Care Home: Holmhurst Care Home

What the care home does well Before anyone can move into this home they undergo an assessment. This helps to prevent someone moving in whose needs cannot be met and helps people to decide whether the home is right for them. Staff are appropriately trained and recruitment procedures offer people living at the home protection. People are free to make their own decisions and lifestyle choices and receive a healthy diet. What has improved since the last inspection? The provider has continued to make improvements to the physical environment. Since our last visit all bedrooms have been redecorated and bedroom furniture has been replaced. Four double bedrooms have been converted into single rooms and en suite facilities are gradually being provided in bedrooms giving people more privacy and comfort. What the care home could do better: This report makes a number of requirements. The standard of care planning needs to be improved so that there is less of a risk that people`s mental health needs will be overlooked. Information in care plans must be checked to make certain that is relevant and if it is then instructions need to be followed especially with regard to people`s health related issues such as blood glucose monitoring. This needs to be done so that people are not put at risk of not having their health care needs met. Whist we found that people are free to make their own decisions and lifestyle choices this could promoted further by involving people more in planning their care. Greater emphasis needs to be put into ensuring that the home`s medication policy is adhered to and that staff receive regular supervision. This is to make sure that people receive their medication safely and that staff receive the support they need to carry out their role in order to meet people`s needs effectively. More regular auditing of records and monitoring of quality assurance in general is required, so that the home is run in the best interests of the people living there. Key inspection report Care homes for adults (18-65 years) Name: Address: Holmhurst Care Home 28 Gordon Avenue Portswood Southampton Hampshire SO14 6WD     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: Chris Johnson     Date: 0 8 0 9 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 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 28 Information about the care home Name of care home: Address: Holmhurst Care Home 28 Gordon Avenue Portswood Southampton Hampshire SO14 6WD 02380348403 F/P02380348403 holmhurstcare@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Susan Boyes care home 20 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: 20 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 Disorder, excluding learning disability or dementia - MD Date of last inspection Brief description of the care home Holmhurst Care Home is a large family home, extended to provide accommodation for up to twenty people. Accommodation is provided in a range of single and shared rooms on the ground and first floors. Communal space comprises a lounge, dining area and quiet room. The home is located in a quiet side street a few minutes walk from the centre of Portswood and is close to local amenities and public transport. People living at the home are responsible for paying for their own chiropody, toiletries and items of a personal or luxury nature. Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 20 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 purpose of this inspection was to assess how well the home is doing in complying with regulations, compliance with previous requirements and to assess what the outcomes are for people who live at his home. The findings of this report are based on a number of different sources of evidence. These included: An unannounced visit to the home, which was carried out over one day on 8 September 2009. We arrived at the home at 10:15 and completed the visit at 17:15. During the visit we looked at all key standards and followed up on requirements that were outstanding from the previous inspection. Any regulatory activity since the last inspection was reviewed and taken into account including any notifications sent to the Care Quality Commission and the predecessor organisation the Commission for Social Care Inspection. Care Homes for Adults (18-65 years) Page 5 of 28 The Commission for Social Care Inspection carried out an Annual Service Review (ASR) of the home on 16 July 2008 and this did not change the commissions opinion of the service or raise any issues for concern. We requested that the provider complete an Annual Quality Assurance Assessment (AQAA) prior to this inspection. This was sent to us within the agreed timescale and this document forms part of the evidence for this report. During this visit we looked at the physical environment including, peoples bedrooms and all communal areas of the home. We examined records, policies and procedures. We talked to people who live at the home and some members of staff. We observed staff during their day-to-day interactions with people living at the home. We also sent surveys to staff and people living at the home. At the time of writing this report we had received completed surveys from fifteen people who live at the home and ten members of staff. The provider was present during the visit to answer questions and discuss issues and verbal feedback was provided to her at the end of the inspection. As a result of this inspection we made one immediate requirement. Care Homes for Adults (18-65 years) Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are fully assessed prior to admission so that the individual and the home can be sure that the home is right for them and will meet the persons needs. Evidence: At