Care Home: Hazelwood

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What the care home does well The home continues to provide residents with spacious single occupancy en suite bedrooms. The dining area and individual bedrooms will benefit from planned upgrading. Residents enjoy making regular use of the comfortable front lounge furnished in a modern style and recently enhanced by the addition of new floor to ceiling double glazed units. The AQAA informs us that residents are supported to access the community and are engaged in a number of activities suited to their own interests and abilities, and this is supported in documentation examined during our visit. Records viewed inform us that staff help to promote independence of residents and are supportive of them exercising decisions and choices in their daily lives. Residents benefit from the continuity and stability provided by an experienced core staff team committed to ensuring their best interests are upheld. Staff benefit from detailed and information care plan and risk information to help them understand and support the individual needs of residents. Examination of care records and discussion with the registered provider informs us that staff` are proactive in assuring that residents are provided with access to routine health care, consider the benefits alternative therapies may have in helping with some conditions and ensure that medication is routinely reviewed. The service maintains good links and communication with health and social care professionals in the best interests of the residents. Opportunities exist for staff to talk with residents informally about their daily routines and ensure they are doing things they like and enjoy. Better systems are in place to enable the service to self audit and reflect on service quality and this would benefit from inclusion of feedback from residents and other stakeholders and how this has influenced service development. What has improved since the last inspection? The AQAA tells us that since the last inspection the service has: Made significant improvements to the environment and the overall fire safety of the building. Residents are benefiting from increased 1-1 time with staff. Staff are making improved use of photographic imagery to foster dialogue with residents about things they like to do and enjoy to inform activity programmes.Implementation of a more transparent and honest approach with residents has ensured no complaints have been received. A more proactive seizure management programme has been introduced. Ongoing staff training updates have been provided and management training has been progressed. What the care home could do better: The home has demonstrated compliance with regulation and has shown commitment to addressing outstanding requirements to a good standard, and also implementing many of the good practise recommendations we made at the last inspection. We have previously made known our concerns at the lack of oversight by the registered person in the day to day operational management of the home, some improvement has been made in ensuring previous shortfalls are addressed, but, if the home is to sustain the progress made it is essential that the registered person takes a more proactive role in the running of the home, and there is less reliance on key tasks we consider the responsibility of the registered person being delegated to senior staff. This inspection has identified some further areas where we consider current practise falls short of the legislation and where we have required improvements. These are in respect of : Maintaining daily records of residents. Making improvements to the way medication changes are recorded and monitored. That policies and procedures are thoroughly reviewed to take account of changes in legislation and best practise and ensure that these are effective and useful guidance for staff to use in their everyday work with residents. We have also made some further good practise recommendations which the home should consider implementing and these include:Ensuring staff have a better understanding of adult safeguarding and are proactive in raising alerts of incidents that occur between residents. Key inspection report Care homes for adults (18-65 years) Name: Address: Hazelwood 9 Church Road St Leonards-on-sea East Sussex TN37 6EF     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: Michele Etherton     Date: 1 1 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 32 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 32 Information about the care home Name of care home: Address: Hazelwood 9 Church Road St Leonards-on-sea East Sussex TN37 6EF 01424423755 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Graham Robert Jack care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 3 The registered person may provide the following category 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 category: Learning disability (LD) Date of last inspection Brief description of the care home Hazelwood is a privately owned establishment offering a safe environment for 3 young adults with a learning disability. The home offers 24-hour care in a homely environment. The home does not provide nursing or disabled access. The home is located in St Leonards-on-Sea within easy walking distance of both shops and the seafront. The home has its own vehicle with local transport facilities nearby. All bedrooms are decorated to individuals choice and needs, with all having en-suite bath and toilet facilities. The rooms are of good size and are personalised by the Service Users. Some rooms have sea views. The communal areas are adequate in size. The home benefits from a large back garden, which service users partly use for growing vegetables and developing horticulture projects. An annual holiday outside of the home environment is offered to Service Users who choose both the destination and who to Care Homes for Adults (18-65 years) Page 4 of 32 1 8 0 1 2 0 0 8 3 Over 65 0 Brief description of the care home travel with. Information on the range of fees charged is within the homes current statement of purpose/service user guide and ranges from £482 to £945 per week. Additional charges are made for extras includes personal items such as toiletries and clothes, part of the basic cost of annual