Care Home: Havenmere

What the care home does well Staff are very open and friendly and appeared to know a lot about the people living in the home. The Company provides a safe and clean environment in which to prepare meals and this has gained a 5-star rating with the local Environmental Health Officer for an exceptional service. The Company also provides a clean and safe environment in which people can live. Each person can change their room setting to suit their tastes and needs. There is also a range of other facilities in the home which people can use if they so wish. Such as a gym, games room and cinema. Each 10-bedded unit has its own semi-secluded garden and has been developed to suit the current needs of people living at Havenmere. A quality assurance programme is in place which takes into consideration the views of people living there and also monitors how safe the building is to live and work in. What has improved since the last inspection? Since the last key inspection the home has employed a full time manager who is now seeking to be Registered with CQC. What the care home could do better: The Company has provided a good range of documentation for staff to use and record the needs and expectations of people living in the home. This is not always used to reflect those needs. When we tracked a number of records there was some inaccurate recording in some notes especially in the recording of accidents. Some evaluations of peoples needs had not been reviewed for a couple of months. This could put people at risk if staff are not aware of peoples current needs. There was very little evidence to support that peoples health care action plans had been reviewed and what involvement local health care professionals had in assisting the home with peoples outstanding problems. This could put peoples health and wellbeing at risk if these are not continually addressed. We also have concerns that a standard letter appeared to be in use for the crushing of medication. This should be on an individual basis only and take into consideration other options in consultation with other health care professionals. Prior to commencement of employment adequate checks must be made on staff to ensure they are safe to work with vulnerable people. After employment they must have regular supervision to ensure they are doing their jobs correctly and safely. This is especially so for those staff who have been subject to disciplinary action within the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Havenmere 191 Pelham Road Immingham NE Lincolnshire DN40 1JP     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: Theresa Bryson     Date: 1 3 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 28 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 28 Information about the care home Name of care home: Address: Havenmere 191 Pelham Road Immingham NE Lincolnshire DN40 1JP 01469557340 01469577042 havenmere@exemplarhc.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Havenmere Name of registered manager (if applicable) Deborah Michelle Broadway Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia physical disability Additional conditions: The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Dementia Code DE, Mental Disorder, excluding learning disability or dementia - Code MD, Physical disability - Code PD. Date of last inspection Brief description of the care home Havenmere is a new build purpose built home set in the small town of Immingham. It is close to the larger fishing port of Grimsby and the seaside resort of Cleethorpes. All with good transport links to Immingham. Each room has en-suite facilities and there is Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 0 0 40 40 40 Brief description of the care home also a wide range of nursing equipment to meet all types of needs of people using the service. The home is split into 4 10-bedded units each with a range of sitting rooms and a separate dining room. There is sensory equipment in some bathrooms and also a sensory room in the building. All garden areas are accessible by wheelchair and there is ample car parking space. The Statement of Purpose and Service Users Guide is on display in the large reception area and given to each prospective person wanting to use the home. Fees are negotiated on an individual basis and the Company is happy to accept people who are privately, local authority and Primary Care Trust funded. Care Homes for Adults (18-65 years) Page 5 of 28 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: We looked at the service history for this home and saw that since the last key inspection there had been several safe guarding investigations. The home had also notified us about some errors which had been made in the administration of medicines by staff and several other instances where the safety of people living there had been put at risk because the management of some peoples behaviour towards others was not being sufficiently observed. Since the last key inspection the home has also been without a Registered Manager. We talked to a number of health and social care professionals prior to the site visit, either by telephone or in person. On the day of the site visit we talked to a number of people living there, some relatives and a number of staff. We looked at a number of records and documents and toured the home and grounds. We have reviewed our practise when making requirements, to improve national consitency. Some requirements from previous inspection reports may have been Care Homes for Adults (18-65 years) Page 6 of 28 deleted or carried forward into this reoport as recommendations - but olny when it isconsidered that people who use services are not being put at significant risk of harm. In future, if a requirement is repated, it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 7 of 28 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 order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 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 