Care Home: Gatwick Grove

What the care home does well The service provides a homely and comfortable environment for people living there. People living there are supported in having active lifestyles. They take part in a range of activities in the community and within the care home. People living at Gatwick Grove are supported in making their own decisions and in developing daily living skills. What has improved since the last inspection? Improvements have been made to the handling and laundering soiled clothes to prevent the risk of cross infections. What the care home could do better: Care plans are very bulky as information has been repeated in different formats. They need to be reviewed to ensure that important information they contain about the needs and wishes of individual residents is easier to access. Improvements are needed to the cleanliness and hygiene of the utility room. This will mean the risk of cross infections is reduced. The manner in which staff time is allocated to each resident needs to be reviewed. This will ensure each resident is provided with sufficient staff support without affecting others. Monthly visits must be carried out by representatives of the registered provider and their outcomes recorded. This will mean the day to day running of Gatwick Grove is being monitored whilst a manager is recruited. A system for reviewing and improving the quality of care provided must be put in place. This will mean that Gatwick Grove is being run in the best interests of residents. We have been made aware of allegations of abuse which have been investigated by the local authority. Their investigations have been completed and the outcome is that some allegations have been substantiated. The local authority has also been monitoring the work of the registered provider to ensure improvements are made. We saw evidence of improvements made during our visit. However, the registered provider needs to appoint a manager to ensure improvements become embedded in care practices. Key inspection report Care homes for adults (18-65 years) Name: Address: Gatwick Grove Poles Lane Lowfield Heath Crawley West Sussex RH11 0PY     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: David Bannier     Date: 1 4 0 1 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 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Gatwick Grove Poles Lane Lowfield Heath Crawley West Sussex RH11 0PY 01293551506 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: ditchlingcare@btconnect.com Ditchling Rural Care Ltd care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 6. 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 Gatwick Grove is a care home, which is registered to provide personal care for up to six service users in the category learning disability (LD) who are between the ages of 18 to 65 years of age. It is a substantial detached character property, which has been adapted for its current use. It is situated at the end of a private road in Lowfield Heath, which is conveniently located and served by public transport to access Gatwick, Crawley and surrounding areas. The property is a two -storey building providing private accommodation to service users in single bedrooms located on the ground and first floors. Communal accommodation is made up of a lounge and a dining room located on the ground floor. The house stands in grounds of 5.5 acres of land, Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 6 Brief description of the care home including stables and the registered provider is renting a further 22 acres surrounding the boundary to facilitate the agricultural day service that is planned. A fenced private garden area to the side of the house has been established and a workshop has been built to the rear of the house. Fee levels currently range from £1,400.00 to £1,950.00 per week. Personal items such toiletries and hairdressing are not included. The registered provider of this service is Ditchling Rural Care Ltd. The post of manager is currently vacant. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. The inspection has followed the Inspecting for Better Lives methodology and is called a key inspection as it assesses those standards determined by the Commission as key standards. This inspection will also determine the frequency of inspections hereafter. We asked the registered provider to return an Annual Quality Assessment Form known as an AQAA prior to the inspection. The information received from this document helps us to form an opinion about how well the service is being run and is a legal requirement. This form had not been returned to us by the time this report was being written. A visit to the care home was made on Thursday 14th January 2010. This was an Care Homes for Adults (18-65 years) Page 6 of 30 unannounced inspection. This means the registered provider had no prior warning of our visit. We met and spoke with all of the residents as far their communication abilities allowed in order to form an opinion of how it is to live at the care home. We also observed care practices and interactions between residents and staff. We sent surveys in pictorial format entitled Have Your Say to all residents. We were informed residents needed support and help to complete them. All five surveys were completed returned to us before our visit. We have referred to them during this report. We also spoke to some of the staff on duty in order to gain a sense of how it was to work at the care home. We also viewed the accommodation and observed care practices. Some records were also examined. The visit lasted approximately six hours. We gave a senior manager feedback of our findings on its completion. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: 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 Care Homes for Adults (18-65 years) Page 8 of 30 order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 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 30 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. Prospective residents needs are assessed before they move into Gatwick Grove. Evidence: During our last visit we judged that prospective residents individual needs and aspirations have been assessed. On this occasion we were informed that no new residents have been admitted since. All five surveys completed and returned to us by residents confirmed they had been asked if they wanted to move into Gatwick Grove. They also confirmed they had received enough information about the home so they could decide if it was the right place for them. Staff we spoke to were able to discuss the needs of each resident and how they should be met. Our observations of care practices demonstrated that staff knew how to meet individual residents needs. Care Homes for Adults (18-65 years) Page 11 of 30 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 assessed needs have not been reflected in their individual care plan. Care staff do not have up to date information to follow to ensure such needs are met. Residents