holidays, and hairdressing.. Inspection reports are not routinely sent out to families and advocates after each publication although a copy is kept on display in the reception area of the home and can be obtained via the manager. A service user guide containing the most recent inspection report is sent to any interested person [or their representatives] looking to move into the home. Care Homes for Adults (18-65 years) Page 5 of 32 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: A key unannounced inspection of this service has been undertaken, this has taken account of information we have received from the service and about the service since the last inspection. This includes an Annual Quality Assurance Assessment (AQAA) again completed by a senior staff member and not the provider/manager;we found this had not been completed to a satisfactory standard and did not provide us with all of the information we need, this would be improved by more supporting evidence to illustrate how the service is operating on a day to day basis, how it is planning to address identified shortfalls and current and future plans. Our inspection of this service includes an unannounced site visit to the service on 11th November 2009 between 10:50 a.m and 14:50 pm. During which time we were shown structural improvements and upgrading works in resident bedrooms and communal areas. On the day we visited one resident was at home and was supported by the Registered provider, no other staff or residents were seen during this visit. Care Homes for Adults (18-65 years) Page 6 of 32 All key standards have been assessed in addition to those where outcomes became evident during our visit. During out visit we examined a range of documentation including support plans, risk assessment information, menu records, medication records and storage, staff supervision and training records, complaints, accident and health and safety information. In arriving at our judgement we have been proportionate in considering compliance with regulation and outcomes for the residents alongside the overall risks and impacts of identified shortfalls Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? The AQAA tells us that since the last inspection the service has: Made significant improvements to the environment and the overall fire safety of the building. Residents are benefiting from increased 1-1 time with staff. Staff are making improved use of photographic imagery to foster dialogue with residents about things they like to do and enjoy to inform activity programmes. Care Homes for Adults (18-65 years) Page 8 of 32 Implementation of a more transparent and honest approach with residents has ensured no complaints have been received. A more proactive seizure management programme has been introduced. Ongoing staff training updates have been provided and management training has been progressed. 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 32 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 32 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. Information is available to inform residents about the service they live in but consideration should be given to whether this can be made more accessible. A procedure is in place to ensure that a robust assessment of need and compatibility is undertaken of prospective residents. Terms and conditions information has been provided to all residents but this may need review,to incorporate additional charges and be provided in a more accessible version for residents. Evidence: Statement of purpose information has been updated to reflect changes in the Commission and its contact address. The format is not accessible to residents and some thought should be given as to how some of this important information can be communicated to residents in a form they would be able to understand. No new residents have been admitted and this is unlikely to change in the foreseeable future. The AQAA informs us that prospective residents would experience a robust assessment of need which would also take account of compatibility issues prior to any decision to admit to the home. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: Each resident has a contract in place, this may need revision as it is currently unclear if residents are routinely being charged for a contribution towards petrol. The provider has agreed to clarify this matter with staff, as this does not seem to be applied across the other home also run by the registered provider Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have a full understanding of the needs and preferences of individual residents and any risks they may be subject to. Home staff are respectful of individual rights and decision making ability but incapacity judgements need to be more clearly evidenced. Clarity is need to determine where assessment of risk for individual residents is to be recorded. Evidence: Detailed support plans have been developed that provide staff with comprehensive knowledge and information about individual residents preferences and routines and how best to support and assist them. Care plans also highlight individual risks residents may experience or pose to others, this information is routinely updated in keeping with care plan reviews. Identified risks, however, are not easily distinguishable within the care plan without reading it. A system where individual risk assessments have been developed for Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: residents is in place, but these have not been maintained and are not reflective of some of the risks now identified for residents. Clearly the Registered person and staff will need to decide on which system they intend to use and make sure that risk information can be identified easily, ensuring that staff are made familiar with the measures for risk reduction, and lessen the likelihood of support around risks not being offered consistently. We noted that each resident has a daily log book in which a record of their activities and happenings are recorded each day. These generally contain good content, that is reflective of support plans, however, omissions in the frequency of recording is occurring that means home staff are unable to provide a picture of everyday life for residents sometimes for up to six days without any record being made. This