Care Home: Heathcotes Care (Blythe Bridge)

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What the care home does well People using the service have a service user guide that tells them about the service, the fees and charges they can expect to pay. Prospective users of the service have their needs assessed and can visit the home before deciding to move in. Risk assessments are colour coded for ease of reference. People using the service have access to a range of activities out of the home. People`s health needs are monitored and there is evidence that staff support people to attend health appointments. Medication is appropriately stored. A complaints procedure is available in a easy to use format and people using the service have told us they know how to make a complaint. Staff meet regularly as a team and have regular one to one supervision sessions. The number of staff trained to National Vocational Qualification at level 2 is good. Recruitment practise is good. What has improved since the last inspection? The service has introduce some new care planning documentation. The manager has been registered with us and is now approved as a fit person to manage a residential care service. New Policies and procedures have been developed. What the care home could do better: The Statement of purpose that provides information for prospective users of the service should be updated. Support plans and risk assessments should be individualised, dated and signed, and the service should evidence how people using the service are involved in the implementation of them and review. Staff should receive training in the implementation of Person Centred Plans and goal setting. The service should evidence how people using the service are involved in planning and choosing their meals and provide menu information in a format that they can easily understand. Medication management needs to be improved. Although there is some evidence that the service has made some improvements since the last key inspection. There continue to be problems with how the stock control of the medication is managed, recorded and monitored. The environment should be well maintained and decorated for the benefit of people who live there. Staffing levels should be kept under review to ensure that there are always enough staff to meet the individual needs of people using the service. Staff need to receive training about the Mental Capacity Act 2005 and Deprivation of Liberty. Key inspection report Care homes for adults (18-65 years) Name: Address: Heathcotes Care (Blythe Bridge) Southlands Aynsleys Drive Blythe Bridge Stoke on Trent Staffordshire ST11 9LR     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: Wendy Jones     Date: 2 2 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Heathcotes Care (Blythe Bridge) Southlands Aynsleys Drive Blythe Bridge Stoke on Trent Staffordshire ST11 9LR 01782398372 01782393577 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.heathcotes.net Heathcotes Care Ltd Name of registered manager (if applicable) Mr Gary Sidney Tideswell Type of registration: Number of places registered: care home 6 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: 6. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: either, whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD of the following age range: from 18 years of age and above, maximum number of places: 6. Date of last inspection Brief description of the care home The service is a large detached property in its own grounds in a well established residential area of Staffordshire. It provides accommodation for up to 6 people, all bedrooms are for single occupancy and all have en-suite facilities. Communal facilities are satisfactory and provide comfortable accommodation for the people who live there. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 6 0 8 0 7 2 0 0 9 Brief description of the care home There is a large rear and front garden and parking for approximately four vehicles. The service is located within walking distance of local facilities, but also has its own transport for access to facilities further away. Any prospective user of the service or their supporters should approach the provider for information about the fees and charges they can expect to pay. 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: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We carried out an unannounced key inspection visit on one day, that included formal feedback to the manager of the service The focus of our inspections is upon outcomes for people who live in the home and their views of the service they receive. This process also considers the homes capacity to meet regulatory requirements, national minimum standards of practise and focuses on aspects of the service that may need further development. To prepare for the visit we looked at the last inspection report and our records of the information we have received about the service since the last inspection visit. Each year the service has to complete and return an Annual Quality Assurance Care Homes for Adults (18-65 years) Page 6 of 30 Assessment (AQAA) to tell us how they meet the needs of the people who use, or may use the service. This focuses on what they do well, how they evidence this, and any areas they feel are in need of improvement. Before key inspections we send out surveys to people using the service, staff, relatives and anyone else who has involvement with people who live there. We have used the information in the surveys, we received, to help us make a judgement about how the service supports people living at the home. When we were at the home we focused on a small number of people who use the service. This involves discovering individual experiences of living at the home by meeting and talking with them, discussing their care with staff, looking at medication and care files and reviewing areas of the home relevant to these people. This helps us to understand the experiences of people who use the service. We looked around the home to make sure it is safe, clean and comfortable and we looked to see whether people who use the service are being protected, and the arrangements the service has for listening to what people think about living at Heathcotes (Blythe Bridge). We have made 13 recommendations as a result of this visit and have asked the service to provide an improvement plan telling us how it intends to address the matters we have raised. 