection? What they could do better: Care plans could include more written detail of the current and topical social aspirations and goals that people are expressing and wanting to acheive. The induction arrangement for the brief and initial induction in the first 2-3 days when a new worker commences employment, should include safeguarding awareness and this brief induction should be fully recorded. Records made when medicines are received into the home, when they are given to people must be more accurate, so that all medicines can be accounted for and the home is able to demonstrate that people receive their medicines as prescribed. Handwritten changes or additions to medication records should be signed and dated by the person making the entry and checked for accuracy by a second person who should also sign the record. Care Homes for Adults (18-65 years) Page 8 of 32 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured the service has full knowledge and a written statement of a persons needs before they decide to move into the home. Evidence: The home had updated their Statement of Purpose in March 2009 and had added further information about the service and about the staff who work at the home. They have also written a document entitled, Further information for service users and their families, which is an overview of the service and an introduction to what people can expect should they decide to move into the home. They have made it clear in these documents where to make a complaint in relation to the service. The process for people to move into the home remains rigorous and as it has previously been found. The homes usual arrangement is to fully prepare people for living at the home and to ensure the service is comprehensively familiar with a persons assessed needs. Most people, but not all, are admitted from hospital after they have been extensively assessed for their neurological capability and capacity and who are considered as clinically stable, and that rehabilitation is required as a Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: continuing aspect of their needs. These assessments are usually conducted by a multidisciplinary group of Health Service professionals that will usually consist of a Neurological Psychiatrist, a Psychologist, an Occupational Therapist and other Health service professionals and Social Care Managers. The home would then be approached and asked to provide a service and to make a judgment whether they are able to provide a service. All people living at the home had been assessed in this manner and the home had been fully involved in the whole process of each persons arrangements from an early stage. The service does not offer permanent care. There is an emphasis on rehabilitation which is reflected in the contract. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured their care is well planned and is known by care staff. People would be better assured if their social aspirations were consistently recognised in their written care plans. Evidence: Care plans for two people were read. The plans are in two parts that deal respectively with peoples clinical issues relating to their neurological progress and clinically assessed functioning and the other aspects of their care that are associated with their social needs, activities of daily living and personal care. There is a continuous level of clinical re-assessment of all people that is made up of two programmes. The initial programme for the first 12 weeks after somebody has moved into the home is a comprehensive assessment to determine their potential for rehabilitation and brain functioning. This is in addition to the previous assessment conducted before somebody moves into the home. The other programme is a continuous and longer term approach to rehabilitation that incorporates a continuous assessment and for some people a distinct concentration on their social and daily activity skills to enable them to live Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: independently and to potentially move-on from the home. These different aspects of care and support encompass the different stages and the range of needs that people have. One person who we spoke to and whose care plan we read said, I will move from here soon and live on my own. He explained to us how his is managing to earn money and to manage money and getting prepared to be on his own. He was very positive about his aspirations and realistic that he would achieve these plans. He had organised his own programme that gave him opportunities to develop work skills and manage finances. Support staff had worked with him to achieve this and one support worker described how he was supported by her. His written plans for his social support did not reflect in full all the facts he told us and all the support that staff had given him. It was later discussed with the manager that his care plan should include and account for his current and topical aspirations and his activities and staff involvement that had been planned to accomplish his goals. Generally, peoples social care plans were not so well recorded as their clinical profile and evaluation. There were instances where personal aspirations had not been completely explained or clarified in the social part of their care plan and it was not clear how staff should follow instructions relating to a person aspirations. However, when we spoke to support staff they were very aware of peoples changing needs and their personal aspirations and demonstrated they knew the goals that were being achieved. The care plans included a printed weekly routine of activities. The plans also included reviews that showed whether a longer term of rehabilitation is necessary. There were detailed behavour charts that map a persons progress and patterns of behaviours (and mood). Rehabilitation is reviewed through the review meetings that are held 3, or 6 monthly and all involved parties are invited. Two people whom we spoke to told us in detail how they use theire daily charts to remind them of what they are doing. They described how they make decisions about meals and whether they want to go out. Care plans included risk assessments and risk taking. Two people who were anticipating moving from the home because they had shown their potential to live independently had made choices about their risks and what they felt comfortable with. These choices had been recorded in their plans. The two people told us that staff respected their choices and felt that they were supported to make choices. Over the last year eight people had been enabled to move-on from the home to live a more independent life. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured they are given opportunity to develop their independence and their social skills and are encouraged to pursue a leisure interest. Evidence: Fen House has a spacious gym that is used by people under the direction of a physiotherapist, or a support worker, who is responsible for supporting people through their exercises. One person was using the gym and he explained to us how he used the gym and what he was trying to do. He explained his daily regime and showed he was making the choices about his rehabilitation. Most people had a routine that included exercising and some of this was in the gym, or regular walking outside of the home, swimming and bowling. There were other activities where people used local facilities such as hairdressers, clothes shops, cafes and cinemas. The home has an inhouse bank where people can become familiarized with money. There is a music room and an art room equipped with a piano and CD player and recording facilities. There is Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: a kitchen and a laundry room that are used specifically for familiarization and assessment purposes. One person had enrolled at a local college for a course he was interested in. There are daily community meetings to cover the activities that each person is doing each day. Monthly meetings are held for all to discuss the general affairs of the home. Daily handover meetings are held by staff and these are recorded. Each person has an activity programme that is written each week and most people keep a copy of this close to them so they can refer to it so they can remind themselves. The home employs an activities co-coordinator who arranges some activities for people such as swimming, horseriding, or going to the cinema and participating in local activities and the wider community. Support staff also accompany people into the community to do their personal shopping, or support them to keep dental appointments. Three people told us the food and meals were, OK and very nice and each confirmed there was enough to eat. They informed us that they ate their main meal in the evening. The chef showed us a record of the lunchtime and evening meals provided and these appeared nutritious. A lunchtime snack was observed to be eaten during the inspection and people had made differing choices: some people ate a salad, others had a beefburger and chips. One person asked for a sandwich. People were observed to be spoken to in a polite manner and staff knocked on bedroom doors before asking if they could enter. There was suitable evidence to show that the two people who told us they intended to move on from the home were being assisted and were making the decisions about this. Three people told us that their families are an important part of their lives. Each person had maintained strong and regular family links and went home to see their relatives. Each had a relative who had visited the home and in one case, the visits were daily. An element of rehabilitation is the persons own preferences and control over the level of involvement with their families. Five people who we spoke to made the following comments, I see my wife every day, she comes here to see me. My friend tells me whats going on and looks after my affairs; I go out on my own and do the things I want. I have worked out my plan with staff here and they give me help when I ask. Another person spends every weekend with her partner. These instances were the preferences and choices made by people who told us what they wanted and expected. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: One person had set up a small business of doing specific jobs and had been encouraged by staff to do this. Whilst this was also his lifestyle, it was a major element of his preferred personal support. There was a clear sense of the progress that people were trying to achieve, or wanted to achieve, when we spoke to them. There were expressions of firm intentions to move on and to get back to their previous way of life and even when this was admitted to be unlikely, there was a clear optimism shown by six of the seven people we spoke to. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured their care is given in a manner they prefer, their healtcare is planned and they are adequately protected by the homes management of medication. Evidence: We looked at the practices and procedures for the safe use and handling of medicines. Medicines are stored securely for the protection of residents. The temperatures of the rooms used to store medicines are monitored and recorded regularly but have been above the recommended maximum on several occasions. The failure to store medicines at the correct temperature could result in people receiving medicines that are ineffective. We were told that plans are in hand to improve the temperature control of these rooms. We looked at the medication and medication records for several people in the home and in some cases the records were inaccurate. We found that the date medication was given to people wasnt always clearly recorded and we couldnt account for some omissions in the records or account for all medicines in use, as the dates medication was received or amounts carried forward to a new recording period were not recorded. In some cases hand-written records were not accurate and there was no indication who made the record, when, or if it was checked for accuracy by a second person. When people are away from the home, an agreed code is used on Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: the