can make decisions about their lives with assistance as needed. Residents are enabled to take risks as part of an independent lifestyle. Evidence: We looked through the care records and care plans of some residents. We found that information about each residents needs together with comprehensive and detailed guidance for staff had been drawn up. Staff are expected to follow guidelines, which gives them specific instructions to ensure they work in a consistent and continuous manner with residents. They are also expected to sign them to confirm they understand the contents. We also saw that risk assessments have been carried out when necessary to determine the level of risk an identified activity would present to a resident and the action staff should take to reduce it. However, care records have Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: become confused as the same information is repeated in different formats. This means it can be difficult for the reader to find what they need. We spoke to a senior manager who confirmed that they were aware of this and expected to put this right in the near future. We also saw that reviews are conducted monthly. However, the content of the reviews demonstrated that staff were not fully aware of the purpose of this process. Review notes we looked at indicated that the behaviour of residents had been reviewed and not the information care plans contain to ensure it is up to date and reflects the current needs of each resident. We discussed this with the senior manager who agreed to ensure staff are provided with appropriate training in this area. We also noted that, where possible, care plans had been signed by the resident or their relative to confirm they had been consulted as part of the process. We observed staff working with residents. They demonstrated that care practices and support provided to residents were in line with the guidance provided. Discussions with staff on duty confirmed they had been made fully aware of the needs of each resident and how they should be met. Surveys completed by residents told us that staff do provide them with the care and support they need. One resident confirmed care staff and managers always treat them well, three residents confirmed this is usually the case, whilst one resident confirmed this is sometimes the case. Residents are encouraged to make choices on a daily basis. This includes making decisions about what to eat, how to spend leisure time, when to get up and when to go to bed and what clothes to wear. During the morning we we were informed one resident had gone out to college. We were also informed two residents had chosen to stay in bed. All five residents confirmed in surveys that they can do what they want to do during the day, in the evening and at weekends. Care Homes for Adults (18-65 years) Page 13 of 30 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. Residents are able to take part in appropriate activities. Residents have been encouraged to become part of the community. Residents have been supported in maintaining family relationships. Residents rights have been respected whilst ensuring their safety is maintained. Residents have been provided with a healthy, varied and appropriate diet. Evidence: Care records we examined demonstrated each resident has an individual activity programme for each day. This included a range of activities, including free time, in Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: which they wish to participate. From records and documents seen, and meeting with residents, we concluded that each programme has been drawn up with the interests and hobbies of individual residents in mind. In house activities include helping prepare dinner, looking after the homes animals, games, music, relaxation and DVD movie night. Residents who want to, have been allocated a placement at a local college. Other activities outside of the home include going to social clubs, football, trips to the shops, and trips out in the car. Residents told us they are able to do what they want each day and at weekends. We saw copies of minutes of resident meetings. They showed evidence that residents are regularly consulted with regard to the provision of activities and making plans for holidays. One resident showed us photographs of leisure activities, day trips and holidays they had enjoyed during last year. Records we saw indicated residents are encouraged to keep in touch with their families and friends. This includes information about those people who are important to each resident. We did not join the residents for lunch on this occasion. We were told that residents either take a packed lunch with them or are given money for lunch when they go to college. The main cooked meal of the day is provided in the evening, when residents and staff on duty sit down together. On the day of our visit the evening meal we saw being prepared was sausage casserole. We were told that, where appropriate, residents are expected to help with the preparation of the meal. We saw copies of menus that indicated that residents are provided with a varied diet appropriate to the needs. We were told that residents they choose the food they want to see on the menu. Copies of the minutes of resident meetings we saw demonstrated residents are consulted about menus. Care Homes for Adults (18-65 years) Page 15 of 30 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. Support and personal care provided takes into account the wishes and personal preferences of each resident. Care plans have not been routinely updated to reflect the changing physical and emotional health care needs of residents. Care staff do not have up to date information to follow to ensure such needs are met. Staff deal with medicines in a way that protects and supports residents. Evidence: We examined a selection of care records. The care planning system includes risk assessments where necessary. It also records visits by each resident to doctors and other health care professionals such as dentists and chiropody. However, we noted that care plans have not been routinely updated to take into account any treatment prescribed or any changes to medication. We have already noted that reviews take place on a monthly basis but care plans have not been routinely updated to ensure they reflect the current care needs of residents. We noted that medication has been appropriately and securely stored. Records seen had been well maintained and kept up to date. Medication records and care plans also Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: include clear directions to staff with regard to the administration of medication given on an as required basis. This includes medication which has been prescribed as part of agreed procedures for managing challenging behaviours. Care records include guidelines with regard to the circumstances when medication should be prescribed. Once medication has been given, the circumstances and the outcome of administering medication has