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: The Statement of purpose that provides information for prospective users of the service should be updated. Support plans and risk assessments should be individualised, dated and signed, and the service should evidence how people using the service are involved in the implementation of them and review. Staff should receive training in the implementation of Person Centred Plans and goal setting. The service should evidence how people using the service are involved in planning and choosing their meals and provide menu information in a format that they can easily understand. Medication management needs to be improved. Although there is some evidence that the service has made some improvements since the last key inspection. There continue to be problems with how the stock control of the medication is managed, recorded and monitored. The environment should be well maintained and decorated for the benefit of people Care Homes for Adults (18-65 years) Page 8 of 30 who live there. Staffing levels should be kept under review to ensure that there are always enough staff to meet the individual needs of people using the service. Staff need to receive training about the Mental Capacity Act 2005 and Deprivation of Liberty. 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 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 10 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. People who may use the service and their supporters have enough information available to them about the service to decide if it can meet their needs. And can be confident that their needs will be assessed. Evidence: The service told us in the AQAA that, Transition for new service users into the home is carefully managed; all potential service users are invited and supported to make visits to Heathcotes Blythe Bridge prior to moving in. The prospective service user and their family will also be presented with the Heathcotes Blythe Bridge Statement of Purpose, which provides full details of the home, and its ethos. Two of the three people who returned surveys told us, that hadnt been asked if they wanted to move into the home, but all three said they had received enough information about it. We saw the Statement of Purpose has been produced in a user friendly format. We saw copies of the service user guide that the service provides, in each persons support Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: records. The guides are individualised and have the fees that person is to be charged. We looked at the assessment information for one person who has been admitted to the home since the last inspection visit. Records show a social worker assessment and the services own pre admission assessments. A review of the placement is planned. The individual said he was happy at the home, the manager and staff confirmed he had settled well. Care Homes for Adults (18-65 years) Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service need to be certain that they will be included in making decisions about their lives and that support plans and risk assessments are individualised. Evidence: The service told us in the AQAA that, The service users person centred care plans are detailed and comprehensive and are produced with full involvement of the individual receiving care. These plans are person centred, live documents that are holistic in nature. Our staff members use creative methods such as pictures to record service users personal preferences and to fully involve them in contributing to their care plans. People told us in the surveys that they can usually decide what they want to do during the day, evening and weekend. Staff said, We need more staff so that we can meet peoples needs. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: We looked at the care records of two people using the service. The service has introduced a new person centred planning (PCP) format for each person living at the home. The implementation of this has yet to be completed. We recommended at the last key inspection visit that all staff receive training in Person Centred Planning, this has yet to happen. We cant be sure that PCP will be properly implemented unless the staff have received training and understand the principles of it. We saw that support plans are in place, but these are currently generic plans and not necessarily based upon the known or assessed needs of each person. We saw that the plans have not been dated or signed, and could not evidence that the people using the service have been involved in them. The current format is not user friendly and would therefore be difficult for some individuals to understand. We saw that the documentation includes, Listen to me, Things about me and How I communicate, sections. These are in a user friendly format and when completed with the individual will provide useful information. We saw that people using the service have risk assessments in place, these are again mainly generic. The level of risk is highlighted by a colour coding system ie red for high risk for ease of reference. Care Homes for Adults (18-65 years) Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are being supported to enagage in a wide range of activities both in and out of the home. Evidence: The service told us in the AQAA that, Service users are given the opportunity to access activities of their own choice and are encouraged to get involved in community based activities to encourage inclusion into the local community and promote a sense of belonging. Service users are also encouraged to access vocational activities or work placements. A wide range of leisure activities is also offered to the service users. Adequate staff support is also in place to allow service users to access these activities. One person said in the surveys that, I do alot of activities. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: We saw from the records that people using the service have more opportunities to be involved in activities outside of the home. During this visit, one person went to the gym, two others went to the golf driving range, two people went out for lunch and then to do some food shopping. We saw that people are supported to maintain contact with family and friends. We looked at service user records and saw that they are being supported to make decisions about what they want to do and where they would like to go. One person showed us the things he is interested in and staff said that they intend to support him to have the opportunity for holidays and outings that reflect his interests. We saw that menus are planned by staff based upon the known needs of people using the service. Staff we spoke to couldnt be sure what the meal choices for the day were. The current menu plan is not in a format that people can easily understand and we couldnot be confident