Care Home: Hawthorne Road (10)

What the care home does well People have their needs assessed and recorded and person centred care plans are in place. The home has a friendly, caring inclusive atmosphere in which the service users feel confident that they are very well cared for and their right to privacy and dignity is upheld at all times The home deals with a number of diverse care needs and ensures to offer a personalised service to meet the needs of those using the service. What has improved since the last inspection? The practice of sharing towels in communal washing/bathing facilities has now ceased and there is now the provision of paper towels to avoid the risk of cross contamination and protect the health and welfare of those using the service. What the care home could do better: The service needs to review and ammend the Service Users Guide, Statement of purpose and the complaints procedure to ensure people are provided with correct up to date information. Ensure radiator guards are affixed to the wall and broken fixtures are replaced, so that these potential risks to the service users safety are eliminated. Ensure to make suitable arrangements to enable all those using the service to engage in a wider range of local, social and community activities. Quality assurance visits to the home hjave lapsed and must be undertaken on a monthly basis to meet with the Care Homes Regulations. The organisation must write to ourselves to notify us of the management and responsible individual arrangements for the service . It would be good practice to consider reviewing the application form used for recruiting staff and considering to ask for a full employment history as opposed to the 10 year history so that it meets with the national minimum standards. Key inspection report Care homes for adults (18-65 years) Name: Address: Hawthorne Road (10) High Wycombe Bucks HP13 7EP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Handscombe     Date: 1 7 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Hawthorne Road (10) High Wycombe Bucks HP13 7EP 01494472599 01494475497 cliff.humm@advanceuk.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Advance Housing and Support Ltd The registered provider is responsible for running the service care home 6 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorderexcluding learning disability or dementia (MD) Date of last inspection Brief description of the care home 10 Hawthorne Road is a six-bedded care home providing long term rehabilitation to persons with mental health needs. The home provides all single room accommodation. The home is close to a bus service, which enables service users to access the amenities of the town of High Wycombe. There are local shops near by. The aim of the service is to equip and enable individuals to move on to independent living. People using the service are encouraged to participate in the running of the home by undertaking household tasks with staff support as required. In addition they are Care Homes for Adults (18-65 years) Page 4 of 30 0 1 1 2 2 0 0 8 6 Over 65 0 Brief description of the care home supported in accessing and using local amenities and mental health support services if they wish. The fees at the time of this inspection were #558.11 per week. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over the course of one day and covered all of the key National Minimum Standards for care homes. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion and surveys were sent to people using the service, health and social care professionals and staff. Any replies that were received have helped to form judgments about the service. Information received by the Commission and any visits to the service since the last inspection were also taken into account. The inspection consisted of discussions with acting the team manager, service users and staff, examination of some of the required records, observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given at the end of the inspection. All those who took part in the inspection process, including service users and staff on Care Homes for Adults (18-65 years) Page 6 of 30 the day, are thanked for their co-operation and hospitality during this unannounced visit. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an appropriate system in place for the preadmission assessment of prospective residents, and evidence from care plans indicates ongoing review and assessment of needs. Information is provided to propsective and current users of the service through a service users guide and statement of purpose, but these need reviewing as they contain out of date information. Evidence: At the time of this inspection the home was at full capacity with six service users and no vacancies. We were informed that there have been no new admissions since our last visit. We discussed the admissions procedure with the team manager who informed us that prospective users of the service are provided with a full assessment of needs prior to moving into Hawthorne Road, information about the home in the form of a service users guide and initial visits to the home to meet with fellow service users and staff, to ensure that all parties are confident that their needs can be met appropriately. The last Key inspection evidenced that there was a good assessment Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: procedure in place and peoples needs were thoroughly assessed prior to moving into the home. Information about the service is provided to servie users and prospective users of the service in the form of a Service Users Guide and Statement of Purpose, however although we were informed that these had been reviewed in May 2009, they contained out of date information; they listed named staff members who are no longer employed and working at the home, they documented a previous registered manager of the home as the manager of the home, athough he left in May 2009 and the Commissions contact details were incorrect. The service users guide and the statement of purpose must be kept under review by the registered person and revised when changes are made to the service. Care Homes for Adults (18-65 years) Page 11 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service benefit the development of detailed and individual care plans. Individuals living at Hawthorne Road know that the decisions they make are supported. A comprehensive set of risk assessments have been developed for each service user. Evidence: People who use the service, their link worker and relevant professionals are involved in the development of individual care plans and their subsequent reviews. The care plans have specific headings to address peoples individual health, personal and social care needs. Care plans are drawn up with the involvement of those using the service and any other relevant persons which provide people who use the service with specific goals to work towards, and inform and direct staff in how to support the individual to achieve their goals to encourage them to maximise their skills