Care Home: Harelands House

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What the care home does well Before people went to stay at Harelands House they were gradually introduced to the home and the staff to find out if they would like to stay there, and so that staff could get to know them and find out what care and support they needed. People could visit the home for short periods and have a meal before spending a night or two and longer periods. There was also some good written information about the care and support that people needed and about their likes and dislikes, for example, what they liked to do in their spare time and liked to eat (see below). The staff looked after people well and worked hard to make people`s stay in the home happy and enjoyable. Those who were spoken with seemed happy staying in the home and appeared to get on well with the staff. The people who completed the questionnaires and their relatives praised the care and support in the home. One said that Hareland House was "a very friendly ordinary type of home that makes you feel important, respected and valued". Another said, "there is a good connection between staff, parents and individuals and they are constantly looking at more opportunities for everyone". Someone else said, "we think the staff are excellent". People staying in the home were supported to carry on with their interests and activities that they did at home, and arrangements were made for people to attend their day centres. People also were able to attend any health care appointments that coincided with their stay at Harelands House. Even though people only had short stay periods at Harelands House they were given choices about what they could do in the home, such as what to eat, entertainment and where to go at the weekends. Also people could sometimes stay in the home when they wanted, such as when their friends were staying, and the home tried to meet the special needs of people because of religion or culture. Relatives knew what to do if they were not happy with anything, and people`s concerns were taken seriously. People were safe living in the home and staff knew what to do to protect people. The home was comfortable, clean and pleasantly furnished and was in keeping with the service users` age group. Staff had the right qualifications and training for working with people with disabilities and had a good understanding of how to look after them. The training programme was developed according to people`s needs. The home was run in the interests of the people using the service and their families, and the staff had ways of finding out people`s views and wishes about how the home should be run. The home made sure that people enjoyed their stay as much as possible. What has improved since the last inspection? The home had made some improvements that they were asked to make at the last inspection in 2007, such as some service users were given keys to their room and some parts of the premises had been improved and disabilty equipment replaced with more modern equipment. What the care home could do better: The written information about some of the service users and the care and support they needed on admission could be improved so that all support and care needs are reviewed for each visit and updated as necessary. However we are confident that this will be improved following the guidance given at the visits to the home. Also some information about cultural matters, choices and risks was not detailed enough to provided useful instructions to staff on all important matters. The written information about the risks to people in their every day life (risk assessments) was not as good as it could be and there was not enough guidance to staff to help them protect people, such as for the use of bed rails, epileptic seizures and and for people who want to administer their own medication. However we were confident that shortly after the site visit the risks associated with the use of bed rails had been eliminated. The written instructions telling staff when and how to manage and give out "when required" medication could be improved to make sure that people get the right medication at the right time whilst staying in the home. Some aspects of the premises could be further improved, and the outstanding repairs identified carried out more quickly. Also the homeliness and privacy matters in one bedroom could be improved by the separation of the sleeping area from the bathroom and toilet area. We are assured that this would be addressed shortly after the site visit. The records kept in the home for new staff could be better. They need to include all relevant information about people`s application and employment history to demonstrate that people are suitable applicants. Key inspection report Care homes for adults (18-65 years) Name: Address: Harelands House Samson Street Belfield Rochdale OL16 2XW     The quality rating for this care home is:   two star good 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: Pat White     Date: 2 2 0 3 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 29 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 29 Information about the care home Name of care home: Address: Harelands House Samson Street Belfield Rochdale OL16 2XW 01706651712 01706715363 ssharelands@rochdale.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Rochdale MBC Name of registered manager (if applicable) Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: 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 on admission to the home are within the following categories: Learning diability - Code LD. The maximum number of service users who can be accommodated is: 5. Date of last inspection Brief description of the care home Harelands House, which is owned by Rochdale MBC, offers short-term support accommodation for up to five service users over the age of 19 years, with a learning disability. The service aims is to provide respite to parents/carers of people who are cared for in their own home, to enable them to maintain their role as carers. The home is adapted to meet the needs of profoundly disabled individuals. Four beds are for short-term respite care and one bed is for emergency placements. Lengths of stay vary, dependent upon need, but the service is available 52 weeks a year. An outreach service is also provided. The bedrooms are single and have en-suite facilities. The home is situated close to local shops, pub and public transport. A safe enclosed garden Care Homes for Adults (18-65 years) Page 4 of 29 5 Over 65 0 Brief description of the care home area is provided which is