also been routinely recorded. Training records seen confirmed that staff have received in house training in the safe administration and dispensing of medication. Staff we spoke to confirmed the training they had received. Care Homes for Adults (18-65 years) Page 17 of 30 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. The home has set up a system for ensuring residents views are listened to. Improvements are being made to care practices to ensure residents are protected from abuse, neglect and self-harm. Evidence: A complaint procedure has been drawn up so that residents and their families know how to make a complaint if they wish to do so. A procedure which is in picture form has also been drawn up. We saw that they were on display in the front hallway of the care home. However, we also noted that the information the procedure contained was not up to date. For example the procedure included the name of a manager who has since left. The contact details of the Commission was not up to date. We brought this to the attention of the senior manager who agreed to ensure amendments are made. Four surveys returned by residents confirmed they knew who to speak to if they were unhappy. However, only one resident confirmed they knew how to make a complaint. One survey confirmed staff and managers always listen to residents and act on what they say. Two surveys confirmed this is usually the case, whilst two confirmed they are only sometimes listened to. We asked to see the record of complaints that have been received. The member of Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: staff was unable to locate it. We looked at minutes of resident meetings. Residents are supported by staff and encouraged to discuss any issues that can be sorted out before they become major concerns. We spoke to some staff, who confirmed they know how to identify different types of abuse and also know what to do if they witness a resident being abused. Training records confirmed that staff are provided with training about adult protection. Prior to our visit we were made aware that the local authority has received a number of safeguarding adult alerts. As a result the local authority has conducted an investigation into the allegations made. We have been informed that the outcome of the investigation is that some of the allegations have been substantiated. They relate to the delivery of care to residents. We have also been made aware that the registered provider has put together an action plan to make the necessary improvements and submitted it to the local authority, who will be monitoring how improvements have been implemented using its powers under safeguarding adults procedures. Care Homes for Adults (18-65 years) Page 19 of 30 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. Residents have been provided with a homely, comfortable and safe environment in which to live. The premises has been decorated, maintained and furnished to a good standard. The majority of home has been kept to a good standard of cleanliness and hygiene. Some improvements are needed to standards of hygiene in the utility room. Evidence: We visited the bedrooms of three residents, the lounge and dining room. Those areas of the home seen were presented in a homely and comfortable manner. The decoration and furnishings provided ensured residents live in a comfortable and homely environment. We were told that residents have been able to personalise their own rooms. They were involved in choosing colour schemes and have also bought items such as posters and pictures, televisions, radios and CD players. We also saw that residents have been provided with equipment related to activities. For example we watched a resident play a game on a mini pool table in their room. Two surveys returned by residents confirmed the home is always fresh and clean whilst three surveys confirmed this is usually the case. We also viewed the kitchen, the utility room and the bathrooms and toilets. Apart Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: from the utility room, these areas of the premises were fresh, clean and hygienic. The floor in this room was very dirty and disused equipment, including radiators, a tumble drier and a washing machine was being stored here. We were informed staff clean these areas regularly, involving residents where appropriate. We were advised that, the state of the floor was due to the weather conditions on the day of our visit. Snow and ice were still lying on the ground. We advised the staff on duty that this area of the care home should be maintained to a good standard of hygiene and cleanliness to prevent the risk of cross infections. We also spoke to the senior manager who agreed to take the necessary steps to improve cleanliness and hygiene in this area of the care home. We were informed that staff also support residents with their personal laundry. Where necessary red bags and protective clothing are used to transport soiled clothing and bed linen to reduce the risk of cross infections. We noted there was a red bag containing wet clothes in the utility that had been left on the top of a work surface. We were informed the clothing was not soiled but had been soaked in the bath by the resident. The resident is known to do this when they are agitated. The bag had been used to transport clothing as they were soaking wet. Care Homes for Adults (18-65 years) Page 21 of 30 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. Competent and qualified staff support residents. The homes recruitment practices and procedures protect vulnerable residents. Allocation of staff to provide for residents means the staff team may not be able to meet residents needs. Evidence: We examined the recruitment records of three staff that had been appointed since our last visit. We found that all appropriate information and checks had been obtained to ensure vulnerable residents have been protected. This included two written references, proof of identity and criminal record checks. We spoke to two members of staff who were on duty. We asked them about their role at Gatwick Grove and what was expected of them. We asked them about the specific requirements of the residents and what staff are expected to do to ensure their needs have been met. We also asked them about the training they had received, including induction training, since they had been working at Gatwick Grove. This demonstrated staff were knowledgeable about their role and were able to explain the needs of individual residents and how they are to be met. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: We looked at staff training records. They demonstrated that newly appointed staff undertake structured induction training. This includes providing an understanding of the principles of good care practices and covers the promoting of residents rights, independence, choice and dignity. We were shown a copy of the induction booklet which is given to new members of staff. We were unable to see a completed record. We were informed records of newly inducted staff were with an external agent who was ensuring they had been satisfactorily completed. Training records we examined confirmed staff have been provided with mandatory training such as identifying and reporting abuse, fire safety, health and safety, first aid, infection control and food hygiene. Staff spoken to confirmed the training and induction training they had received. We observed staff on duty interacting with residents. This showed us that staff treat residents with respect and ensure their dignity is upheld. Following discussion, we were informed that staff are allocated to work with individual residents. They are expected to meet their needs according to care records and guidelines and they are expected to document what they have done on a daily record form. This includes information about appointments the resident has attended, activities and social events the resident has taken part and any visitors they have had. A separate sheet entitled service user daily activities provides an overview with regard to which member of staff has been allocated to which resident. It also includes information about duties staff are expected to undertake that are not specific to a resident . On the day of our visit we noted that there were five members of staff on duty. According to information provided on the allocation sheet four of the five residents had been allocated a member of staff who were to work on a 1 to 1 basis with them. The allocation sheet indicated that all staff were expected to work with the fifth resident. We were told the fifth member of staff was working an administration shift in order to complete paperwork and carry out other office based tasks. It was not clear from information provided what would happen if the resident being supported by all staff required assistance at the same time as another resident who required 1 to 1 support. Given the information we were given about the needs of residents accommodated, there is a possibility that this will cause conflict between two residents. We recommended that thought is given to clarifying how staff should respond if this occurs. Care Homes for Adults (18-65 years) Page 23 of 30 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 care home has not always been well run and in a way which benefits residents. The provider has been unable to demonstrate the care home has been closely monitored whilst a permanent manager is recruited There was no evidence that demonstrated a system of self monitoring, review and development of the care home. has been set up. The health, safety and welfare of residents and staff have not always been promoted. Infection control procedures have not been put in place with regard to maintaining hygiene standards in the utility room. Evidence: We have been informed that the post of registered manager fell vacant in September 2009. This person was also the designated responsible individual acting on behalf of the registered provider. We were informed that an acting manager was put in place whilst recruitment took place. We have since been informed that the acting manager has also resigned. The current management arrangements for Gatwick Grove are, Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: therefore, not clear. We have requested further information about this in correspondence separate from this report. The day to day running of the care home has been affected by the change in managers. This has also had an impact on residents living at Gatwick Grove. The investigation carried out by West Sussex Adult Services has substantiated some of the allegations made. The incidents investigated to took place at the same time. We have noted that care plans need to be reviewed and reorganised, consideration needs to be given to how staff are allocated to provide for residents needs, improvements are needed to maintaining hygiene standards in the utility room, and care staff need coaching and support in understanding the purpose of reviewing care plans. Whilst we have noted that the registered provider has worked toward making improvements required there has been insufficient time to ensure they have become embedded in practice. Shortcomings identified in this report are related to the day to day management of the care home. The appointment of a manager would ensure staff receive the leadership and direction they need to provide good quality care to residents. We were informed that representatives of the registered provider visit Gatwick Grove each month. When we examined reports of such visits we could not find evidence that visits had been made in November and December. Given the current management situation we would expect the registered provider carried out such visits so that the registered provider can demonstrate the day to day running of the care home is being closely monitored. We were informed that the registered provider has appointed a senior manager to be responsible for quality assurance. We were shown an organisation chart of Ditchling Rural Care Ltd that showed where this post fits within the organisation. However, we could find no evidence that system for reviewing and improving service provision had been set up within the care home. We spoke to a senior manager who confirmed that such a system had yet to be implemented. We were shown records of staff supervision and staff meetings. They demonstrated that such meetings are held regularly and are used by the registered provider to communicate with staff and to ensure staff are appropriately supported. Staff we spoke to confirmed that such meetings do take place and that, as a result they felt well supported in their work. There is an internal system for staff to use to record and report any issues related to the maintenance of the premises to ensure any defects or repairs are dealt with in a Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: timely manner. We have noted in the Environment section of this report that, as part of infection control procedures, good standards of hygiene have not always been maintained in the utility room. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 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 30 13 The registered provider must ensure the cleanliness and hygiene in the utility room is maintained to a good. This will reduce to risk of possible cross infection. 01/02/2010 2 39 26 The registered provider must ensure regular unannounced visits to the care home are carried out on a monthly basis. They must also be recorded. This will ensure the day to day management of the care home is appropriatley monitored. 01/03/2010 3 39 24 The registered provider 01/03/2010 must set up a system for reviewing and improving the quality of care provided. This will ensure the home is being run in the best interests of residents Care Homes for Adults (18-65 years) Page 28 of 30 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 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!