the last inspection of the home on 12 September 2007 we found this outcome area to be good. We carried out an annual service review (ASR) on 16 July 2008 and this did not raise any concerns with this outcome area. The provider stated in the annual quality assurance assessment (AQAA) that, A comprehensive assessment is made of prospective service users, this is always carried out by the manager and may, as in the case of a recent admission, involve several visits to current placement and attendance at CPA review meetings. Several trial visits are arranged, initially to look round the home and meet other residents, then to visit perhaps for an afternoon. During the visit to the home we asked to see all the assessment documentation for the most recent person to move into the home. The provider was able to locate some Care Homes for Adults (18-65 years) Page 9 of 28 Evidence: of this material. We saw evidence that information had been gathered from the persons previous residential setting and that information and assessments from other professionals had been obtained. The provider was unable to provide any other written evidence such as the assessment completed by herself prior to the person moving in. The provider gave a verbal description of the assessment that she had undertaken and this involved meeting the person at their previous place of residence, attending discharge and planning meetings. the provider also explained that the person had made several visits to the home accompanied by family members and on their own. Based on this information and our previous knowledge of the homes assessment process there is sufficient evidence to conclude that the home continues to carry out a thorough assessment before admitting someone. However the provider agreed that in future all assessment documentation would be maintained. Care Homes for Adults (18-65 years) Page 10 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person living at the home has a care plan detailing their support needs and these are kept under regular review. However they lack detail regarding peoples mental health support needs and this puts people at risk of not having their needs and wishes met. People are not very involved in their own care planning. Evidence: The previous visit to the home on 12 September 2007 found that, The assessed needs and personal goals of individuals are reflected in a plan of care and residents are supported to make decision about their lives with assistance given by staff. Residents are supported to take responsible risks and this allows them to live an independent lifestyle as much as possible. During the most recent visit to the home we looked at the care plans of three people who live at the home. Each care plan looked at provided information regarding peoples support needs in the following areas; dressing and undressing, washing and bathing and use of the toilet, eating, mobility, communication and mental health. All three care plans had been kept under regular Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: review. Risk assessments were in place for any identified risks. Not all care plans were dated and it was difficult to ascertain which was the most up to date plan for one person as there were three versions on file. The current system of review is that the staff member responsible signs a sheet to evidence that the review had taken place without actually rewriting the care plan. The provider told us in the annual quality assurance assessment (AQAA) that, We are presently changing the format of our care plans to make them clearer. In discussion with the provider we saw examples of the new format which was intended to be held electronically on computer. We discussed with the provider the need to ensure staff have quick and easy access to the care plans. Some have already been put into the new package. The provider explained that the new system would allow for review information to be added to the care plan more easily. The current system must be improved as it does not ensure that peoples needs are safely met and a system that responds to peoples changing needs must be implemented. All staff who returned a survey were of the opinion that they were given up to date information about the people living at the home (for example, in the care plan). However we noted that there was very little information in any of the care plans regarding peoples mental health support needs, despite the fact that this is the primary care need of people who live at the home. For instance in the mental health section in respect of one person the care plan stated, Is quiet and withdrawn. Staff to monitor mood and report any concerns. Care plans did not provide sufficient information about the signs, symptoms or triggers to an episode of mental ill health. Neither did they provide detail of how these were to be managed. We also could see little evidence of peoples involvement in their care plans. This means that peoples wishes and preferences may not be taken into consideration in the care that is provided. In discussion the provider agreed that people could be more involved in this process. The provider agreed that these issues would be taken into consideration when implementing the new care plan format. We were shown examples of care plans that had already been transfered to the new system and saw that there were sections for comments and complaints, critical incident section and a matrix for analysing level of risk and need as well as specific care and support needs. The provider reported that she plans to have all care plans transfered to this system by 8 October 2009. Care Homes for Adults (18-65 years) Page 12 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at this home are supported to pursue