accessible by people reliant upon wheelchairs. The charges for the service are dependent upon the age of the person and how long they were staying and information about up to date fees is available from the manager. Service users had to pay for their own outings and toiletries. The manager makes information about the service available to people in the form of an information pack Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This main (key) inspection was undertaken to assess all the important areas of life in the home according to the National Minimum Standards for Younger Adults, and to determine an overall quality rating of the home about the care, services and facilities provided. This inspection included 2 site visits to the home that were undertaken of the 19th and 22nd March 2010. During these visits we talked to some people staying there, looked round, looked at service users care records and other documents, and talked to staff and the manager. Also we used some written information about the home that was given to us before the visits and which told us about the facilities in Harelands House, the staff and the premises. Questionnaires were also sent to some people using the service, and their families, and to some staff, to find out peoples views about the service. At the time of writing the report we had received completed questionnaires from 4 service users whose relatives had completed them on their behalf, and 7 Care Homes for Adults (18-65 years) Page 6 of 29 members of staff. Some of the views of these people, and the people who were spoken with, are included in the report. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? The home had made some improvements that they were asked to make at the last inspection in 2007, such as some service users were given keys to their room and Care Homes for Adults (18-65 years) Page 8 of 29 some parts of the premises had been improved and disabilty equipment replaced with more modern equipment. 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 order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 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 29 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 admissions procedures would help ensure that peoples needs were understood before they came to stay in the home, and also that people were as prepared as possible for the break from their families. Evidence: All the written information about the home available for people who used the service and for prospective service users was not assessed at this inspection. However we saw that there were information packs in the bedrooms and that some of this information was pictorial, such as the complaints procedure and examples of menus. Therefore this information could be understood by some service users who cant read. Through talking to staff and and looking at records it was evident that before people had respite care at Harelands House for the first time, they were gradually introduced to the service to see if the home was suitable for them, and to see whether or not their needs could be met there. There was a thorough procedure for this introduction, starting with a comprehensive assessment of the prospective service users needs undertaken by their social worker. Senior staff of the home met with service users and Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: their main carer and family to get to know them, and to gradually introduce them to the home. Service users could then visit the home for meals and overnight stays before deciding whether or not they wanted to regularly use the respite facility. However some of these visits and the information learned from them were not written down, so useful information about people and their needs may not be available to assist staff in understanding these needs. For people who regularly stay at the home their needs, and any changes, were updated through social work reviews and contact with the families before the booked period of respite. This contact with the families before each stay served to update peoples health care needs and medication. However this did not include a review of other important matters relating to personal and social care according to the National Minimum Standards, such as moving and handling, communication, mental health matters and information about specific conditions. Whilst there was no evidence at this inspection that peoples needs were not being met in the home, written updated and accurate information about peoples needs is necessary to assist communication amongst staff that helps them provide the right care and support. This was discussed fully with the manager and on the second site visit a document had been devised that could be used to update the information on all aspects of health and personal care. We were told that this would be used immediately. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans were detailed and person centred and provided useful information to staff to assist them, but more accurate information was needed to guide staff on how to protect people from risks. Service users were encouraged to make choices in their lives whilst staying in the home and to maintain their independence. Evidence: Each service user staying at Hareland House, for however short a time, had a care plan which provided written information about their needs and how staff should meet these needs. The 2 plans looked at showed that some parts of these plans were detailed and person centred. This means that they described how people said they would like to be supported, and included details of peoples preferences and likes and dislikes and some useful information about their lives. There were sections on all relevant aspects of personal, social and health care, and as stated above some sections were completed fully and provided useful guidance to staff. However there were some gaps in the written care plans. For example one care plan did not provide written guidance about the risk associated with epileptic seizures and guidance to staff Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: on what to do if and when these happened. Also this care plan did not have satisfactory accurate information about the risk of falling out of bed and the use of bed rails (see later sections). Another care plan did not have sufficient information about how decisions were made about a service user not smoking whilst staying in the home and what staff should do if they requested cigarettes (see below). Though there was no indication that people were not receiving the correct support, detailed written instructions