9 of 28 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. Peoples assessed needs are generally being met but the staff must ensure that all relevant parties are aware of each persons current needs. Evidence: Comments had been made to us by health and social care professionals that the home had possibly taken a person outside their registration category. We checked the assessment diagnosis of all thirteen people living in the home and each one fell with in the category of registration. We also checked the care plan file for the last admission to the home and found they had received an holistic assessment of their needs and this had been used as a basis to put together a fuller programme of care. Some people living in the home were able to tell us how their current needs were being met and how their lives had changed since being in the home. For example one person told us the staff have helped me walk better with my frame and another said they help me get in and out of the bath and because they are here I can have one when ever I like. A relative we spoke to had a clear understanding of how to contact health and social care professionals, should the need arise. Care Homes for Adults (18-65 years) Page 10 of 28 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 must always reflect the current needs of people living in the home and be evaluated on a regular basis. There must be accurate recording of any accident or incident which occurs to ensure people are free from harm. Evidence: As the key inspection had been brought forward there was no time for us to send survey forms out prior to our site visit or for the service to complete their Annual Quality Assurance Assessment (AQAA). We were able to speak to four people who live in the home during our site visit and two relatives. We also spoke to three health professionals and five social care professionals either by telephone or in person prior to our visit. The reviews and evaluations of peoples needs who live in the home had been spasmodically recorded as being completed. For example in one file the last time a persons complex needs had been evaluated was in October 2009, despite this person having problems with an open wound. There was in place an open wound chart showing where the wound was and a plan detailing what treatment this person should Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: receive, as well as a speech and language professionals review of the persons needs. But the established care plan for this persons wound management did not reflect these current needs. If staff did not see the detailed instructions for this wound care and followed the original care plan this could put this person at risk if different treatment had been prescribed. In another persons care plan some accidents had been not aways recorded accurately. The written evidence showed, in some instances different times on documents dated the same, but we were informed by staff it was the same accident. In another incident an accident had been recorded on the accident form but not written in the daily report sheets, as the Company policy stated it should be. The risk assessments for this person had only been spasmodically reviewed despite seven accidents/incidents which had occurred from the middle of November to the time of our visit. This could put the person at risk of harm if a plan was not in place to address their current needs. Staff also seemed unsure of what should be written in the care records document and the daily report sheet, as the recording on these documents differed. As on one document seen a concern had been raised by the person receiving the care on the daily report sheet document and in another file this was on the care records document. This could lead to concerns being missed and as in both cases the incidents reflected unmet care needs those peoples needs and expectations were not being met. People living in the home and some relatives were able to tell us the types of decisions they were making for themselves to enable them to live as independently as possible. For example one person told us how they keep in touch with their family members and another told us how they choose where they sit to watch their favorite sports programmes sometimes I like to watch a big football match with other people who live here and we all shout together but I like to watch other sports in my room. A relative and a person living in the home told us how they felt their needs were not being addressed and felt frustrated that staff havent got it right. Some important issues were raised and fed back to the Acting Manager as described under Standard 3. When checking this persons care plan we saw that, for example, their position chart which tells staff when last the persons position was changed, as they cannot move themselves, had only been spasmodically completed over a period of days. This could result in this person developing sore pressure points on their body and be left laying in uncomfortable positions for long periods of time. We did read some good examples of where specific needs had been addressed. For example with some one whose daily behaviour was subject to change, staff had developed a core plan of care and had included in their assessment a review of the persons medication, a risk assessment of their ability to leave the building without assistance and a daily behaviour diary. There was also an assessment from health care professionals working with this individual at the memory clinic. This has ensured Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: that safe practices have been put in place to ensure this person can lead as independent a life as possible. In another care plan a person had altered sleep patterns and again a core plan of care had been put in place to cover a 24hour period. The daily report sheet detailed how often this person was asleep and how they had been roused and how often they had been checked through a 24 hour period. Care Homes