their own interests and take part in activities inside and outside of the home and within the local community. They can keep in touch with friends and family and receive a healthy varied diet. Evidence: During our visit to the home several people went out and about into the local community. People spoken with confirmed that they could come and go from the home as they pleased. One person went to a pottery class and another to a hospital appointment. People told us that staff would support them to go shopping for clothes and personal items. During the visit one person was overheard to confirm with staff a shopping trip planned for the following week. Staff said that they were able to go out with people and named Southampton Common and the Hawthorn centre as places that they visited. In discussion with other people living at the home they confirmed that they went to day centres and drop ins. The results of surveys were as follows; Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: when asked whether they could make decisions about what they did each day, twelve people responded, Always, two answered Usually and one person said Sometimes. Everyone who returned a survey told us that they could do as they wanted to at all times of the day including the weekend. The provider said that some people had their own front door keys and keys to their rooms and that those that did not chose not to. We discussed this with people living at the home and any that did not have keys said it was because they did not want one. The home has a visiting policy and this was on display in the entrance to the home. People spoken with told us that they were supported to keep in touch with friends and family and that they could receive visitors whenever they wished to. The provider told us in the annual quality assurance assessment (AQAA), Most of our service users attend clubs such as pottery or gardening, workshops (woodwork, mechanical). We have made contact with the local City Limits project and they are presently trying to find paid employment for two more of our service users. We have already arranged a holiday in Blackpool this year which was a great success and are planning the summer holiday. Four service users are active members of the local church and one attends an evening group monthly accompanied by a friend from the church. We saw examples of menus during our visit. The home uses a four week rolling menu. Peoples individual likes and dislikes are recorded so that staff know whether people like the planned meal or not. It was unclear whether there was a cooked alternative to the main meal. People did tell us that they could have something different if they did not like the main menu item and that generally they were happy with the food provided. One person had their own fridge in their room and were able to make themselves hot drinks in their room. We saw evidence they were given support to maintain food hygiene standards. When we asked about peoples opportunity to be involved in cooking we were told that were not involved in meal preparation. However one person preferred to have pre-prepared frozen meals and they were supported to prepare these. The provider told us that people had the opportunity to do baking twice a week with staff support. In discussion with people they told us that they had the opportunity to do jobs around the home. We saw minutes from a residents meeting where this had been requested by some people. A rota of jobs had been compiled rota allocating people different jobs on different days. Care Homes for Adults (18-65 years) Page 14 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at this home have access to a full range of health care support. However the failure to follow information in care plans puts people at risk. Medication recording procedures are lacking at times. This puts people at risk of not receiving their medication safely. Evidence: Examination of care plans and associated documents provided us with enough information to demonstrate that people living at the home had access to a range of health services as described in the homes annual quality assurance assessment (AQAA) which stated , All service users are accompanied to mental health clinic appointments and some are assisted with trips to doctor, dentist, outpatients clinic, blood tests etc. The Home has a visiting optician service which provides a repair and replacement service as well as regular eye screening. Service users with diabetes are always accompanied to their nurse and hospital reviews as well as podiatry clinics. We have a chiropodist who visits every eight weeks (or more often if requested) and a visiting hairdresser. When service users become ill, we seek advice immediately from appropriate agencies for equipment such as pressure mattresses, walking frames etc. Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: Discussion with people living at the home provided us with further evidence to support this. The home has supported people to adopt healthy lifestyles and had recently supported two people to quit smoking. What did concern us was that one persons care plan stated that they required daily blood glucose monitoring each morning. We asked to see records to demonstrate that this monitoring had been taking place. The provider advised us that this persons glucose levels had never been monitored since they had lived at the home. We were also told that the home were unaware that this was part of the persons care needs. The home was issued with an immediate requirement in respect of this, as this was clearly putting this persons health at risk. The medication administration records were checked for three people during the visit. The first record had been correctly signed and would indicate