for independent living. The service is proactive in ensuring that the people who use the service are Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: encouraged and supported to play a role in the day-to-day running of Hawthorne Road. The service has a series of detailed risk assessment on file to ensure that the people who use the service are safe. A random sample of the risk assessments demonstrated that they are reviewed and are updated when necessary. All those living in the home have keys to to their personal bedrooms and the front door. Generally there are regular monthly house meetings which held, as well as regular one to one time with their key worker, both of which enable people to voice their opinions and views on different aspects of their lives, both within and outside of the home and allows for them to contribute to the running of the service. However, there has been a lapse in the timescale of the house meetings which have recently been undertaken quarterly. The minutes of these meetings are held in the home and were made available for us during this inspection. It was noted from the minutes that a discussion was had around the choice of places in which the service users would like to go on holiday, but whilst talking to service users we were informed that not all were provided with the opportunity to take a holiday.( see section headed Lifestyle) People who use the service participate in making decisions about important aspects of their daily lives, according to their individual abilities and this was observed during the inspection. There are also formal one to one meetings held each month with their link worker so that people can discuss issues about their needs and wishes. Residents can choose the level of privacy they wish to enjoy in their private accommodation. Care Homes for Adults (18-65 years) Page 13 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. qqq Evidence: There are no set regimes within the home; all three people who completed comment cards said that they can do what they want to do during the day, evenings and weekends. Two of the three said that they make decisions about what they do each day whilst one said that they never make such decisions. From observing records withinthe service and discussions with those using the service, it was apparent that there is little opportunity for them to partake in work placements/volunteer jobs or work related training schemes. General observation throughout our visit was that of little stimulation for those using the service. Part of the rational for a placement in this home is to improve the individuals opportunity to integrate into the local community life. The home is very Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: well placed for this as it is very close to the centre of the town and the variety of facilities available offer the residents the opportunity to broaden their experiences. However, evidence seen during the inspection suggests that the service users are not offered many opportunities to integrate into the community. One service users weekly activity plan consisted of attending a club once a week and visiting family on a Saturday, whilst another service user has no planned activities and does things as they crop up according to his/her choice. A further service user, in discussion with the inspector, said he/she visits their family, goes into town and goes to a day centre once a week and spoke of a day trip to Bournemouth he/she had taken with the day centre, the service user went on to tell us we missed out on a holiday this year because the home was short staffed. We did note from the minutes of a house meeting held in March that the subject of holidays was spoken about and Bournemouth had been a place suggested, however it did not materialise. We also looked at the activities which are logged in a book in the office, which informed us that since march 2009 very few activities have been undertaken; the information documented consisted of two service users having attended four football matches and a further service user had been to a local supermarket to do his monthly shopping. It was noted that one service user has shown an interest in having guitar lessons and we are informed that a tutor will be coming into the home to enable him to take up his interest. The acting manager has identified in the AQAA that this is an area in which improvements could be made and states we could develop more links within the community so service users can partake in more activities if they so wish. A requirement has been made within this report to make suitable arrangements to enable all those using the service to engage in a range of local, social and community activities. Assistance is given by the staff to ensure that family links and friendship outside the home are maintained. Family and friends are always made welcome when visiting the home. Independence is encouraged and maintained; staff support and encourage those using the service in maintaining responsibility for household tasks, such as cleaning, dusting, seeing to their own laundry and cooking, each user of the service has a timetable detailing their tasks. Care Homes for Adults (18-65 years) Page 15 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. qq Evidence: Healthcare needs are considered as part of the care planning process and regularly reviewed. Discussions with people who use the service and documentation showed that they access external healthcare providers, including specialists, when they need to. Feedback from health and social care professionals generally indicates satisfaction with the provision of care provided at Hawthorne Road. All three who completed a survey tell us that that peoples social and healthcare needs are properly monitored, reviewed and met by the service; two told us that the service always seeks advice and acts on it to meet peoples healthcare needs and improve their well being whilst one answered sometimes. One care manager told us the service is excellent in all areas. This is in my opinion due to the quality of staff. another told us I have worked with Hawthorne Road staff for a number of years now...I have always found staff to be very professional, very supportive of servie users and holistic in their work with them. We have a good working relationship... the people who have been placed at Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: Hawthorne Road have worked towards recovery and have greatly benefited from staff support. A third told us that the service has improved a lot over the last couple of years..this service appears to be trying to move ahead with improved attitudes towards service users and has become more geared up to active rehabilitation...it has become much more open to new ideas. The same person spoke of care and support that the organisation provide to service users in another establishment but those comments have not been included within this report as they do not relate to this registered service, although the comments were fed back to the acting