Care Home: Four Nevill Park

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What the care home does well Residents` surveys returned to us prior to the inspection included the comments: "Nice food. They make me feel welcome. I feel safe here". "I`m happy here!" "Happy and content". People living at the home are supported in maintaining contact with their family and friends. Robust recruitment processes are followed to help ensure the home employs only appropriate staff. What has improved since the last inspection? There is a new management team comprising of a Manager and a Care Co-ordinator. They are being supported by a recently appointed Deputy Operations Manager and the Operations Manager. They recognise where improvements are needed and are implementing them. The organisation`s Behavioural Team is giving support and guidance to the homes` staff in providing care for the residents. The deployment of staff has been revised so the home works more cohesively rather than as separate units. A revised staff roster has been introduced so more staff members are available at weekends and at key times during the day. Additional safeguards have been put in place in regard to residents` medications and finances. The home`s induction programme has been revised so that staff members have a proper induction prior to commencing duties The windows have been replaced and parts of the house have been redecorated and refurbished. The hot water supply has been improved. What the care home could do better: Four Requirements have been made as a result of this inspection:The home must develop the care plans to be more person centred and comprehensive. Risk assessments must be more comprehensive. They must be updated and recorded in response to incidents and changes in residents` welfare. The home must provide an action plan for staff training to include areas pertinent to the needs of the residents. This training must include Autism and Challenging Behaviour. The home must ensure that all staff members receive the training necessary so that they have the skills to meet needs of the residents. There is a programme of redecoration and refurbishment within the home to provide a more dignified and safe environment for the people who live there. We recommend priority be given to the high infection risk areas such as kitchens, dining areas and bathrooms. It is strongly recommended that the home be more consistent in encouraging independence within a risk assessed framework. The Manager has undertaken to update the complaints procedure and to ensure that it and the homes policies regarding safeguarding are consistently adhered to. Notices should be displayed in parts of the home more appropriate than communal areas such as kitchen/dining rooms to make for a more homely and less institutional environment. Key inspection report Care homes for adults (18-65 years) Name: Address: Four Nevill Park 4 Nevill Park Tunbridge Wells Kent TN4 8NW     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: Gary Bartlett     Date: 0 8 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Four Nevill Park 4 Nevill Park Tunbridge Wells Kent TN4 8NW 01892519520 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): springmeadow@ilg.co.uk Evesleigh (Kent) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 24. 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 Four Nevill Park is a large detached Victorian property standing in its own grounds situated in a private road in an elevated position. The home has been developed to offer care for people with a diagnosis of Autism or Aspergers Syndrome. It is located on the outskirts of Tunbridge Wells; the town centre is a short distance away with easy access to public transport. Shops, pubs, post office and church are within easy walking distance of the home. There are large gardens, mainly laid to lawn, to the front and rear of the home and there is car parking available. Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 24 3 0 0 9 2 0 0 9 Brief description of the care home Although it is registered for 24 service users it is currently used to accommodate 16 people. It is set out over four floors and is divided into three units. There is also accommodation for people in semi-independent flats and these are located around the building. The home employs support workers, operating a roster, which gives 24-hour cover. The home has an administrator and there is a maintenance person. The fees are dependent on the type of support being provided. Full details of these and of any additional charges can be obtained from the Manager. Care Homes for Adults (18-65 years) Page 5 of 33 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 unannounced Key Inspection was conducted by Wendy Mills and Gary Bartlett, Compliance Inspectors, who were at Four Nevill Park from 10.15 am. until 4.30 pm. Judgments about quality of life and choices are based on information gathered before this visit and evidence gathered at this visit. During this visit we made direct observation and spent time in discussion with the people who use this service, the management team and staff. Important records, such as care plans and staff files, were examined and a tour was made of the home. We also made reference to reports from health care records that were available to us through recent Safeguarding processes. Survey forms were received from ten residents and five staff members prior to the inspection. These indicate general satisfaction with the home, but there were some concerns about the activities and staffing levels. Comments made are included in the Care Homes for Adults (18-65 years) Page 6 of 33 text of the report. We asked the people who use this service how they would like us to refer to them in this report. they told us that they like to be called, Residents. We have therefore used this term to refer to them throughout this report. We would like to thank everyone involved for their contribution to the inspection. The quality rating for this home is one star. This means that the people who use this service experience adequate outcomes in the care and support they receive at the home. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Four Requirements have been made as a result of this inspection:The home must develop the care plans to be more person centred and comprehensive. Risk assessments must be more comprehensive. They must be updated and recorded in response to incidents and changes in residents welfare. The home must provide an action plan for staff training to include areas pertinent to the needs of the residents. This training must include Autism and Challenging Behaviour. The home must ensure that all staff members receive the training necessary so that they have the skills to meet needs of the residents. There is a programme of redecoration and refurbishment within the home to provide a more dignified and safe environment for the people who live there. We recommend Care Homes for Adults (18-65 years) Page 8 of 33 priority be given to the high infection risk areas such as kitchens, dining areas and bathrooms. It is strongly recommended that the home be more consistent in encouraging independence within a risk assessed framework. The Manager has undertaken to update the complaints procedure and to ensure that it and the homes policies regarding safeguarding are consistently adhered to. Notices should be displayed in parts of the home more appropriate than communal areas such as kitchen/dining rooms to make for a more homely and less institutional environment. 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 33 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 33 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 Manager is aware of the need to ensure prospective residents are properly assessed and to be sure the service can meet their needs, prior to them being offered a place in the home. Evidence: The home has an assessment and admission policy and procedure to ensure each admission is undertaken in a planned way. Prospective residents would only be admitted to the home after a full assessment of needs. The forms prompt the recording of assessments of personal support, health care needs, religious and cultural needs and social interests. Where appropriate, information from relatives and health care professionals is included. The initial assessment form is the starting point for the preparation of the individual care plans. Further assessments are undertaken once a resident is admitted to the home. There have been no admissions to the home since 2008. The Manager stated that it is not intended to admit further service users until the completion of a full review of the home. This is to ensure that the needs of the residents, and the way in which those Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: needs are to be met, are identified, also that staff will have the necessary skills to meet residents specialist care needs. Care Homes for Adults (18-65 years) Page 12 of 33 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. Residents would benefit from improvements to their care plans and be better safeguarded by more comprehensive risk assessments. Evidence: Each resident has a care plan. It is important that the care plans provide easily accessible information to identify individuals current care needs and are directive so staff members know how the needs are to be met. This is especially so, as Four Nevill Park is currently dependent on agency staff to maintain staffing levels. Our last two Key Inspections of this home were conducted on 9th July 2008 and 30th September 2009. At each of these inspections, the managers present had been appointed a short while before. Both had recognised the need to implement a new, more person centred care planning system to make important information more readily accessible. At this inspection, we looked at three care plans in detail. We found them to be a collection of disparate documents that are not well ordered. For example there was a separate file for medical but details of the residents GP were in the Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: main care plan and not in this file. Although the care plans include some review dates, it is not always clear who was involved in the review or what assessments have been made to decide if changes are needed. Some of the terminology used is prescriptive, written in the third person and not reflective of person centred care. A local authority Reviewing Officer has expressed concerns to us that recommendations made at reviews are not being followed up. The homes new management team and a staff member we spoke with acknowledge this and have included the need for improvements in their Service Intervention and Development Plan. They demonstrated a good knowledge of person centred care planning. In view of the organisations failure to ensure the care plans were improved as stated they would be at previous inspections, we are making a formal Requirement that this be done. We are also making a Requirement that Risk Assessments are more consistently recorded to better safeguard people at the home. Details of risk assessments are hard to find and, for many aspects of life in and out of the home, they are not in place. Of the daily records seen, some are more detailed than others when describing daily activities and in recording how the resident has responded during the day and how they feel emotionally. Accurate and detailed information gives a full picture of the persons lifestyle and helps when it comes to reviewing peoples care plans. The Manager is aware of this and is monitoring the quality of the daily records and offering support and guidance to staff where required. Daily records are kept in the form of a daily diary book for each resident, using a page per day. In most instances there are gaps between entries. We recommend the entries be made without gaps so that there is assurance that the records are contemporaneous. A senior staff member told us that residents have regular opportunities to contribute their views and ideas with regard to the running of the home at regular meetings, however, the number of staff who have received training in appropriate forms of communication, such as non-verbal interaction, is unclear. Clear ways of communicating with residents, some of whom are non-verbal, are essential to elicit their views. The Manager has arranged for staff to undertake some training in this area. A member of the ILG Behavioural Team was at the home. Staff said they are regularly in the home giving advice and support. The home does not act as appointee for any resident. The systems for holding their monies and recording amounts of cash held and payments made have been reviewed recently. Commendably, each resident will have a personalised financial profile and Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: additional safeguards have been implemented. Interaction between residents and staff was observed to be generally good. Care Homes for Adults (18-65 years) Page 15 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents should be more consistently supported in their individual choices and development of their life skills. Evidence: Views as to whether the home fully supports residents to enjoy individual lifestyles and to develop their life skills are mixed. When asked on a survey form what the home does well, one resident responded Happy about independence and having own personal money. Content of freedom of choice. Content about regular appointment and activities. Five residents think the home could do better. Their surveys included Improve on activities, Another computer. More trips out, Whilst the home does offer external activities a wider variety would be good, More outings and Whilst the home does organise external activities, more variety eg horse riding would be welcomed. All of the forms had been completed with the assistance of staff. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: There was some evidence of activities going on. There are daily activity plans displayed in the kitchens of each unit and some of the residents were out, or about to go out, on the day of our visit. However, there is little in the care plans to show that these activities were agreed with the residents and were person centred or reviewed properly in conjunction with the residents. We found no evidence to show that the residents are offered new choices and encouraged to try different forms of activities. Two care plans identify that these residents have communication difficulties. Although staff members were seen to be able to communicate with each of them, the care plans do not give staff enough detail about they way they should communicate. This is especially important in a home that depends so heavily on the use of agency staff who may not know the residents well. We found no evidence to show that more innovative or individual communication styles have been explored. Indirect observation throughout this visit noted several occasions where staff did not appear to communicate with the residents at all. Throughout the day we noted five occasions when staff were in the company of service users but not engaging with them or encouraging activities. On one occasion this led to a confrontation because staff had not properly communicated with the individual they were accompanying. We did not find good evidence to show that the residents are properly consulted about their choice of activity or offered opportunities to try new activities. Residents go on holidays. We observed one resident becoming very anxious about the dates for his holiday. We also noted a safeguarding alert where a resident was left unescorted whilst away from the home. Discussion confirmed that there is there is consultation about where holidays are spent and which staff member will accompany the resident. Clearer written plans about the holiday process that include such things as ground rules for staff and residents, dates and times, and who will support the resident during the time away, may help prevent escalation of anxieties over holidays. A revised staff roster has been introduced so more staff members are available at weekends and at key times during the day. The management team at the home is committed to promoting independence and is aware that not all staff members are good at getting a balance between keeping people safe and enabling them. Throughout our time in the home several staff appeared to be reacting to negative behaviours and that encouraging and reinforcing positive ones. Some residents can still not use a communal bathroom independently because the Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: taps have had to be removed in response to one residents water fixation. It is, therefore, again recommended that the home be more consistent in encouraging independence within a risk assessed framework. People living at the home can receive visitors when they choose and have use of a telephone to call family and friends. The staff members spoken with understand the need to support residents in building and maintaining appropriate relationships. Of the surveys sent to us by residents, three make reference to the food. Two residents make the comment Nice food, whilst one states the home could do Better meals. A senior staff member told us that residents participate in planning the menus and doing the food shopping. In one unit, there was a pictorial menu book for two residents who are non-verbal. There is also a small booklet with pictorial choices that is used for shopping. However, the menu choice book was was not broken down into a progression of choice. For example, meat or fish? If meat, red or white meat?. If red meat, lamb or beef? It is not evident the book caters for special diets such as vegetarian or religious and cultural. A senior staff member told us there is one diabetic resident whose diabetes is controlled by tablets and two residents with high cholesterol and that special diets can be provided for these people. Care Homes for Adults (18-65 years) Page 18 of 33 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. Improved recording will better show how residents are supported with their personal and health care. Evidence: As stated earlier in this report, the care plans do not show that personal support is responsive to the individual preferences of residents or that staff members are readily made aware as to the type and nature of the support required for individuals personal and intimate care needs. The Manager is reviewing records of care to help ensure they are more consistent in quality of information included. Discussion, care plans and other records, confirm that residents have access to health and social care professionals. Support with appointments is given where appropriate. The home has policies and procedures for the management and administration of medicines. There have been a number of reported medication errors and a possibility that other errors have gone unreported. Staff said that it is likely that the increase in reported errors is due to an auditing procedure that has been introduced recently. There is now a weekly audit carried out by a senior support worker and CCTV