that people using the service have a real choice of meals. The manager said that he is in the process of completing a menu for people that is more user friendly. We did note that one person is involved in preparing his own meals on a daily basis. Care Homes for Adults (18-65 years) Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have their health needs monitored and met but must be confident that medication is managed safely, to be confident that they are not being put at risk. Evidence: The service told us in the AQAA that, Privacy and dignity are promoted in all aspects of personal support. Personal support is also offered in a way that promotes independence and allows choice and flexibility, as the level of personal support each resident require varies. Capacity assessments are also completed around personal and health care, to ensure that service users are given appropriate support in these areas. We found that the service has documentation relating to how peoples health needs can be met. But in the samples we saw the documentation hadnt been completed. The manager stated that the organisation has introduced new documentation to promote Person Centred Planning and Health Action Plans these are being worked on. We did see that the service monitors the health needs of people using the service and Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: supports them to attend health appointments, such as to the GP and Dentist. We saw that records provide evidence that the service liaises with health and social care professionals on a regular basis. We checked the records relating to medication administration and management. There is evidence of improvement since the last key inspection where we made a number of requirements for the service to action within given timescales. We also carried out a random inspection to check that they had complied and acted to make the improvements we required of them. At the time of the random inspection of May 2009 we concluded that the service had addressed the concerns we had identified. But at this inspection we have found that some improvements have not been sustained and are concerned that we could not undertake a proper audit of some medication, because the records are not satisfactorily maintained. We saw that medication is stored properly and have been told that staff are trained to administer it. We recommend that competency assessments are carried out to ensure that staff put the training they have received into practise. We are concerned that one person did not have a Medication Administration Record in place, even though he is prescribed medication. This means that staff do not have the information they need to administer medication as it is prescribed. There is evidence of poor stock controls systems in relation to as required (PRN) medication. We saw that medication administration procedures are in place. Consent to medication has been agreed with the GP and medication information is in simple language and pictures for ease of understanding. Care Homes for Adults (18-65 years) Page 18 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 can be sure that they are protected by a robust complaint procedures and know who to go to if they have any concerns. Evidence: The service told us in the AQAA that, Complaints systems are in place and have been developed to ensure service users and other stakeholder complaints are listened to and acted upon accordingly. Staff are fully aware of the companys policy on Whistleblowing and Raising Concerns; this helps to ensure that service users are protected from possible abuse and harm. Three people said in surveys that they know how to complain and who to go to if they have any concerns. We havent received a complaint about this service since the last key inspection visit, but are aware that one safeguarding referral has been made and looked into. We saw that complaints record at the service, this showed that two complaints have been made one has been resolved and the other is being looked into. We have also been told that a safeguarding investigation is taking place to look into allegations of alleged service user abuse. The complaints procedure is available in a user friendly format. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: Staff have been trained to recognise and report suspected abuse and how to protect people using the service. But need to receive training relating to the Mental Capacity Act 2005 and Deprivation of Liberty. We looked at peoples finance records and found them to be satisfactorily maintained. Care Homes for Adults (18-65 years) Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service should live in a home that is well maintained and decorated Evidence: The service told us in the AQAA that, The home environment is appropriate for the individual needs of the people who use the service. It is also accessible to the local community and is reflective of, and can accommodate the six strands of diversity. One person said in a survey that the home is always clean and fresh. We found that some areas of the home are in need of re-decoration, for example, some of the walls in the lounge need painting. The manager confirmed that a redecoration programme has been agreed, in addition to replacement of some of the homes furniture. We noted that the home appears clean and tidy. We saw two bedrooms with the kind co-operation of the occupants. We found that bedrooms have been personalised to reflect the individuals hobbies and interests and have the furniture and furnishings they need. Each of the bedrooms have an en-suite and the occupant can have a key to their bedroom if they want one. We noted in the homes audit of November 2009, that standards of cleanliness has Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: been identified as a cause of concern, the manager stated that daily checks are now carried out. All staff are reported to have received infection control training. Care Homes for Adults (18-65 years) Page 22 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. People using the service can be sure that they are supported by a staff team who are well trained. Evidence: The service told us in the AQAA that, Staffing levels are maintained in relation to the assessed needs of the service users who live here. Well-trained and competent staff members provide support to our service users. Our recruitment and selection process matches the service users that we have. All of our staff are either working toward or have an NVQ2/NVQ3 in care. Two people said in surveys that, Staff always treat me well. One person said, they usually do. Two people said, Staff always act upon what I say. One said, they usually do. Two people said, Staff look after me well. We observed staff and user interactions during the visit. We found that there is evidence that people using the service relate well to staff. People told us that they like the staff on duty and two people could name their key worker. A member of staff told us, The key worker role is really important and it enables to build positive relationships with people, they then feel able to talk to us about anything they need to. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: The manager said in the AQAA that the service has good recruitment procedures. We looked at a sample of 3 recruitment files and found them to be satisfactory. With all the required checks undertaken. We saw that people using the service are sometimes included in the interviews of proposed new staff. We asked about staffing levels, we have been told that the home has a small number of vacancies, but is actively recruiting to these. Five staff have left the service since the key inspection. Staff meetings are arranged regularly, the manager told us he intends to improve on this and arrange team meetings in addition. Staff told us that the team model to staffing the service can cause problems with consistency. consistency can be a problems because we work in team, you can go off duty for a couple of days and come back to find things have changed or all the work you thought youd completed is unravelled. The manager should monitor this to ensure that the quality of care isnt affected because of this. Staffing levels are usually maintained at 1 member of staff to one service user during the day. But due to staff sickness and absence at the time of the inspection this had not been maintained. There is no use of agency staff and staffing deficits are addressed by the use of bank staff or regular staff overtime. Care Homes for Adults (18-65 years) Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have benefited from a stable management team, who know what they need to do to continually improve the service. Evidence: The service told us in the AQAA that, The management team of the home is diverse and varies in age, skills and experience; this compliments the overall running of the home. The service users benefit from having both a manager and a senior team. The management team ensure that service users rights are promoted. We received the AQAA when we asked for it. It was completed by the current manager and contained detailed information about the service, what it does well, how it has improved and what it could do better. The manager has now applied to be registered with us, but we had to remind him formally to do so. At the time of writing this report he has been approved. We saw that risk assessments have been carried out for individuals and for the Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: environment. We saw that they are reviewed regularly, but have commented that where risk assessments have been carried out for individuals the service should demonstrate how people using the service have been involved. We also noted that more work needs to be done to ensure that they are produced in a user friendly format. We saw that the organisation has introduced new policies and procedures since the last key visit. The manager stated that staff are in the process of reading through them. Once they have, staff are expected to sign to evidence that they have done so. The manager keeps us informed of events in the home. This includes accidents and incidents we have received two notification of this type since the last key visit. We saw that the organisation monitors the service at least monthly and provides a report on its progress. There are also additional home audits carried out. The manager has an action plan to work through based on the outcome of the audit, with timescales to ensure improvements are made. We looked at finances, we found that records are accurately maintained. All of the people living at the home need support to manage their money. Staff check the balance of the monies kept on behalf of people at each change of shift. Care Homes for Adults (18-65 years) Page 26 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 27 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 6 6 The service should ensure that people using the service are involved with all aspects of planning their goals. The service should ensure that support plans are signed and dated, so the people using the service know they are current and reviewed regularly. Support plans should be specific to the individual, so that people can be sure that the care they receive is person centered. The service should make further efforts to make support plans more user friendly. To evidence that they are accessible to people using the service. All staff should receive training in Person Centred Planning. So the people using the service can be sure that they know how to implement the plans. The service should ensure that risk assessments are relevant to the individual and user friendly. The service should evidence how people are involved in making decisions about their daily lives ie menu choice. 3 6 4 6 5 6 6 7 7 17 Care Homes for Adults (18-65 years) Page 28 of 30 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 8 20 Staff should have medication competency assessments so that people using the service can be confident that they put their training into practice. The service should ensure that medication administration records are an accurate representation of the medication regime prescribed for individuals. To be confident that the margin for error is reduced. The service should ensure that the system in place for monitoring the stock control of medication is robust. To be confident that medication management is safe. The service should ensure that all staff have received training in the Mental Capacity Act 2005 and Deprivation of Liberty. So that they know what action to take, if there are concerns about someones capacity to consent. And are able to recognise if someones liberty is being deprived and how to report it. The service should ensure that all areas of the service used by people who live there are monitored regularly for cleanliness. The service should ensure that all areas of the service used by people who live there are well maintained. The staffing levels of the service should be closely monitored, to be sure that sufficient staff are provided to meet individual needs. 9 20 10 20 11 23 12 24 13 14 24 32 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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