Care Home: Gracelands

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What the care home does well People who live at Gracelands are supported to make decisions and choices and this means that people have control over their lives.People are supported to take part in activities of daily living thus promoting their independence. What has improved since the last inspection? Over recent months there have been a number of changes at Gracelands that have led to people receiving a better, and safer service.Staff are trained and supported to manage behaviors that may place people at risk of harm and they have also implemented support plans that have reduced incidents within the home that cause people upset and distress.Opportunities for people to enjoy activities have improved and people now have money and support to do the things that they enjoyCare plans and risk assessments are up to date and reflect peoples care and support needs and this has been particularly useful for the new staff that have joined the team to help them get to know the people they are to supportStaff feel well supported and well trained meaning they are better able to offer safe and effective support to people living at GracelandsStaff told us that morale at the home has improved and staff now enjoy coming to work. What the care home could do better: The current manager of the home should have been given more information about how the home is run when she started the job. This would have enabled her to be more knowledgeable of systems in place to protect people living at Gracelands and will be aware of processes to follow when things go wrong.Gracelands need to be redecorated to make it a nice place to live.Bathrooms need to be refurbished to make them more modern and hygienic.Records that show how much money people have could be made easier for people to use.Care plans could be written in a way that the people they belong to can understand. This way people will feel part of the care planning processes and be able to be involved in their development and review. Key inspection report Care homes for adults (18-65 years) Name: Address: Gracelands Ellesmere Road Whittington Oswestry Shropshire SY11 4DJ 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: Sue Woods Date: 2 7 1 0 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 37 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (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 37 Information about the care home Name of care home: Address: Gracelands Ellesmere Road Whittington Oswestry Shropshire SY11 4DJ 01691652153 01691652153 Telephone number: Fax number: Email address: Provider web address: www.loppingtonhouse.co.ukEmailoffice@loppingtonhouse.co.uk Loppington House Ltd The registered provider is responsible for running the service care home 7 Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 7 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 7 Date of last inspection 2 5 0 8 2 0 0 9 A bit about the care home Care Homes for Adults (18-65 years) Page 4 of 37 Gracelands is a large house that is shared by seven people. The home is situated in the village of Whittington which has its own shops and pubs as well as an historic castle. Everyone who lives at the home has his or her own bedroom. Nobody has to share a room. The home has three bathrooms, a kitchen that you can access with staff support as it has a lock on it, and a small patio at the back of the building where people sit and relax or play ball games. The home has two cars Care Homes for Adults (18-65 years) Page 5 of 37 available to take people to the shops, to visit family or to access leisure and social activities. The manager and the staff team support people to make decisions about how they live their lives and there is an advocate who visits the home to make sure people are able to make choices and have a say in the running of the home. He is happy to support anyone who lives at the home. Care Homes for Adults (18-65 years) Page 6 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 37 How we did our inspection: This is what the inspector did when they were at the care home We visited Gracelands on 27th October 2009 and stayed there for six hours. The home did not know we were coming. During the time that we were there we looked at what it is like to live at the home. We did this by meeting and speaking with the people who live at Gracelands and talking with the project manager and staff on duty. As some people could not tell us their views of the home we also spent time watching how staff support people to live their lives. Care Homes for Adults (18-65 years) Page 8 of 37 We looked in more detail at how the home meets the care and support needs of two people by meeting and observing the people chosen, talking about their care with staff and looking at their care files. We also looked at how the home supports a third person although we did not meet him on the day of our visit. This process helps us understand what it is like to live at Gracelands and whether those people receive a good service or not. We looked at staff files to see how the home makes sure that people working at Gracelands are safe and suitable to do so and we also looked at other records to see how the home is run. Care Homes for Adults (18-65 years) Page 9 of 37 Before the visit the home sent us the Annual Quality Assurance Assessment (AQAA). The project manager completed this. This is a form that tells us how the manager thinks the home is meeting the needs of the people they support and also tells us other information relating to how the home is run. What the care home does well People who live at Gracelands are supported to make decisions and choices and this means that people have control over their lives. Care Homes for Adults (18-65 years) Page 10 of 37 People are supported to take part in activities of daily living thus promoting their independence. What has got better from the last inspection Over recent months there have been a number of changes at Gracelands that have led to people receiving a better, and safer service. Staff are trained and supported to manage behaviors that may place people at risk of harm and they have also implemented support plans that have reduced incidents within the home that cause people upset and distress. Care Homes for Adults (18-65 years) Page 11 of 37 Opportunities for people to enjoy activities have improved and people now have money and support to do the things that they enjoy Care plans and risk assessments are up to date and reflect peoples care and support needs and this has been particularly useful for the new staff that have joined the team to help them get to know the people they are