is not acceptable and we have made our concerns known to the registered person and we have issued a requirement for this to be addressed. Residents are encouraged to develop independence skills and staff actively promote residents exercising greater control over personal decision making, however none of the present residents manage either their own medications or finances, the registered person should ensure that judgements to support the decision around non capacity are clearly documented and subject to review. Care Homes for Adults (18-65 years) Page 14 of 32 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. Staff help residents to lead the life they choose Evidence: Residents have individualised activity programmes which take account of their interests. Examination of daily logs indicates that on the whole these show residents are being provided with opportunities to participate in the activities they enjoy, although the frequency of recording needs improving. In order to ensure effective communications is in place to enable residents to express their views about what they would like to do, they are supported in making choices and decisions by use of photographic imagery to help dialogue and to ascertain their wishes. We are informed that staff have helped residents make collages of things they like. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: Communication board information is in place for residents so they know what they are doing each day. The home is supportive of residents maintaining links with family and friends where these exist and facilitate visits home. Care plan information indicates staff practise to promote and encourage individual decision making by residents. One resident we met told us that he collects the post when it comes and staff sort this, he opens his own post and gives it to staff to read it for him. His care plan indicates staff are working with him to enable him to responsibly hold and use his own key but this is still in the early stages. The resident we spoke with told us that I like everything I eat he said that he eats cornflakes and toast for breakfast, and has a packed lunch. As residents are usually out each day Monday to Friday the main meal of the day is taken in the evening and residents may help with this, records of food intake recorded highlight that residents receive a varied range of meals which has been developed from their preferences, and to ensure a healthy balanced diet is maintained. Care Homes for Adults (18-65 years) Page 16 of 32 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. Generally the personal,physical, mental and health care needs of residents are well supported. Resident safety would be better safeguarded by implementation of required improvements to the management of medications Evidence: Care plans and files provide evidence that residents are supported to access routine health care appointments and are escorted to specialist appointments where needed. Clinic notes are recorded to ensure information and changes discussed within clinic appointments can be made known to all staff. Residents are generally fit and well, but two experience regular seizures. There is good individual guidance contained in care plans as to how this impacts on residents and should be managed, seizures are monitored and this information provided to specialists at appointments. Residents weights are taken routinely each month. In general we found medication records to be completed satisfactorily if somewhat scruffily and greater care should be taken in the presentation of these records. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: Administering staff are all trained although we found one certificate could not be evidence for one staff member although training records confirm this has been achieved.A register of administering staff is maintained. When we viewed MAR sheets we found one handwritten change to prescribing instructions, whilst this change could be supported by clinic notes recorded for the resident concerned it is good practise for changes on MAR sheets to be accompanied by a signature and date of the person making the change. The majority of medication in the home comes in MDS system however there is some boxed tablets and we noted that there looked to have been a medication error for a resident in respect of a new medication. Boxed medication is not routinely dated upon opening we therefore found this difficult to audit,we were subsequently advised this had been an error and we have discussed the procedure for recording and reporting medication errors with the registered provider. An examination of the current medication procedure highlights that this fails to inform staff of the actions they should take. The registered provider has accepted that improvements are needed in this area and we have required that he makes the necessary improvements to ensure the safety of residents is not compromised. Care Homes for Adults (18-65 years) Page 18 of 32 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. Systems are in place to safeguard residents but care must be taken to ensure these are kept updated and staff understand the procedures they must follow Evidence: There is a complaints procedure in place that is in a widget version for residents. The main procedure is in need of update as this does not reflect the change in Commission and its contact address nor does it incorporate local authority office details which we would deem to be good practise. Whilst a timescale is recorded in the main complaint procedure for the resolution of complaints,it does not make clear the different stages of the complaint process and the different timescales for addressing each one. Residents are provided with opportunities to express their views through surveys and 1-1 time with staff. Systems are in place to ensure that residents monies are handled appropriately but care must be taken to ensure that additional charges made of residents are made clear within contractual information. Staff have previously received adult safeguarding training and the registered person and staff have previous experience of the adult safeguarding process, however we noted that staff training is overdue a refresher, the frequency of staff training has been discussed with the provider who is now