that all medicines had been given as per the homes medication policy. However omissions were found in the records of the other two people. For one person staff had signed the medication administration record (MAR) indicated that the person had been administered on two occasions although the medication was still in the blister pack. There was also an occasion when the medication had been administered though not signed for on the MAR. Two other errors were noted on the third persons MAR whereby the medication had been administered and not signed for. These errors were brought to the attention of the provider. Who agreed to investigate. The home carries out an audit of the medication records however the above findings would suggest that this is not carried out frequently enough. We saw evidence that staff administering medication are trained and the provider had recently organised several members of staff to undertake a twelve week external course to supplement their knowledge. Staff who completed a survey were all of the opinion that they received enough training about health care and medication. We saw evidence that the home had a policy and procedure regarding medicines brought into the home and that all medicines received into the home were checked and accounted for upon receipt. Care Homes for Adults (18-65 years) Page 16 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has systems in place to safeguard people from abuse. Evidence: The home reported that they had not received any complaints in the last twelve months. We looked at the complaints log during our visit and can confirm that none were recorded. At previous inspections of the home this outcome area has been judged to have been met. Out of fifteen surveys completed by people living at the home thirteen answered that they knew who they could speak to if they were unhappy about anything and everyone said that they knew the procedure for making a complaint. Equally staff all answered that they were aware of the procedure should someone raise concerns about the home. The annual quality assurance assessment (AQAA) stated that, Staff are all trained in Adult Protection issues and we have our own training materials which are used during the induction process. During our visit to the home we saw sufficient evidence to support this. The home has the facility to look after peoples money for them. There is a policy and procedure for this that includes keeping records of all money looked after and the safe storage of the money. We looked at the records for three people and checked these against the balance held in the home. There were slight errors with two of them. For one person the actual balance was slightly higher than the record indicated and for the second it was slightly lower. It was agreed that people were safeguarded as the records were completed and up to date and on each occasion that a transaction had Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: been completed the person who the money belonged to had signed the record. However the provider agreed that a more regular audit needed to take place. Care Homes for Adults (18-65 years) Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean environment. The introduction of en suite bedrooms and the reduction in the number of shared rooms has provided people with more privacy. There have been several improvements made to the physical environment. However certain areas of the home would benefit from new furnishings and redecoration, so that people are provided with a pleasant environment in which to live. Evidence: At the previous visit to this home carried out on 12 September 2007 this outcome area was judged to be adequate. On that occasion it was found that, Generally people who use the service live in a homely and comfortable environment, which is clean, hygienic and free from offensive odours. However certain areas of the home would benefit from repair and redecoration The provider told us in the annual quality assurance assessment (AQAA) about the changes that they had made to the home since our last visit. This included; the redecoration of all bedrooms, the completion of a shower room, with work underway to provide four new en suite shower rooms. Four double bedrooms had been converted into single rooms. The floors in the dining room, laundry room and Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: bathroom had all been replaced. The laundry room had been completely refurbished with new units. Blinds had been fitted to seven rooms. All the bedroom furniture had been replaced. The provider acknowledged in the AQAA that the kitchen needed to be refurbished and said that due to the cost of fitting four en suite bathrooms it was unlikely to be done until at least the end of the year or possible early next year. During the visit to the home we saw all communal areas and several peoples bedrooms. The provider showed us the changes that had been made and they were as described in the AQAA. At the time of visit one bedroom that had previously been a shared room was having an en suite fitted and was being converted to a single room. We saw that people had been able to personalise their rooms with their own belongings. People spoken with said that they were happy with their rooms and those whose rooms had been converted to en suites said that it was better not having to share facilities. Communal facilities consist of a lounge, dining area and quiet room that can also be used to meet visitors in private. the home was found to be clean and tidy and there were procedures in place for the control of infection. The main lounge in the home is quite bare and was in need of redecoration. It did not have the appearance of being very homely and lacked soft furnishings