are useful to help make sure that the right support is provided in the safest way and the right decisions are made. There was evidence that people had sufficient choices in their lives whilst staying at Harelands House and as stated above the care plans we looked at were person centred and stated what people liked to do and how. Talking to staff, looking at records and the information provided to the commission by the service prior to the site visits showed that people had choices in their daily routine, meals, channels on TV and what to do at the weekends. Staff worked closely with the relatives to establish peoples likes and dislikes and what they would like to do whilst staying in the home and peoples preferences were accommodated whenever possible, such as some people choose the same period of respite as their friends. Some service users chose to manage their own spending money whilst at Harelands House, and staff support them in this. Service users and families were encouraged to participate in the running of the home in ways appropriate for a short term care facility. Peoples opinions were sought after every stay in the home and this contributes to the development of the service. Staff understand the need to encourage service users to maintain and if possible increase their independence. For example staff said that residents could have a key to their bedroom door if they could manage one, and that some people could help in the kitchen if deemed safe. Care Homes for Adults (18-65 years) Page 14 of 29 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. Service users were encouraged to take part in appropriate activities and to maintain their independence. Relationships with family and friends were encouraged and supported and the food served was in accordance with peoples preferences. Evidence: The information provided to the commission prior to the site visit told us that service users were encouraged to continue with their interests and activities whilst staying at Harelands House and this was confirmed through talking to people and looking at records. Some service users continued to attend their day centres, with transport to and from the house being provided. Service users interests and activities were recorded in service users personal records and showed that people were taken shopping, enjoyed watching TV and listening to music, and were encouraged to use local facilities such as the cinema, going to local beauty spots and going to restaurants. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: Staff in the home made sure that close links were maintained with families. Families were involved in the planning of the service and informed of any concerns during peoples stay in the home. They were also involved in reviews in between periods of respite care. The relatives who completed the questionnaires for the commission felt that they worked in partnership with the staff in the home. One said that there was a good connection between staff, parents and individuals and that they were always looking at more opportunities for everyone. Service users were also encouraged to maintain and develop friendships, and sometimes people chose to stay in the home when their friends were there. Friends could have meals in the home. As stated above there was information on the care plans about peoples preferred routines and likes and dislikes and these records and talking to staff demonstrated that in general peoples independence and rights were promoted. People could have keys to their bedroom door (see above) and most service users had free access around the home. The food was cooked and served by the support staff, and peoples likes and dislikes were catered for, some of which were recorded on the care plans. The menu showed a mix of traditional and more contemporary meals that were in keeping with the service user age group. Food was also served according to cultural and other special requirements, such as Halal meat. A tea time meal was observed on the day of the site visit - a buffet style meal that service users looked forward to each week. The meal was relaxed, with good interaction between staff and service users. Appropriate assistance was given to some service users who required feeding. However at the time of the first site visit the variety of the food served was limited, as meals were planned using a one weekly menu, and a recommendation made at the previous inspection regarding a more varied menu had not been followed. This was discussed with the manager and by the time of the second site visit a second (week) menu had been devised. We were assured that this was for immediate use, and which should ensure a greater variety and choice for the service users, and particularly for those who stay longer than a week. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People received appropriate personal care support and health care. Medication was managed and administered safely though written guidance for staff could be improved to ensure all medication is taken safely and at the right time. Evidence: Records and talking to staff showed that people received the various levels of personal support they needed and that staff understood their needs. Time was spent in the introductory period getting to know people and how to look after them, and relatives were inviolved in this process. There was also evidence that people received personal support in a culturally sensitive way such as whether people required male or female carers. Peoples health needs were recorded on the care plan and were updated for every visit. Though the home was not responsible for the organising of peoples health care, the home ensured that people received the health care they needed whilst staying in Harelands House. For example people would be taken to a hospital appointment if this fell within the period of their stay. People had access to their General Practitioner and the out of hours services if need be. We were also informed that if people had Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: significant health care needs, such as for pressure areas, extra staff would be on duty and the relevant outside agencies would be involved. There were policies and procedures for the management and administration of medication and some good practices were in place. Looking at records and checking 2 peoples medication showed that good records were kept of medication coming in and out of the home, and accurate records were kept of the medication administered. Every effort was made to ensure that medication was administered according to how this was administered