for Adults (18-65 years) Page 13 of 28 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. Further exploration should be made to ensure every individuals social, religious and cultural needs are being met. Evidence: When looking at the five care plans during the site visit we saw how staff were encouraging people to be come aware of their local community. For example one person told us they regularly go swimming, which they said they enjoyed. And another told us how they shop for their own personal needs and also sometimes have a take away meal. A relative told us my husband has settled in so well I am never worried about leaving him and he and I can have a bit if independence.Other links had been forged in the local community with visits recorded to local shops, places of religious worship and leisure facilities. At the time of our visit there was no one undertaking any educational opportunities or employment. This and other leisure pursuits need expanding upon to ensure each Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: persons individual expectations can be met. For example one person wanted to have an Indian takeaway meal but there was no evidence to support this ever occurred. Another person wanted to keep up their interests in motorbikes but there were no events recorded to show this hobby had been pursued. Relatives and social and health care professionals told us how welcomed they are by staff, always ready with a cup of teaas one person stated. Staff were seen through out the day assisting people with a number of tasks, which they did in a calm and dignified manner. Encouraging each person in a manner suited to their needs. For example speaking slowly and using a combination of sign language, written words and speech. People living in the home have unrestricted access and can have access to the key pad codes to move freely around the building once a risk assessment has been completed to ensure they are safe to do so. Since our last key inspection the kitchen area has been reevaluated by the local Environmental Health Office and received in September 2009 a five star rating for cleanliness in the kitchen. This is the highest award this department can give and shows excellent processes are in place to ensure food is prepared in a safe environment. We made a brief tour of the kitchen and found food was being prepared using safe practices.The menus were basic but people told us they were not hungry and that mostly their is something on the menu to suit their needs. The client group in this home is predominately young in age but the care plans seen did not reflect all of their dietary expectations. For example one person would like regular Indian food and another wanted to have items cooked which they had bought. There was no written evidence to support this was happening. In an occupational activities room there were items in the fridge and freezer which were in date but not labeled, despite us being told the items belonged to people living there. This could result in this food not always being used by the person who bought it. Care Homes for Adults (18-65 years) Page 15 of 28 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. Peoples current health care needs should be recorded and all medication risk assessments be in place to ensure people are free from harm. Evidence: Whilst tracking the five care plans we looked at evidence of whether peoples health care needs were being met and they were receiving any personal support to help them live as independently as they could. Preferences such as when individuals liked to have a bath and how this could be a relaxing experience for them was recorded. Some aids in use, such as walking frames had evidence recorded they were checked for safety features such as clean furrell ends. People we saw moving independently around the home appeared to be wearing safe foot wear. Since the last key inspection there have been three safe guarding adults investigations in the home, one of which resulted in training having been given by the Community Matrons to ensure staff are using up to date techniques in wound management. In the care plans seen there was some evidence recorded on professional visits sheets of when interaction had take place with, for example, local GPs, Community Matrons and hospital and community health and social care professionals. There were no Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: specific health action plans in place or health passports to reflect peoples current needs. It was therefore difficult to ascertain whether each persons annual health checks were being met. We looked at the medication records of people whose care plans we had tracked. Generally the administration records appeared to be correct and people were receiving medication as prescribed. In one file there was a letter signed by a local GP in answer to allowing medication to be crushed for an individual. There was no record of how this had been assessed by staff and the GP appeared to have just replied to a standard letter. In the drug administration records there were a number of blank letters asking for this to happen. Staff could not give us any explanation why this method of drug administration is asked for before other avenues have been explored.This could put people at risk if medication is crushed when it could be unsafe when digested in this way. The storage area was clean and tidy and regular temperature recording is made for the room and drugs fridge. The headed paper record for this is not totally accurate as both columns stated fridge temperatures and should be one for fridge and one for the room. Staff appeared to have a sound knowledge base of what medication is in use and one senior member of staff searched for some evidence to show the correct amount of controlled drugs had been used for one individual. In the last year the management team in the home have notified us of nine medication errors which staff had made. in one incident it was reported as a