aware that this should take place a Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: minimum of every two years. Examination of accident/incident information highlighted an incident of a resident being attacked by another resident causing scratches. Although a minor incident the home staff had not followed the procedure for alerting such incidents to the adult safeguarding team. When we examined the adult safeguarding procedure for the home, we found this lacked the necessary guidance to inform staff about the actions they should take, we have recommended that the registered person implements the improvements discussed. Care Homes for Adults (18-65 years) Page 20 of 32 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. Residents live in a safer comfortable home that will benefit from further planned upgrading Evidence: The provider has made a substantial financial investment into upgrading the home and addressing shortfalls in fire arrangements to better safeguard residents. A new fire alarm and emergency lighting system has been installed, door guards are fitted on most doors, additional fire doors and exclusion corridors have been created. Fire tests and checks are being conducted and we have discussed improving the frequency of some of these. Records indicate fire drills are held regularly and a resident informed us that he attends some staff courses and told us where he would go in the event of the fire alarm sounding. Records of fire drills would benefit from the inclusion of staff names to ensure all staff participate in a minimum of two drills annually Remedial works to address a longstanding problem with the roof has been addressed and New double glazed windows have been installed to the front of the building, repainting of the front of the house is underway, and the home will benefit from additional plans to redecorate internally and paint the rear of the premises in the Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: spring. Residents enjoy single occupancy of large spacious bedrooms with en suite facilities, we noted one top floor bedroom with an unsecured restrictor and this has been brought to the notice of the registered provider for urgent attention, which he has agreed to do. The communal lounge is furnished in a comfortable modern style and provides a pleasant space for residents to sit, the dining area will benefit from proposed upgrading and de-cluttering to ensure this is a viable and attractive area for residents to eat their meals in and to participate in activities provided in-house. The house is maintained to a good standard of cleanliness. Care Homes for Adults (18-65 years) Page 22 of 32 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. Residents benefit from the continuity provided from a familiar, experienced staff team. Systems are in place to ensure that the recruitment, induction and training of staff are effective and well supported. Staff are provided with opportunities to meet regularly with their colleagues and for individual supervisions. Evidence: Residents benefit from the continuity of a longstanding and well established core staff team. They are supplemented with hours from staff at another home owned by the registered provider, who are also familiar to residents. The registered provider informs us that they never use agency staff but try to cover any gaps in the rota between themselves. Staffing levels have been increased in response to the identified need for residents to have additional staff time to go out in the evenings and weekends. There has been no further recruitment to the staff team since the last inspection although the registered provider is seeking to recruit at this time. He demonstrated an understanding of previously identified shortfalls in regard to exploring gaps in employment and verifying with applicants reasons for leaving previous care roles. He has indicated that he will be implementing these improvements when recruiting new staff. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: The registered person also demonstrated an awareness of the skills for Care induction process and systems are in place to use this programme of induction with new staff as and when they are recruited. Examination of staff training records evidenced that a programme of mandatory training is in place to ensure that staff are kept updated, however we found there was some confusion as to the frequency of safeguarding training and we have reminded the provider of the need to ensure this is updated for staff a minimum of every two years, this is now overdue for staff in the home and we recommend a training course is pursued for staff at the earliest opportunity. Staff enjoy regular team meetings and these are documented. Systems are in place for the supervision of staff and we noted that when working well supervision contracts and regular supervision sessions are maintained for staff, however one file we looked at had no supervisions recorded for the past year although the registered provider assured us these are undertaken routinely. We have been advised subsequent to our visit that this information was in the home but had been placed elsewhere, we have reminded the registered provider of the need to ensure documentation is retained in the home and available for inspection. Care Homes for Adults (18-65 years) Page 24 of 32 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 service is generally well managed with the interests of residents taken account of. Evidence: The provider is appropriately qualified and experienced to manage the service. Whilst responsible for the day to day running of the service he may not be actively on site every day, sharing his time between this and another home. A senior staff member shares day to day management of the service. We have previously expressed our concerns at the absence of regular oversight by the registered person in ensuring that the home is managed to a good standard. Whilst we acknowledge there has been some improvement in his involvement to ensure previous shortfalls are addressed, if overall improvement is to be sustained, it is essential that he takes a more proactive role in the day to day management of the home. Since our last inspection there has been considerable investment in the home to address shortfalls in the fire