at their own home. Staff administering medication had undertaken training. Service users who administer their own medicines at home were supported to do so in Harelands House. However this was not underpinned by a risk assessment that identified whether or not this was safe, identified any risks, or stated what staff needed to do to ensure the service users took their medication safely. Also some other matters were identified that needed reviewing according to good practice guidance, such as, there was insufficient information about whether or not non prescribed medicines (homely remedies) that people brought in to the home were safe for people to take. Though staff had undertaken specific training in the administration of suppositories there were no specific written guidelines to instruct staff on when this (when required) medication should be given. This is necessary so that the suppositories are given at the right time. We are confident that the improvements suggested will take place. Care Homes for Adults (18-65 years) Page 18 of 29 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. There were thorough systems in place to ensure that peoples concerns were taken seriously and to help protect people from harm and abuse. Evidence: The complaints procedure was available in the home, and there was a picture format available to assist some service users to understand what to do. According to the information supplied by the home prior to the site visit no complaints had been made to the home in the last 12 months. None had been made to the commission. Those service users and relatives completing the commissions questionnaires said that they knew what to do if they were not happy with anything. There were satisfactory policies and procedures to help protect people from abuse, including a whistleblowing procedure, and staff had undertaken relevant training in Safeguarding Adults. This should further help to protect people. Since the previous inspection there had been one incident between 2 service users that required investigations under the safeguarding procedures. Initially this had not been reported properly to management, but subsequently all correct procedures had been followed, and appropriate action taken. Records were kept of this to show how matters had been dealt with, and the outcome of the investigations resulted in an improvement in the staffing levels in the home at appropriate times. Care Homes for Adults (18-65 years) Page 19 of 29 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. The home provided comfortable and safe accommodation in accordance with the aims and objectives of a short term respite service for this service use group Evidence: The information supplied by the home prior to the site visits told us that some recent refurbishment and re decorating had been done in the home. There were some new carpets and a new cooker had recently been fitted. We were also told that some new disabilty equipment had been installed in 2 bedrooms to enable people to have their personal care undertaken safely and comfortably. These developments were confirmed during a tour of the premises at the site visit, and when we found the home to be comfortably and pleasantly furnished and in keeping with the residents age group. However some areas that needed repairing were identified. We were told that these had been reported to the organisation responsible for maintenance. As stated above there was new equipment to assist people with multiple disabilities, including tracking hoists. One bedroom had been recently adapted to include a number of appliances including a shower with a trolley. However at the time of the site visit due to structural problems this room was open plan with no separation of the sleeping area and the bathroom/toilet area. This was discussed with the manager who agreed to ensure that a partition would be found to ensure a more homely, Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: comfortable bedroom that upheld peoples right to privacy in personal care. Two beds had ill fitting bed rails at the time of the site visit which could have put people at risk from entrapment of limbs. Before the end of the site visits steps had been taken to make these beds safer and we were also informed that there were plans to purchase a specialist bed with integrated bed rails (See Conduct and Management of the Home). At the site visit we found that the home was clean in the areas viewed. In the survey questionnaires returned people were satisfied that the home was clean and fresh. Care Homes for Adults (18-65 years) Page 21 of 29 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. There was a well qualified and trained staff team that could meet the needs of the service user group. Staff recruitment procedures should help ensure that only suitable people worked in the home but the records kept in the home to evidence this could be improved. Evidence: The information supplied to us prior to the site visit and talking to staff indicated that those new members of staff without relevant qualifications had to undertake National Vocational Training including the Induction to Care course specific to those working with people with learning disabilities. Records showed that staff had access to a variety of training course through Rochdale Borough Council, including health and safety related training such as moving and handling, first aid and food hygiene, and training in medication, mental capacity, safeguarding of vulnerable adults and person centred planning. At the time of the inspection about 80 of the permanent staff at Harelands House had completed relevant National Vocational Qualifications at different levels. There was also evidence that staff had completed the in house induction in addition to that required for those working with people with learning disabilties. This should ensure that people were confident and competent when they commenced work in the home. This was confirmed by the staff who completed the commissions questionnaires. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: We were told that the home was staffed according to the needs of the residents, though 2 staff who completed questionnaires felt that more staff should be on duty sometimes to increase the options for service users, as did one relative. This should improve when the home is fully staffed again, as is expected in the near future (see below). There was a mixture of male and female staff that enabled them to provide a gender specific service if need be. We were also told that there had been some staffing problems since the previous inspection which had resulted in staff vacancies and pressure on the existing staff team. However at the time of this inspection staff were being recruited and we were told that the situation was improving. All those spoken with, and some who completed the questionnaires, felt that there had been an improvement in all areas, including staff morale, since the new manager was appointed. Staff records were looked at to check the staff recruitment procedures and these were also discussed with the manager. These showed that the necessary checks, such as the Criminal Records Bureau and references, were carried out prior to people starting work in the home, but that there were some gaps in the records kept in the home. For one member of staff whose records were viewed there was no application form in the home or record of this having been seen by the manager, and for another there was no application form or copies of the written references in the home. We were told that these were kept centrally in Rochdale Borough Council but that copies of the references were normally sent to the home. The manager subsequently confirmed her receipt of the outstanding references, and we were also reassured that records would be kept of relevant details on the application form such as whether there were any gaps in the employment history and what explanation was given for these. Staff spoken with, and most who completed questionnaires, felt that they were satisfactorily supported by managers. Regular team meetings were held, and these support measures should assit communication and good team work. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was managed and run in the interests of the service users and families who need respite care. The health and safety of the staff and service users was promoted. Evidence: There was a new manager in the home who was not yet registered with the commission and had not yet completed the required management qualification. However she had relevant experience and had completed numerous other relevant courses. She was also in the process of applying to the commission for registration and of enrolling on the required management course. There was also a senior support worker in post, who also acted as the deputy manager when required. We were told by other staff that, after an unsettled and difficult period, the new management was now providing the leadership and guidance that was needed. Systems were in place to try to find out the views of service users and their relatives. Questionnaires were given to people, service users and relatives, after every stay in the home, to find out their views and what could be improved. Families were also contacted before admission to see what services they needed and if any changes to Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: care and support were needed from the previous visit. Relatives who completed the commissions questionnaires indicated that they felt the service was developing according to peoples needs. The health and safety of the service users and staff was promoted, though there were concerns about the use of bed rails at the commencement of the site visits (see previous sections). However at the end of the site visits we were reassured that sufficient steps had been taken to protect people whilst using equipment to prevent them from falling out of bed. We were also subsequently informed of the more long term solution to this matter which included the immediate use of accurate risk assessments and the use of more suitable equipment including a specialist bed with integrated bed rails. The information supplied to the commission by the home prior to the site visit showed that all the necessary maintenance and servicing of appliances and installations had been undertaken, and were current. Relevant health and safety training was undertaken reguarly, such as moving and handling, first aid, food hygiene and internal fire safety training. Looking at the fire procedures indicated that the equipment was adequately tested and maintained and that fire drills were held frequently. This gave all staff an opportunity to take part. All accidents and incidents were appropriately recorded and the manager notified the commission of all the necessary incidents under the Care Homes Regulations so that we can monitor events in the home and ensure they are dealt with properly. Care Homes for Adults (18-65 years) Page 25 of 29 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 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 There must be a written 03/05/2010 assessment regarding whether or not people can administer their own medication and that includes any risk associated with self administration and what staff need to do to support people So that staff know how to support people and to ensure that people take their medication correctly and safely. 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 All matters related to peoples personal, health and social support and care needs should be written down and should be regularly reviewed and updated. The care plans should include sufficient and accurate information about all matters related to health personal and social care and which includes sufficient guidance to staff, Page 27 of 29 2 6 Care Homes for Adults (18-65 years) 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 including what to do in the event of an epileptic seizure. 3 9 When risks are identified there should be a written risk assessment that identifies the risk, the extent of the risk and what needs to be done to eliminate or minimise the risk including for the use of equipment to prevent people from falling out of bed. Staff should seek confirmation as to whether or not the homely remedies brought with service users are safe to take and compatible with their prescribed medication. There should be sufficient written guidance to instruct staff about the administration of all when required medication including suppositories. All areas of the home should be in a good state of repair The bedroom identified should be further adapted to increase homeliness, and privacy in personal care. All the documents related to staff recruitment, or copies of, or a tracking system should be in place within the home to demonstrate that all the necessary procedures have been followed according to the Care Homes Regulations. The manager should become registered with the commisssion as soon as possible 4 20 5 20 6 7 8 24 26 34 9 37 Care Homes for Adults (18-65 years) Page 28 of 29 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. 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