safe guarding investigation. The management had to be reminded that they should include on information sent to us the names of staff so we can determine whether the correct course of action has taken place with each staff member. Staff would benefit from a more up to date reference book to refer to when administering medication as the one currently in use was dated 2007. Care Homes for Adults (18-65 years) Page 17 of 28 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 should be able to raise concerns knowing they will be fully investigated and an outcome reached to their satisfaction. Evidence: Since the last key inspection the home management team have dealt with ten internal complaints. There was written evidence to support the outcomes from the investigations. The file where this evidence was kept was very disorganized and it took a long time before we were able to gather all the evidence together to support complaints had been dealt with promptly. In the last year there have been three safe guarding investigations undertaken in the home. People we spoke to knew how to make a concern known to the correct statutory body. Some were dissatisfied with the process currently in place in the home and said we never hear of any outcomes and some staff we feel dont tell management when we ask them to look into matters. The process of following through concerns and complaints should be reviewed to ensure everyone who has contact with the home, including staff, are aware of the procedure. Care Homes for Adults (18-65 years) Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can live in a safe and secure environment. Evidence: During the site visit we were able to have a tour of the building and grounds. We looked briefly through the two wings which are closed at the moment due to the low occupancy levels. We checked all communal areas in use and all toilets, bathrooms and most of the bedroom areas in use. Only the main lounge and dining room areas appeared to be in frequent use, despite the home having a well equipped games and gym room and activities room and cinema room. Most of the latter areas were untidy and looked unused. The senior member of staff told us that they were unaware of who was qualified to use the gym equipment, which was why it was unused. All areas were clean and free from hazards but were untidy in places. For example in the gym where equipment had been taken out of packages the ripped packaging was still on the floor. In the cinema room apparatus was still on show from a staff training session and was not a tidy or homely area in which people could relax. Some people told us they choose to stay in their rooms and there was ample evidence of how they had been allowed to alter them to suit their needs and tastes. For example by putting pictures up of their previous interests or about family members. People living in the home and some relatives and health professionals told us they Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: were happy with the standard of cleanliness. The garden areas are split into four main sections for each of the ten bed units and all appeared different to suit the needs of those occupants. This included seats and other garden furniture. Walk ways and bar-b-que equipment as well as well laid out borders. The ancillary staff were able to explain how they maintain infection control in the home and how such as the laundry system works to avoid the spread of infection. All equipment was in working order. We also saw the safety certificates which showed us how well the home was maintaining it for the safety of those living and working there. Care Homes for Adults (18-65 years) Page 20 of 28 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. Sufficient safety checks must be made on staff prior to their commencement of employment and they are then trained and supervised to ensure they are capable of completing their jobs. Evidence: We were able to speak to five staff whilst on the site visit. Each person told us they were happy about working in the home and that they had received a lot of training to help them do their jobs. They also told us that we work together. The only concern they had were about the staffing levels. Making such comments as bit short staffed at times but it is ok if every one comes in and staff moral was jaded at times. This was partly due, staff stated to the large change in manager support since the home opened, as different people tell us different ways of doing tasks. There is now a permanent manager in post. We looked at the staffing rota.People in the home told us thatgenerally all their needs could be meet butwhat can I do if they are short of staff I cant bath my self and so I sometimes have to wait. People also told us there were staff available who could communicate with them and some who had special skills such as the ability to use sign language such as Makaton.The management team must ensure that there are enough staff on duty at all times to meet peoples needs so they are not at risk of harm and can always have their needs and expectations met. Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: We tracked six personal records of staff. In one record there was no full Criminal Records Bureau check on record but we were assured this is kept by head office and we asked that this proof be given to us as soon as possible, to ensure that person was safe to work with vulnerable people. The acting manager voluntarily agreed to only allow this staff member to work under supervision until such time as this could be verified.In two files there was some evidence to support where people had received disciplinary due to poor methods of delivering care, they had been set action plans to complete. We were made aware of a third file where a person should have had a disciplinary due to poor methods of delivering care but this wasnt on file. In the same file there was also doubt as to the persons legal work status for working in this country. We asked for