Care Home: Horncastle Care Centre

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What the care home does well The home is relaxed and supports people in the way they wish to be supported. There is a wide range of activities provided and outings arranged. The premises and grounds are well maintained, spacious, and decorated and furnished to a high standard. What has improved since the last inspection? An additional mini bus driver has been employed, which has helped increase the number of trips and outings people living in the home can go on. Additional activities staff have been employed, which has helped increase the range of activities and outings arranged for people. A number of suggestions by people living in the home and others have been implemented - for example rebuilding the jacuzzi to make it accessible to people who require hoisting. What the care home could do better: Proper arrangements are not in place for `as required` medicines, and new stocks of medicines are not always being obtained when needed. People are not receiving copies of their care plan in a format they can understand. This would support them in contributing to their plan of care. Some staff not trained in food hygiene may be handling and preparing food, for example breakfast, in the home. This may present a risk to people living in the home. The service has not always protected and safeguarded people who live in the home in ways they have a right to expect. Key inspection report Care homes for adults (18-65 years) Name: Address: Horncastle Care Centre Plawhatch Lane Sharpethorne East Grinstead West Sussex RH19 4JH     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: Edward McLeod     Date: 0 2 0 2 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 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) © 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 32 Information about the care home Name of care home: Address: Horncastle Care Centre Plawhatch Lane Sharpethorne East Grinstead West Sussex RH19 4JH 01403217338 01403219842 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Dr Shafik Hussein Sachedina,Mr Shiraz Boghani care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 20. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Physical disability (PD). Date of last inspection Brief description of the care home Horncastle Care Centre is a care home registered to provide personal and nursing care to ten people in the category of younger adults. The home is purpose built and has wide corridors, specialist equipment such as overhead tracking hoists and specialist bathing equipment and there is also a multi sensory room and a hydrotherapy spa. Service users bedrooms are all on the ground floor and there is access to patio areas and extensive gardens. The home is situated near the town of East Grinstead and a minibus is avialable to enable service user to access the local community. The Care Homes for Adults (18-65 years) Page 4 of 32 2 4 0 2 2 0 0 9 20 20 Over 65 0 0 Brief description of the care home Registered Manager is Mr Rezaul Hossen and the Registered Providers are Dr Shafik Hussein Sachedina and Mr Shiraz Boghani. Current fees range from one thousand two hundred pounds per week to two thousand nine hundred pounds per week. 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: 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: We risk assessed that there was a need for an inspection visit to review the quality and safety of the care being provided. The inspection was attended by an inspector, an expert by experience and their advocate. An expert by experience is a person with experience of the type of service being visited, for example as a service user. Experts by experience receive training and support in contributing to Care Quality Commission (CQC) inspections. The inspection commenced at 10 a.m. on the 2nd February 2010, and the Commission was on the premises for six hours. In preparation for the visit we looked at all the information we have received, or asked for, since our previous key inspection. This included: Care Homes for Adults (18-65 years) Page 6 of 32 - The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. - Information we have about how the service has managed any complaints. - What the service has told us about things that have happened in the service. These are called notifications and are a legal requirement. - The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. - Relevant information from other organisations and what other people have told us about the service. We received the AQAA by the date requested, and it included all the information we had asked for. We had also sent to the home on the 23rd December 2009 questionnaires for ten people living in the home, ten staff, and ten relatives or advocates of people living in the home. We understand from Mr Hossen that these were only received by the home after our inspection visit. At the time of the writing of this report, we have received two CQC surveys back from people living in the home, and five CQC surveys back from staff working in the home. Some of the information received has been included in the writing of this report. During our visit we spoke with five people living in the home, six members of staff, and the registered manager Mr Hossen. We also spoke with a manager employed by the providers who was visiting the home and assisting with our questions. We visited all the communal areas of the homes two units - Maple Lodge and Willow Lodge. We observed interactions in the home, including during the serving of lunch. Records sampled included care records for five people and medication records for six people living in the home. We also looked at the records of three complaints, and other documents including records relating to health and safety and quality assurance. Staff records sampled included recruitment records for three members of staff and training records for six staff. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 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 9 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. 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. Evidence: The AQAA tells us that all service users have a contract which specifies the fees structure and any other chargeable facilities provided. This information is shared with service users. We sampled the care records for five people living in the home. We found that assessments carried out before admission which we sampled were setting out in detail what the persons care and support needs were. We found that the persons needs were being discussed with them or people close to them in detail at a pre-admission visit. Care Homes for Adults (18-65 years) Page 10 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples 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 staff promote their rights and choices. People are supported to take risks to enable them to stay as independent as possible. 