to support Staff feel well supported and well trained meaning they are better able to offer safe and effective support to people living at Gracelands Care Homes for Adults (18-65 years) Page 12 of 37 Staff told us that morale at the home has improved and staff now enjoy coming to work. What the care home could do better The current manager of the home should have been given more information about how the home is run when she started the job. This would have enabled her to be more knowledgeable of systems in place to protect people living at Gracelands and will be aware of processes to follow when things go wrong. Care Homes for Adults (18-65 years) Page 13 of 37 Gracelands need to be redecorated to make it a nice place to live. Bathrooms need to be refurbished to make them more modern and hygienic. Records that show how much money people have could be made easier for people to use. Care Homes for Adults (18-65 years) Page 14 of 37 Care plans could be written in a way that the people they belong to can understand. This way people will feel part of the care planning processes and be able to be involved in their development and review. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sue Woods 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT 01216005300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 15 of 37 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 16 of 37 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 17 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an appropriate admissions policy in place should the need arise and the Statement of Purpose is kept up to date. This means that should any one move to the home they can be confident that their individual care and support needs can be identified and will be met by the home and information provided by the home will be useful when deciding if the home is right for that person. Evidence: The projects manager told us that there have been no new admissions to Gracelands within the last two years. However we have previously seen that the home has appropriate procedures in place to ensure the successful admission of a person to the home and that people already living at Gracelands are fully consulted and involved in the process. The homes Statement of Purpose and Service User Guide were both displayed in the hallway and copies of the Service User Guide were seen on care files reviewed. Both documents reflect current management arrangements and the projects manager has agreed to ensure that information about any restrictions in place within the home are recorded in these documents to make any one who may be interested in the home aware Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: of them. Care Homes for Adults (18-65 years) Page 19 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans, on the whole, promote independence and ensure that people receive care and support in a way that they prefer and are supported to be safe in their homes Evidence: We looked at the care plans for three people living at Gracelands to see if they reflected peoples care and support needs. The plans were clearly written and promoted peoples independence in every day living tasks and we found that peoples likes and dislikes are recorded as well as things that are important to people. This suggests that the home wants to support people in ways that they prefer and offer choices and opportunities for people to enjoy full and active lives. However there is work to be done to enable people living at Gracelands to be involved in the development of these plans and staff are to receive training to enable this to happen. Plans are now in place to support people when they are anxious or displaying behaviours that place themselves and others at risk of harm and staff are very confident that these plans (along with the training they have received) will enable them to keep people safe and support people consistently during times when they are agitated or anxious. Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: The home continues to work with an independent advocate who visits the home to support people to make decisions and share their views. His last meeting with people living at Gracelands was recorded and showed that people were asked about menus, activities and staff. The advocate fed back to the home actions agreed at the meeting. This process helps peoples views and wishes be heard and actions be monitored to enable people to live the lives they choose. We found that the home ensures that daily activities are as safe as possible for people to enjoy. Risk assessments were seen in place for community and home based activities and they had been reviewed to ensure they were still appropriate. Although improvements to care plans were noted during this visit we did find that some assessments carried out by the home did not accurately reflect care plans. People may be vulnerable if assessments or care plans are inaccurate. Where restrictions are in place within the home, risk assessments support them. The manager is looking to review arrangements in place to keep people safe to be sure that they are the least restrictive options for others living at the home. Care Homes for Adults (18-65 years) Page 21 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Gracelands are now starting to access a variety of activities both within the home and in the local community enabling them to enjoy a better quality of life. People are being involved in household tasks enabling them to remain as independent as they are able. People continue to benefit from supported family contact and involvement meaning that they are able to stay close to the people that matter to them. Evidence: A number of changes within the home have meant that people are now able to enjoy a range of activities and opportunities that enable them to enjoy a better quality of life. Staff feel enabled to arrange trips and activities and, with money available, are able to offer a range of community based activities that people enjoy. For example one person is Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: planning a shopping trip and a group of people went out for a meal the night before our visit and one person told us that she had enjoyed herself, while staff said that people had been relaxed and chatty. Although the manager and the staff team want to develop activities further everyone is positive that people are now having opportunities to take part in activities that they enjoy. Records show activities take place most days and on the day of our visit people went to the local shops and for a walk to the castle. Activities recorded reflected peoples likes and preferences and when