cameras Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: are sited in each medicines room. The medicines rooms on Ruby and Amber, whilst clean and generally well maintained, are cramped and have limited ventilation. The temperatures of these rooms are being monitored to help ensure medicines are stored at appropriate temperatures. Within each room is a locked medicines cupboard with a locked controlled drugs cupboard. We checked the controlled drugs stock in one unit and found these to be correct. The Medicines Administration Record (MAR) sheets seen were completed without gaps. Some handwritten entries were not countersigned although the senior support worker was aware that this should be done. The Manager undertook to address this. Medicines are only administered by staff members trained to do so and there is a sample signature list contained in the medication file. However, some signatures were in full and some were initials. These should be examples of what is signed on the MAR sheets to help with auditing and accountability. Two residents currently self medicate and we are told this is done within a risk assessed framework. The administration of medicines was not observed on this occasion. Care Homes for Adults (18-65 years) Page 20 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service will be better protected by more consistent adherence to the procedures for complaints and safeguarding. Evidence: The Manager agreed to revise the complaints procedure that is made available to people so that it is clear they can make complaints to their Care Managers as well as directly to the home. It also has to include the current address of the Commission and include the information that we do not have statutory powers to investigate complaints. The Manager stated he is intending to make the procedure available in other formats that may be more easily understood by the residents. Records are kept of complaints, their investigations and outcomes. Prior to our inspection we received information from a health care professional that the home had not followed the organisations complaints procedure or safeguarding policy in respect of two recent incidents. We discussed these with the management team. Since that time, they have been provided additional support from the newly recruited and experienced Deputy Operations Manager who is at the home three days per week. They demonstrated a more robust understanding and approach to complaints and safeguarding. They were also able to demonstrate they are working very closely with the local Safeguarding Vulnerable Adults Team. Six staff members are currently suspended as a result of allegations. There are several safeguarding alerts open on the home, some of which are in the Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: process of being closed, others are still being investigated. The homes training matrix shows the majority of staff had had training in safeguarding and it is being arranged for those who have not. The members of staff spoken with have a good understanding of what constitutes abuse and of the protocols to safeguard adults. Care Homes for Adults (18-65 years) Page 22 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples quality of life and safety will be enhanced by further improvements to the environment in which they live. Evidence: Four Nevill Park is a large detached Victorian property standing in its own grounds situated in a private road in an elevated position. The property has four floors and has been arranged into three units, Amber, Emerald and Ruby. Alongside these units there are a number of semi-independent flats. Since our last inspection there has been a lot of redecoration and some refurbishment within the home to provide a more dignified and homely environment for the people who live there. The windows, previously problematic, have been replaced. Some areas still have worn or damaged surfaces, plasterwork, and wall coverings. The Manager was able to show these areas are scheduled to be improved. We recommended priority be given to the high infection risk areas such as kitchens, dining areas and bathrooms. The parts of the home seen were clean and free from unpleasant odours. We discussed how excessive notices, in communal areas such as kitchen/dining rooms Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: made for an institutional rather than a homely environment. Especially, as most of the notices were pertinent to staff rather than residents. This was recognised by the some staff members after we pointed it out to them and they started to remove the notices not relevant to the residents and said they would identify a more appropriate place for them to be displayed. Care Homes for Adults (18-65 years) Page 24 of 33 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. Robust recruitment processes are followed to ensure only properly vetted people work at the home. The home has not ensured that all staff members have the necessary skills to meet residents care needs. Evidence: The last two years have been very unsettled for the home, with constant changes in management and a high turnover of staff. This is reflected in surveys sent to us by residents and staff which, under the section What Could the Home Do Better included the comments Retain staff. Improve staff levels. Listen to staff, There is a large turnover of staff at Nevill which is a cause for concern for consistency with service users and Have more staff. The Manager acknowledges the high turnover of staff which means the home is Dependant on using agency staff to maintain adequate staffing levels and there is a resultant lack of continuity of care, although this is being minimised as best possible. Efforts are being made to recruit more permanent staff. We looked at the files of four staff members. These show that robust recruitment Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: processes are followed to ensure only properly vetted staff work at the home. People applying to work at the home have to complete an application form, provide two references and have Independent Safeguarding Authority (ISA) and Criminal Records Bureau (CRB) checks and attend an interview. Interviews are held locally but the companys head office deals with all the referencing, ISA and CRB checks. New staff members have to undertake an induction programme. A senior staff member confirmed that new staff are now having induction prior to commencing