team manager. Healthcare records are documented appropriately and include detailed records of contact with various healthcare professionals and any one off consultations, dental appointments etc. All those using the service are supported to maintain responsibility for their own medication within a risk management process and are provided with lockable facilities in which to store them. Staff check the dosette boxes regularly to ensure people are administering their medication as prescribed by their GPs. Records are maintained for the receipt of medication and for those that are returned to the pharmacy. Medication administration records sampled had all been completed appropriately and homely remedy protocols were in place for each service user and signed by each individuals GP. Care Homes for Adults (18-65 years) Page 17 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are aware of how to raise any concerns and Hawthorne Road has a formal complaints procedure and informal opportunities (e.g. house meetings, care plan reviews and in one to one time with staff) to raise any concerns with staff before they become serious complaints, but the complaints procedure needs to be reviewed as it contains out of date information. Evidence: Feedback from service users both in discussion and via surveys informs us that they know how to make a complaint, are confident in doing so if the need arises and who to speak to if they have any concerns. All those using the service have access to an independent advocate who will support them in getting their voices heard if required. Whilst viewing the complaints procedure it was noted that the home has not updated the contact details and new name of the Commission and therefore needs updating to ensure that service users have up to date information, for which a requirement has been made. During the last twelve months the service has received two complaints, both of which were documented and dealt with appropriately under the homes complaints procedure. There are policies and procedures in place to safeguard users of the service from abuse and to guide the manager and staff on how to respond to any suspicion of any allegations or incidences. The home works to the local written protocol for Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: safeguarding vulnerable adults. Training is provided to all members of staff both in their induction and regularly thereafter, to assist them in becoming aware of their own care practices, to recognise signs and symptoms of abuse and to emphasise each staff members responsibility to whistle blow on any poor practice or concerns that come to their attention. Information provided to us in the completed AQAA informs us that there have been no safeguarding referrals or investigations during the last 12 months and the Commission has not received any information to the contrary. Care Homes for Adults (18-65 years) Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall residents generally live in a comfortable, well maintained environment with safe access to all parts of the home and grounds. Evidence: 10 Hawthorne Road is located in a large residential estate, a couple of miles from the town Centre of High Wycombe. It is a terraced property and is indistinguishable as a care home. Parking facilities are not provided and staff and visitors make use of the surrounding residential streets. The accommodation is arranged over two floors; the ground floor contains two lounges, one of which is non smoking, the dining area, kitchen, laundry area, shower room, toilet and a couple of bedrooms. On the first floor there is the office, staff sleeping in room, further bedrooms and a bathroom and toilet. All bedrooms are single occupancy. Whilst touring the home it was noted that some areas of the homes decoration was looking tired and many of the carpets looked tired and dirty. One relative also pointed out to us in their completed survey that that improvements could be made and told us that the furniture needs updating and the carpets need to be cleaned. The information provided in the completed AQAA informs us that service plans to upgrade the environment; that they plan to redecorate the home and provide new carpets over the next twelve months to ensure comfort and meet the needs of the people living there. This was also confirmed by those service users spoken to during the inspection. Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: During the last inspection we reccommended that the service cease the practice of sharing towels in communal washing/bathing facilities and provide paper towels to avoid the risk of cross contamination and protect the health and welfare of those using the service. We did note during this visit that the home has acted upon the reccommendation and now provide such facilities. Discussions with the service users and with the staff informed us that the problems with raised water temperatures, found at the last inspection, have now been rectified. We checked the temperatures of the hot water in the communal bathing facilities and in two service users rooms that we viewed and found them to be at appropriate temperatures. Of the two bedrooms that we viewed, each individual informed us that they were happy with their rooms, are offered privacy and that staff always knock before entering. They both informed us that they have their own keys to their bedrooms and to the front door of the home. It was noted that in one of these bedrooms, occupied by a service user who has mobility problems and a history of falls, that the radiator guard was not affixed to the wall. This particular service user told us that he/she had raised this with the home although it still remains unaffixed. Likewise in the other service users bedroom, we noted that the mirror above his/her wash basin was broken which could potentially pose as a risk to his/her safety has been made in respect of the second service users bedroom we viewed, in which it was found that the mirror above his/her wash basin. A requirement has been made within this report to address these findings to ensure they be dealt with so as not to place the service users to any potentiasl risk to their safety. The home provides accommodation for each resident which is furnished and equipped to ensure them the right to comfort and privacy. Residents are enabled to bring small items of furniture and memorabilia to personalise their rooms to their own liking, if they wish, and are consulted with and have a say in the choice of furnishings and decoration for the communal areas and their own personal bedrooms. Suitable equipment to promote independence is gained following consultation with relevant health professionals should the service users require such equipment. Likewise the service have provided outside lighting to the rear entrance to provide safer access to those using the service. Staff were aware of COSHH and relevant lockable storage was in place to store these items. Staff have attended infection control courses. Care Homes for Adults (18-65 years) Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good recruitment process in place to ensure that only suitable persons are employed to look after those using the service. Staff are provided with training and supervision to ensure that they have the skills and competency to care and support those using the service Evidence: During this inspection we viewed a sample of staff personnel files, all of which evidenced that there is a robust recruitment in place, to ensure ensure the service users health, well-being and security. Application forms are completed, references are collected face-to-face interviews are undertaken. Relevant POVA (protection of vulnerable adults) and CRB (criminal records bureau) checks are undertaken to ensure the persons suitability with working with vulnerable people. However, the application form does not ask for a full employment history rather it asks for a 10 year history; it is therefore reccommended that the service consider ammending the application form so that it meets with the namtional minimum standards. Users of the service are involved in the recruitment and selection process to ensure their opinions are taken into account when selecting any new staff. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: Upon appointment all new members of staff undergo induction training, shadow experienced staff and complete all their mandatory training before undertaking their role unsupervised. It was noted that some staffs training was due for an update and we were informed that this has been planned for appropriately. It was noted that staff are now being supervised and supported both formally and informally on a regular basis however, the regularity of supervision is not being provided at the level of one a month as stated in the organisations own policy. In discussions with people who use the service and staff, plus responses to surveys, all felt that there were sufficient staff on duty at all times. During the day there are a minimum of two staff on duty and one staff member sleeps in overnight. Care Homes for Adults (18-65 years) Page 23 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At present the home does not have a registered manager in place although temporary arrangements are in place and is being effectively managed. Evidence: At present the home does not have a registered manager in place, temporary arrangements have been in place since May 2009 in which the homes team leader has been acting as team manager in the interim with support from the registered responsible individual of the organisation. We were made aware of the situation and assured these would be short term arrangements and informed that a person would be recruited to manage the home and subsequently register with ourselves. Recent correspondence from the organisation informed us that they would hope to have recruited a manager by the end of October 2009. However, to date the registered person has not yet appointed a person to manage the home as is required under the care home regulations 2001. We were further informed during this visit that the acting team manager, who is presently managing the service will be leaving the organisation at the end of December and that the responsible individual for the service is also leaving. The commission needs the service to write to ourselves to notify us of the Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: management and responsible individual arrangements for the service for which a requirement has been made within this report. Monitoring visits are undertaken regularly by a representative of the service to assess the quality of the service being provided and reports of these visits are drawn up and forwarded to the home. Evidence of such visits were available for us to view in the home but these are not being undertaken on a monthly basis as is required under the Care Homes Regulations 2001 for which a requirement has been made within this report. As part of the inspection we discussed health and safety issues and saw appropriate maintenance records relating to maintaining a safe environment for residents. Regular safety checks are undertaken relating to fire safety and infectious diseases and regular servicing and maintenance of equipment, all of which were seen to be documented appropriately. The home engages regularly with users of the service to gain feedback on the service it provides; this is undertaken on both an informal and formal basis through feedback and annual surveys, noting any comments or concerns when reviewing residents care and in resident meetings. There is an open door policy within the home in which users of the service and visitors can meet with the team manager, who is managing the service at present to discuss any issues or concerns that they may have. Care Homes for Adults (18-65 years) Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 Review and update the Service Users Guide to ensure that it contains all that is required under the Care Homes Regulations 2001 To ensure that peope are provided with up to date information 15/01/2010 2 1 4 Review and update the Statement of Purpose to ensure that it meets with the are Home Regulations 2001. To ensure that people are provided with up to date information 15/01/2010 3 13 16 Ensure to make suitable arrangements to enable all those using the service to engage in a wider range of local, social and community activities. 26/02/2010 Care Homes for Adults (18-65 years) Page 27 of 30 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 To provide service users with fulfilling lifestyles both within and outside the home. 4 22 22 Ensure to update the complaints procedure with the regulatory bodies new name and contact details. To provide people with up to date information. 5 26 13 Ensure radiator guards are 15/01/2010 affixed to the wall and broken fixtures are replaced, as indicated within this report. To ensure that the potential risks to the service users safety are eliminated. 6 37 8 The organisation must write 15/01/2010 to ourselves to notify us of the management and responsible individual arrangements for the service Regulation 8 (1)(a)(b) of the Care Homes Regulations 2001 requires that: (1) The registered provider shall appoint an individual to manage the care home where(a) there is no registered manager in respect of the care home; and 15/01/2010 Care Homes for Adults (18-65 years) Page 28 of 30 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 (b) the registered provider (i) is an organisation or partnership; (ii) is not a fit person to manage a care home; or (iii) is not, or does not intend to be, in full-time day to day charge of the care home 7 39 26 The registered provider 26/03/2010 must undertake monthly quality assurance visits to the home and prepare a written report of the findings and the actions to be taken to improve the service The Care Homes Regulations 2001 require that such visits are undertaken on a monthly basis. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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