medication record to indicate this but it is not clear if medication is given to them to take with them or if the medication is omitted completely. When people are on extended leave from the home, additional supplies of medicines are ordered to cover this period. We also found some medicines in stock but no record was kept of these. We have made a requirement about the need for accurate records of the receipt and administration of medicines. Where medicines are prescribed on a when required basis e.g. to control behaviour there is good, clear written guidance for staff on their use and risk assessments are in place. Inspection of care records show that these are followed. We watched medicines being given to some people and this was done well with regard to their dignity and personal choice. Four people whom we spoke to informed us that their personal support and health care was satisfactory. They had access to the consultant psychologist and regular discussions about their rehabilitative experiences and progress. When people move into the home they are continually assessed so that their potential and achieved rehabilitative progress can be measured. Some people told us about these meetings and their involvement in the process. They had met with and had regular contact with the homes consultant Psychologist. Peoples care plans were read and these each included clinical elements of neurological functioning, emotional state and behaviour. There were clear and numerous records of the meetings with health care professionals and the comments made by the consultant psychologist as well as any involvement that included the occupational therapist, or physiotherapist. Peoples rehabilitation is part of their daily routine. Each week a programme of daily activities is written and given to each person so they can refer to this as frequently as they need. This weekly routine includes living and leisure pursuits and interest that have been agreed. Many of these tasks have to be carried out with support and some people receive intensive support on a one-to-one basis. These activities are sometimes task orientated to encourage emotional independence and physical well being such as exercise sessions and personal hygiene practice within the overall needs of rehabilitation. We visited the gym room where we observed and spoke to one person who was completing his daily exercises and he explained how and what he does every day to ensure his muscular strength is maintained. During the inspection one person was taken to hospital by ambulance after the home had become concerned about his physical health. The home had in place intensive one-to one support and personal care because of his physical frailty and complex needs. His care had been observed and the one to one support worker who remained with him all day showed us the records of the routine of daily care and the Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: arrangements put in place to ensure he received essential and adequate nutrition and fluid and other personal care. Each person is registered with a GP and have District Nursing input whenever necessary. Diabetic needs are managed through District Nurses. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured they will be safeguarded by the home. Evidence: The homes Statement of Purpose and their information for people using the service, gave clear indications of how a complaint would be dealt with. The home has a comprehensive complaints policy that stated they will respond within an appropriate timescale. Their records showed that this has been upheld whenever they had responded to a complaint. One complaint was tracked and was seen to have been extensively addressed and had involved other professionals who were relevant to the issues raised. The home has a safeguarding policy and current guidelines from Cambridgeshire County Council with information about where to report any allegation or suspicion of abuse. Safeguarding matters had been dealt with correctly and all had been referred to Cambridgeshire County Council as Safeguarding issues. Recent referrals had taken place and the records for these were seen and had been sent to the Commission as required. Two staff that we spoke to demonstrated they knew how to contact and report directly to Cambridgeshire County Council if they chose to, but stated they would expect to inform the manager in the first instance if they had any concerns. The telephone contacts to make these referrals were available to staff in each of the two units. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: Staff training for safeguarding is provided for all staff and as soon as possible for newly recruited staff. The training for awareness of abuse for staff during their induction period does not always take place immediately they commence employment and there can be a period of waiting until their Skills for Care Common Induction, or when the training that is provided through Cambridgeshire County Council is available. It was discussed with the manager that staff should be able to safeguard people as a priority function and as the overarching approach to providing care. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured they will be provided with clean, well maintained, spacious and comfortable accommodation. Evidence: The building is divided into two units. Each unit has its own front entrance from the car park at the front of the building. One unit has 10 places for short-term rehabilitation that consists of nine single rooms and one transitional living flat for completely independent living. The other unit has 15 places for people who need a longer period of rehabilitation. The first floor of the home has offices, meeting rooms, and therapy rooms and staff facilities. All bedrooms are single and have an en-suite toilet, washbasin and shower. There are three dining rooms, three lounges, a games room and a smoking room as well as a main kitchen and laundry. There is a large enclosed central courtyard, landscaped in a modern style. There is a kitchen and laundry in each unit that are used for rehabilitative purposes. The home also has a main commercial laundry. Two housekeepers and a handyman maintain the clean and tidy environment. The home was very clean throughout. Toilets and bathrooms were very clean. Hot water temperatures were safely controlled by thermostatic valves. There were no hazards or harmful substance accessible. All fire exits and passageways were clear. A Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: recent inspection by Cambridgeshire Fire & Rescue Service gave a notice of deficiencies that had mostly been met and one outstanding issue about the quality and style of the kitchen doors was being discussed with the Fire Safety Officer. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are generally assured they are provided with care from trained staff. Evidence: The staff team consists of the manager, two assistant managers, senior team leaders, rehabilitation support workers, cooks and domestic staff, as well as a team with a medical emphasis consisting of a Clinical Psychologist, a onsultant Psychologist, a Psychology Assistant and an Occupational Therapist. The manager informed us that all staff are expected to achieve NVQ level 2 awards in care and are given opportunities to achieve this. About 50 of staff had attained this award. A range of suitable training had been provided for staff. This included training in challenging behaviours; Basic Brain Injury to all staff and Intermediate Brain Injury for senior staff; Controlled Physical Intervention; Safeguarding, a set of mandatory health and safety training such as Fire Safety, Food Hygiene and Moving and Handling and Epilepsy. All staff had received Safeguarding training through Cambridgeshire County Council. The training manager has been trained by Cambridgeshire County Council as a person able to give basic Safeguarding training to staff. The records for the initial indication after staff first commence employment did contain Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: brief detail but did not include an awareness of Safeguarding. Staff complete a Skills for Care Common Induction after their initial induction. It was discussed with the manager that in the initial induction, during the first few days a new care worker commences employment, that the programme should be enlarged to include safeguarding awareness. The training manager had already made plans to improve the initial induction and the manager stated this addition to the induction programme would be implemented. After inspecting the staff records it was also discussed with the manager that individual staff training and development profiles should be further developed, so that a clear check can be made to ensure the exact training that each staff member has undertaken. Two staff files showed that staff had been recruited safely and after CRB disclosures had been obtained. These disclosure included POCA & POVA list checks. One persons application form did not allow for adequate details of her previous employment, such as the type of work and position held. This was discussed with the manager who said she would make the amendments to these forms to allow this detail to be shown. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured they are provided with a safe and well managed home. Evidence: The manager is completing her registered managers award after a period of maternity leave. A new training manager had recently been appointed. The home has implemented a quality assurance system whereby relatives are invited to respond to surveys. A service users questionnaire is conducted annually and the findings from these are published. People living at the home are given daily and weekly opportunities to be listened to and are asked for their views about the food and about how the home is run. There are monthly meeting for service users that are minuted. Records of these meetings were seen. The service has a business plan which we saw during the inspection. Audits had been completed and these included a Health & Safety audit on 11/12/2008; a Stakeholder audit and a user focused audit. Lifting and hoisting equipment used by the home had been serviced. The fire alarm had been serviced on 08/01/2009. A fire evacuation had been carried out on Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: 29/06/2009 and on 25/08/2009. A visit by Cambridgeshire Fire Rescue Service was carried out on 08/01/2009 and several recommendations were made. Weekly fire alarm checks had been carried out and recorded. On the 29/06/2009 the Environmental Health Officer for Food Safety inspected the kitchens and found them clean and safe. The Care Homes Regulations 2001 Regulation 26 & 37 reports have always been sent to us by the home in a timely manner, whenever they have been necessary. The home has a comprehensive and suitable range of polices. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Accurate and clear records must be kept of the receipt and administration of medicines. This will ensure that all medicines are accounted for and demonstrate that people are given their medicines as prescribed. 30/09/2009 2 20 13 Medication must be stored at a safe and suitable temperature. This will ensure that people will receive medication that has been safely kept by the home. 30/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Care plans should consistently record the social aspirations that people have and the planning that is in place to Care Homes for Adults (18-65 years) Page 30 of 32 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 promote individual activities and independence to help achieve these aspirations. 2 20 Hand-written changes or additions to medication records should be signed and dated by the person making the entry and checked for accuracy by a second person who should also sign the record. The initial brief induction given to new staff in the first few days when they commence employment should include safeguarding awareness, so that people are assured they are always safeguarded by competent staff. 3 35 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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