duties. Previously some staff started working in the home without having had induction training. The Manager described the development of the induction programme to make it more relevant to the home. Existing staff will be required to complete this programme, regardless of how long they have been working at the home. We were shown the training matrix. It identifies which members of staff have had the necessary training so that they have the skills to meet residents care needs and to comply with current legislation and good practice guidelines. The matrix shows gaps in important training areas such as autism and managing challenging behaviour. The high dependency on agency staff means that the home cannot be sure that all staff working in the home at any one time have the necessary training and skills to meet the needs of the residents. Since our last inspection there has been a change to the staffing structure and the deployment of staff so the home works more cohesively. A revised staff roster has been introduced so more staff members are available at weekends and at key times during the day. When we spoke with staff members about these changes, the response was not always centred on the benefits to the residents but rather how these changes impacted on the working lives of the staff. The Manager stated he is arranging for senior staff to have training so they can provide effective supervision to other staff. Care Homes for Adults (18-65 years) Page 26 of 33 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. The owning organisation must ensure the homes management team is supported in implementing the changes they recognise as being needed to improve the standard of service. Evidence: There has not been a registered Manager at Four Nevill Park since early in 2007. This is not compliant with the Care Standards Act 2000. Throughout this period there has been inconsistent management of the home. This has led to a lack of continuity of care that the home gives. Concerns about this lack of continuity were expressed in surveys returned to us and by health care professionals. The previous manager, who was present at our last inspection, left in January 2010 at very short notice. The current Manager has worked at Four Nevill Park since 1st March 2010. He has experience of working with people with learning disabilities in a residential setting and was previously the Deputy Manager at another home operated by the company. He has recently been confirmed as being permanently in post and has applied for a Criminal Records Bureau check as the start of the Commissions registration process. Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: Support is being provided by the Care Co-ordinator who has been working at the home for three months, the Deputy Operations Manager who is recently appointed to the organisation and is at the home three days per week. The management team are all very new to the home and, as such, are not yet able to demonstrate consistency and stability. Staff are generally aware of safe systems of working. For example, the standard of cleanliness in the kitchens and surrounding areas is satisfactory and they are careful to ensure COSHH requirements are complied with to safeguard residents. The systems for holding residents monies and recording amounts of cash held and payments made have been reviewed recently. Commendably, each resident will have a personalised financial profile. In response to recent safeguarding alerts concerning alleged missing monies, additional safeguards that include CCTV have been introduced. There are sound systems for the regular checking of fire safety systems. The staff members spoken with have a good understanding of emergency procedures. The organisation undertakes monthly visits to the home to monitor the quality of the service and there are regular meetings and surveys to request the views of residents and other stakeholders. Care Homes for Adults (18-65 years) Page 28 of 33 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 33 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 17 The registered person shall maintain records as specified in Schedules 3 and 4. It is a legal requirement for the registered person to keep records of care that are up to date and specific in detail of information required. All service users must have a comprehensive and detailed care plan that is inclusive of personal, health and social care needs by the given timescale, if not sooner, and which is maintained thereafter. 03/09/2010 2 9 13 The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. It is a legal requirement for the care home to minimise 03/09/2010 Care Homes for Adults (18-65 years) Page 30 of 33 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 risks as far as is practicable. Risk assessments must be comprehensive and recorded in response to incidents and changes in service users welfare. Comprehensive individual and environmental risk assessments must be in place by the given timescale, if not sooner, and maintained thereafter. 3 35 18 The registered person shall, 23/07/2010 having regard to the size of the care home, the statement of purpose and numbers and needs of service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform including structured induction training. It is a legal responsibility to ensure the staff group has the knowledge and skills to meet service users needs. A detailed staff training programme that includes training in autism and managing challenging behaviour must be completed. A copy of the training programme and details of the training Care Homes for Adults (18-65 years) Page 31 of 33 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 providers and any accreditation they may have, must be received by the Commission by the given timescale. 4 35 18 The registered person shall, 30/09/2010 having regard to the size of the care home, the statement of purpose and numbers and needs of service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform including structured induction training. It is a legal responsibility to ensure the staff group has the knowledge and skills to meet service users needs. Eighty percent of staff working at the home to have received training in autism and challenging behaviour. 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 32 of 33 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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