this to be checked so we could be sure people working in the home were safe to do so. All other records showed adequate safety checks had been made prior to their commencement of employment. When checking the training records of staff it was not clear which staff had received mandatory training so this was going to be checked by the Acting Manager.Some records showed this could be as high as 83 but not all training certificates could be found. Staff seemed satisfied with the level of training they were receiving. Saying it has helped me understand basic care and also the Company is good about sending us on courses such as managing aggressive people to ensure we can do our jobs. Health and social care professionals told us the knowledge base of some trained nurses depends on who is on duty. There must be sufficient staff on duty to ensure the needs of people living there can be addressed st all times by a competent work force. It would also help staff to see their short comings if the supervision records were up to date. Staff should have at least six sessions a year and be a balance of discussion and observation. We tracked five files. One person who had been employed since July 2008 had only had four sessions. Another employed since September 2008 had only had one session despite them having extensive sick leave. In another file another person employed since July 2008 had only had two sessions despite being disciplined for maladministration of drug errors. The Company had already breached this Regulation at the last inspection in 2008 and still has failed to comply on this occasion. This could result in staff putting people at risk they are looking after if they are not monitored to ensure they are capable of doing their job. Staff we spoke to said that supervision sessions were spasmodic and depends who completes it as to how good I feel and know what I should do at the end. It was hoped by staff that this will alter now there is a permanent manager in post. Care Homes for Adults (18-65 years) Page 22 of 28 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. There must be an atmosphere of openness in the home to ensure peoples views are sought as to the planning of services and accurate records kept on all aspects of their care to prevent them from being harmed. Evidence: Since the last key inspection in 2008 the home has not had a Registered Manager, but now has an Acting full time manager on site. Instead of relying on temporary managers covering from other units. At this inspection that person had only commenced employment three days before on this site. They were able to detail for us the type of training they had received so far and the Organizational structure to support them. This appeared adequate as this person was supported on site by a team of staff, some of which had been employed since the day the home had opened and knew all the people living there well. They were able to tell us the basis needs of each person and some of their expectations, which we later checked with individual people living in the home. The Company has an extensive auditing and quality assurance process which we were able to see. Staff appeared to be aware of when audits have taken place and the Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: results. As were people who live in the home and they were able to tell us when they had been sent surveys on topics such as meals and laundry facilities. This ensures that their views are taken into consideration when the Company is looking on how it plans their services. Care Homes for Adults (18-65 years) Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R 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 1 36 18.2. The Registered Person must ensure that all staff receive supervision to ensure they are safe to work with people using the service. 30/09/2010 Care Homes for Adults (18-65 years) Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 18 All care plans must be kept up to date. To ensure peoples current needs are being met 30/09/2010 2 9 17 All accidents and incidents must be accurately recorded. To ensure people are free from harm and risk. 30/09/2010 3 19 12 The health care needs of each individual must be recorded accurately. This is to ensure their current needs are being met. 30/09/2010 4 20 12 Risk assessments must be in 30/09/2010 place when alternative methods of giving medication are in use. This is to ensure people are free from harm. Care Homes for Adults (18-65 years) Page 26 of 28 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 3 Staff should ensure that all parties supporting people living in the home are aware of the current assessed needs of each individual and how they are being met. More contacts and resources should be sought in the local community to ensure peoples social, religious and cultural expectations are being met. More choices should be on offer in the menu planning to reflect the client groups actual needs and time taken to ensure they can explore buying their own food and/or exploring different take away food options. An up to date reference book should be available for those administering medication. The procedure for making concerns and complaints known should be reviewed to ensure all parties having contact with the home are aware of the process and have a recorded outcome. Care should be taken by all staff to ensure that all areas of the well equipped home are in a position to be used should the people living there wish to do so. The training records of staff should show who has attended their mandatory training to ensure they are safe to work with people in the home. The management team should ensure that accurate records are kept at all times to ensure peoples needs and expectations are known and the service is being run for their benefit. 2 13 3 17 4 5 20 22 6 24 7 35 8 41 Care Homes for Adults (18-65 years) Page 27 of 28 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. 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