arrangements, and also to undertake remedial works and upgrading of the premises making the home safer and more comfortable for residents Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: and staff. The home sent us the Annual Quality Assurance Assessment (AQAA) when we asked for it, and told us only some of what we needed to know. The AQAA has been completed to a less than satisfactory standard that fails to illustrate in enough detail the day to day operations of the home and how previously identified shortfalls have been addressed, or what future development of the service is planned. We have expressed our concerns to the registered provider and reminded him of his responsibility to ensure this important information is completed to a good standard and our expectations in regard to its completion in future. A development plan is in place as well as a current employers liability insurance. The AQAA advised us that policies and procedures are routinely reviewed and there is evidence that these have been looked at however, this would seem to be tokenism, failing to ensure that policies and procedures which are there to inform staff practise have been updated to reflect changes in legislation,and are reflective of practise within the home, we have discussed our concerns with the provider who has agreed to take on the responsibility of ensuring these are robustly reviewed. From our examination of policies in relation to complaints, medication and adult safeguarding we consider that there are omissions within this information which fail to inform staff of the correct actions when incidents occur. Whilst we do not consider that residents have unduly been placed at risk because of these shortfalls, it does lead to inconsistencies in the way that staff may address such incidents and we have required that the registered person undertakes to ensure that policies and procedures are standardised across both homes taking account of any specific differences there may be between both households. The registered provider is able to demonstrate that a detailed development plan is in place and this is currently being worked to, a new development plan is to be developed and implemented from January 2010. A quality assurance system is in place that provides opportunities for residents and their representatives to express their views about the service, the registered provider indicates that any issues that arise from this feedback are acted upon immediately, periodic service reviews are undertaken and these inform an annual quality assurance report, at present there is no mechanism for the analysis of feedback from stakeholders and this is not Incorporated into the current annual report and it would be good practise to do so. Some thought may need to be given to the robustness of Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: the periodic review and whether shortfalls we have highlighted should have been picked up within this previously When we examined accident information this informed us that there is a low level of accidents that are experienced by residents some as a result of seizures which are unpredictable. All health and safety certificates and servicing in place Environmental risk assessments have recently been updated, these are not comprehensive and some further thought should be given as to whether these address all the potential known risks residents may experience Care Homes for Adults (18-65 years) Page 27 of 32 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 28 of 32 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 17 The registered person must 01/12/2009 ensure that daily records of residents routines and activities are completed on a daily basis with no exception 17(2)The registered person shall maintain in the care home the records specified in schedule 4 so that the needs of residents and how this is supported on a daily basis can be evidenced 2 20 13 The registered Person must 11/12/2009 ensure that the medication procedure is reviewed and informs staff of what actions they must take in the event of a medication error. Medication errors must be acted upon and alerted to the relevant agencies Handwritten changes on Care Homes for Adults (18-65 years) Page 29 of 32 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 MAR sheets must be signed and dated by the person making the change Medication outside of the MDS system should be dated upon opening for audit purposes 13(2)The Registered Person shall make arrangements for the recording, handling, safekeeping safe administration and disposal of medicines received into the care home. So that the health and safety of residents is safeguarded 3 40 17 The registered person must 30/01/2010 undertake to ensure that policy and procedure information that informs and guides staff practise is kept up to date is reflective of changes in legislation and current best practise 17(2) The registered person shall maintain in the care home the records specified in Schedule 4 So that staff have access to up to date guidance and Care Homes for Adults (18-65 years) Page 30 of 32 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 procedures to inform and support their practise. 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 1 Documentation to inform existing and prospective residents about the service and what is provided including the terms and conditions of residence should be developed into a more accessible and relevant version for them. The registered person should ensure that capacity assessments are undertaken to support judgements about whether residents can manage some areas of their own affairs Where staff become aware of the cause of resident concerns and where they deem that in a more able resident this may precipitate a complaint they should be proactive on behalf of the resident concerned and treat there concerns in a similar manner. The registered provider must ensure that staff are helped to understand adult safeguarding procedures better through more frequent training. Safeguarding procedure documentation needs revising to ensure it provides staff with the necessary guidance and advice to inform their decision making and in what circumstances they may need to raise an alert and how to do this. 2 6 3 22 4 23 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!