activities do not take place key workers and the homes advocate are exploring why. Additional staffing for one person means that he is able to do more activities that he enjoys and staff say he is happier as a result. Family support is encouraged and contact is recorded to show that people stay in touch with the people that matter to them. On the day of our visit one person had been supported to do her laundry and she told us that she was waiting for it to dry. Care plans identify what independent living tasks that people are able to take part in suggesting that people are encouraged to be as independent as they are able. The home is currently looking to develop the menu to reflect peoples likes (and dislikes) and reflect peoples medical support needs. Staff told us that this is happening and the advocate referred to menus in his most recent meeting where he recorded that people like the meals Care Homes for Adults (18-65 years) Page 23 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of the people who live at Gracelands are generally well met enabling them to enjoy good health and receive support in a way that they prefer. Systems are in place to enable the safe storage, recording and administration of medication however if the home does not investigate errors or take action to reduce the likelihood of them happening again then people living at Gracelands are at risk of harm Evidence: Care plans showed us that people attend regular health care appointments in order to keep them well. When people have been seen by health care professionals records show that the outcome of these meetings are recorded and changes are made to care plans as appropriate. This means that people receive the medical support that they need to remain in good health. One person is currently in hospital following a fall within the home. A staff member had visited him on the morning of our inspection and had supported nursing staff with his personal care. This suggests that the home works with health professionals to ensure that the needs of the people who live at Gracelands are met ensuring their care needs are met Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: even when away from home. Care plans are very detailed to enable staff to know how people prefer to have their personal care needs met and people are encouraged to be as self managing as possible. We saw staff support people sensitively and discreetly during our visit. Key workers who spoke with us were knowledgeable of peoples care and support needs and are involved in reviewing plans enabling consistency and continuity of support. Arrangements in place for the recording and storage of medication were satisfactory with protocols in place to enable staff to be consistent when administering medications as and when required. The organisation had recently carried out an audit of medication arrangements however two medication errors had not been properly investigated (or mentioned in the audit) meaning that people are potentially vulnerable. The homes medication policy states that the manager and the operations manager should investigate medication errors and although the manager had looked at implementing a system where two staff sign to witness the administration of medication (although this could not be evidenced at the time of the inspection) no investigation had taken place or additional training or monitoring implemented for the person who made the error. Staff administering medication have been trained to do so, although currently staff witnessing the administration of medication have not. People may not be fully aware of their role as a result. Care Homes for Adults (18-65 years) Page 25 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by procedures in place for managing concerns and complaints and can be confident that their concerns will be listened to. People living at the home can now feel more confident that the home operates with their best interests at heart by being knowledgeable of local safeguarding procedures to protect people from abuse and staff feel more confident to speak out if they have any concerns. People can be confident that their money is managed well on their behalf however if processes were easier to understand it may reduce the likelihood of errors being made thus offering better overall protection. Evidence: Since the time of our last visit the project manager has worked hard to support staff to feel able to share concerns and speak out about poor or abusive practice within the home. This means that people who live at Gracelands can receive a better quality service free from intimidation or harm. Staff have now received training to recognise and report abuse and the home is working openly with the local multi agency team to investigate a recent incident. Staff are now better trained and supported to support behaviours that are complex or challenging and as a result people are safer within the home Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: There have been no complaints about the home since the time of our last inspection and a social care worker recently commented positively about the atmosphere within the home suggesting people are happier and more relaxed. Peoples money is safeguarded by the home as there are a number of checks that take place to ensure all money is accounted for. People do not manage their own money but staff say that money is now readily available for people to enjoy both planned and spontaneous activities meaning they can live full and active lives. Records showed that money was available however it was difficult to see what people had actually spent as the amount is not recorded. The manger was unable to explain the recording system to us and staff said that it was currently very confusing. This could lead to errors being made. The double signing arrangement was not being used on all occasions again making the system vulnerable. Care Homes for Adults (18-65 years) Page 27 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Gracelands are provided with a safe place to live however redecoration and refurbishment will make the house more homely and changing one of the bathrooms into a walk in shower room will offer people a choice of bathing facilities Evidence: At the time of our visit we looked around the home to see if the environment was safe and well maintained. The home was clean and tidy although communal areas require redecoration to make Gracelands a nicer place to live. Bathrooms in particular were in need of refurbishment. At the time of our last visit the manager told us that plans have been approved for one of the bathrooms to be turned into a walk in shower. The current projects manager was