such as sofas. The current arrangement has vinyl type armchairs situated around the perimeter of the room. Care Homes for Adults (18-65 years) Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment procedures are robust and this offers people safeguards. Staff receive training appropriate to their role. Staff need regular supervision so that they receive the support that they need to meet peoples needs effectively. Evidence: We looked at the staff rota for the day of the visit and this proved to be a true reflection of the actual staff on duty. Staff were asked whether there were enough staff to meet the individual needs of all the people who live at the home. Nine responded Always and the other replied Usually. We examined the records of three members of staff during our visit to the home. Two of these were of people who had been recruited to work at the home since our last visit. We saw sufficient evidence to demonstrate that the home carried out appropriate and thorough checks on staff before letting them work at the home. This was consistent with the findings of the previous inspection. All staff contacted were of the opinion that they received appropriate training, training that was relevant to their role and the needs of the people living at the home. The Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: annual quality assurance assessment told us that, everybody had received mandatory training and that the majority of staff had achieved level two NVQ, with others holding a level three. From examination of three members of staff training records we saw sufficient evidence that they were receiving relevant training. The only issue that this inspection raised in this outcome area was the lack of formal one to one supervision for staff. We asked to see supporting evidence that staff had received supervision and the provider could not provide this. The provider agreed that this was an area that was lacking. Currently at least one senior staff member has received supervision training. Care Homes for Adults (18-65 years) Page 22 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally the home is managed safely. However shortfalls in auditing and overall quality assurance mean that people are put at greater risk than is necessary. Evidence: The homes registered provider Mrs Boyes is also the registered manager. Mrs Boyes holds an NVQ level four in care and the Registered managers award. Since taking over the home in July 2007 the provider has continued to make positive changes to the home especially with regard to the physical environment. The provider was observed to interact with staff and people living at the home in a friendly and supportive manner. Throughout the course of this visit. This report has made several requirements regarding care plans, medication, staff supervision and fire safety. Alongside this we have made one immediate requirement. These issues reflect on the effectiveness of the management of the home. Some of these issues are down to a lack of effective quality assurance procedures and this is something that the home needs to improve on. The provider told us that she had employed the services of a business coach and that the plan was to provide each Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: member of staff with positional contracts which would give them specific areas of responsibility such as health and safety and induction. The annual quality assurance assessment (AQAA) provided us with evidence that policies and procedures are kept under review and that equipment used within the home is regularly serviced and checked.We saw documented evidence during our visit to the home that maintenance checks, tests and servicing of equipment are carried out regularly. Examination of the fire logbook confirmed that weekly fire alarm checks are undertaken. However there was no record of a fire evacuation drill being carried out. we also brought to the providers attention that a fire door in an upstairs corridor was being propped open by a fire extinguisher. Care Homes for Adults (18-65 years) Page 24 of 28 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 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 19 12 You are required to check 10/09/2009 immediately with the relevant health professionals as to whether the glucose tests (of the person discussed during the inspection)are required and take action accordingly. This is to safeguard the persons health. 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 12 Care plans must provide 08/11/2009 sufficient information about peoples mental health support needs. This must include the signs, symptoms and triggers to an episode of mental ill health. They also must provide detail of how this is to be managed. This is to make sure that peoples mental health needs are met. 2 20 13 All medication must be administered as prescribed. Administration records must be accurately maintained. 08/11/2009 Care Homes for Adults (18-65 years) Page 26 of 28 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 This is to make sure that people receive their medication safely. 3 36 4 Staff must receive regular supervision. Staff need to receive regular supervision to ensure that they are carrying out their role appropriately and that any support needs are identified. 4 42 13 The provider must consult with Hampshire Fire Authority regarding the frequency of evacuation drills and take action accordingly. The home does not carry out regular fire drills and therefore is unable to determine peoples ability or support needs in the event of a fire. 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 08/11/2009 08/10/2009 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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