unaware of this but felt that a walk in shower would provide people with a choice of bathing facilities. Staff also commented that this would improve the home by giving people more choice. We again recommend that this task be made a priority. Given that one of the walls in the upstairs bathroom is only plasterboard it would be difficult to keep it clean and hygienic. Staff have received training in infection control and staff and people living at the home use disposable gloves and aprons for meal preparation to ensure that overall good standards of hygiene are maintained. Care Homes for Adults (18-65 years) Page 28 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Gracelands receive good care and support from an appropriately trained and committed staff team enabling their needs to be effectively met within the home. Appropriate pre employment checks on staff who work at Gracelands ensure that the home only appoints people who are suitable to work with vulnerable people. Evidence: Since the time of our last key inspection of the home staff have received training to enable them to carry out their roles safely and effectively within the home and this has made people living at Gracelands safer and more consistently supported. Records show that the majority of staff have received all required training and staff told us that they feel they have the skills and knowledge to support people safely and competently. New staff told us that they received a thorough induction and that existing staff have been very supportive and helpful in assisting them to get to know the people they are to support. Key workers confirmed they had been involved in this process. Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: The projects manager is now supporting and supervising formally all staff and staff feel that she is approachable and listens to their views and suggestions. As a result morale is improving within the home and ultimately people are receiving a better service. Staff feel that team work can still improve and the manager agrees. Staff told us that they are planning activities, including parties for people living at Gracelands to celebrate Halloween and Christmas which will also build on team work and staff have responded positively so far. All staff who spoke with us said there were sufficient staff on duty to enable them to meet peoples needs safely and support activities. There has been a drastic reduction in the number of incidents within the home suggesting that people are being stimulated and supported. Staff told us they now look forward to coming to work. All staff spoke positively about recent changes and the current management support. Care Homes for Adults (18-65 years) Page 30 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current management arrangements are impacting positively on the home enabling people living at Gracelands to enjoy a better quality of life however management support must be available to ensure that the project manager is supported and fully aware of policies and procedures that keep people living and working at the home safe Evidence: The projects manager is well respected by her staff team and everyone who spoke with us felt that she was doing a good job and that improvements were being made to the home that are ultimately improving the quality of the lives of the people who live at Gracelands. The project manager is drawing on her experience and prior knowledge and training to support Gracelands to improve the service offered to the people who live there however in order for her to do this she should herself receive training and guidance from senior managers. The projects manager had no formal induction to the home or the processes within it. As a result of this lack of training and support recent medication errors were not investigated appropriately. Overall recording practices have improved at Gracelands however the home is still implementing paperwork that would be more suited to an older Care Homes for Adults (18-65 years) Page 31 of 37 Evidence: client group rather then developing a more person centred approach. Some records do not reflect information in care files suggesting they are not effective tools. We looked at reports produced by senior managers checking that the home is operating safely and in the best interests of the people who lived there. The latest report identified areas of improvement however there was no record on any monitoring visit that looked at the medication errors suggesting that arrangements are still not identifying all areas of vulnerability within the home. Care Homes for Adults (18-65 years) Page 32 of 37 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 of 37 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 6 14 In house assessments of need must accurately reflect peoples care and support needs 27/11/2009 This is to make sure that staff know what peoples needs are and are able to meet them as appropriate. 2 20 13 People administering medication must be trained and assessed as competent to do so 20/11/2009 This is in order to reduce the risk of people receiving the wrong medication or not receiving their medication as prescribed 3 27 23 The home must be refurbished and redecorated as identified at the time of our visit. 29/01/2010 Care Homes for Adults (18-65 years) Page 34 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action This is to ensure that Gracelands is a nice and hygienic place to live 4 37 18 The projects manager must receive an induction to the home . 27/11/2009 This is to ensure that she has the knowledge and skills to take on the management role and ensure the safety and protection of the People living at the home Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 It is recommended that every one living at Gracelands receives an up to date social care assessment of their care and support needs to ensure that the home remains able to meet their needs. It is recommended that care plans are now developed in a format that is user friendly and centres around the person it belongs to. This will encourage and support people to be involved in the development and review of plans It is recommended that the home review the recording sheets for recording what money people have taken out, spent and returned to the home as the current system is confusing and this could lead to mistakes being made. It is strongly recommended that consideration be given to adding shower facilities within the home in order to give people a choice of bathing opportunities 2 6 3 23 4 27 Care Homes for Adults (18-65 years) Page 35 of 37 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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