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. Evidence: We sampled the care records for five people living in the home. We found that the individuals care plan was including relevant risk and ability assessments, and how their needs were to be met - including medical care and communication support Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: needs. We found that there is a regular review of the care plan, usually monthly, and staff told us that as they get to know the persons needs better the range of support being offered to the person is increasing. A member of staff told us that they have established a routine with one person which is helping them settle into the home and have the stimulation they need and that new things are added every month to the care plan as we get to know him. We found that care plans were not being set out in a format which is accessible to the resident, for example incorporating pictures or symbols that the person is familiar with. We discussed this with a manager for the company who was visiting the home, and who thought that this was a good idea and could perhaps be considered at future meetings with people living in the home. A requirement concerning this has been made. The manager advised us that each resident has a communication passport, which includes information on medication conditions and their diary, which people carry around with them. People we talked to told us they were able to make lots of choices such as what to do, what to eat, and what time to go to bed. The two people living in the home who responded to our CQC survey told us they usually make decisions about what they do each day and that they can do what they want to during the day and in the evening. Staff we talked to told us that they meet with people living in the home to seek their views on the service and changes they would like to be made. For example, it was found that the sides of the jacuzzi were too high for people who needed a hoist, so the service did some rebuilding to make the jacuzzi accessible to them. We found that people living in the home are being supported to arrange and plant garden areas, and to help care for the pet rabbits. Risk assessments are in place for each person, and these are supporting people to Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: maintain their relative independence and develop new skills. For example, one person who had previously found it difficult to sit in a cinema for the duration of a film, has been able to do this by supporting him to incease his levels of concentration. Care Homes for Adults (18-65 years) Page 13 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. Each person is treated as in individual and 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. People have healthy, well-presented meals and snacks, at a time and place to suit them. Evidence: We are told in the AQAA that there is a full time activity co ordinator and two activity Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: assistants. The AQAA tells us that two people attend education, and there is an activities programme which includes bowling, horse riding, cinema and theatre. There are regular evening and weekend outings and an outreach programme two days a week we are advised in the AQAA. Records we looked at indicated the Outreach programme takes place on Wednesdays and Fridays between 10 am and 3.30 pm, and each day is usually attended by seven people living in the home. An email seen from a social worker to the home advises that the relative of a service user had found the facilities to be of of high standard and that the service user was well-occupied with activities. A member of staff we talked to told us that activities at weekends include visits to the pub, swimming, physiotherapy, use of the sensory room, drawing, and one person who likes to go to church is supported to attend. People we talked to told of us of events they had attended, such as the Holiday on Ice show and sports events. Since our previous visit the home has acquired a second mini-bus to help transport people who live in the home around. There seemed to be a good balance between activities in the home and community, which helps to overcome the home not having easy walking access to a local town with community facilities such as a sports centre, library, and cinema. People told us that the home welcomes friends and relatives visiting, and that they come to parties at the home. A consultation meeting, known as a service user focus group, was planned for later in the week that we were visiting. Each of the two units has a sensory room. Staff tell us people use them for activities such as aromatherapy and physiotherapy during the day, and also in the evening for relaxation. In each dining room there is a computer with a web camera. Staff told us this is Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: helping one person, for example, have visual contact with a relative who is living abroad. We observed a member of staff assisting a person living in the home with making use of the computer. There are picture menus which assist people with choosing what they wish to eat. Menus are arranged for a four week period. On the day of our visit the lunch provided was lamb tagine with cous cous or jacket potatoes or mashed potato. We spoke with the cook who told us that sandwiches are also an option at lunch. Asked about specialist diets which are being provided, the cook told us that one person is allergic to sea food, and the diets of people who needed gluten free or soft food diets were being catered for. In one of the units, the food likes and dislikes of people were displayed in the kitchenette. We observed lunch in one of the units, and found the atmosphere to be calm and relaxed. People who needed assistance were receiving this. Staff were patient and unobtrusive in providing assistance. Not all staff who provide assistance with eating or who are involved in preparing food have received training in food hygiene. A requirement has been made concerning this in the Staffing section of this report. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. The home could do more to support people in a safe way to manage their medication. Evidence: People who we talked to said staff were friendly and attentive to their needs. People told us that they were happy and liked living in the home, and that they had plenty of activities that they enjoyed. Many people living in the home have complex personal care and communication needs. People told us that the staff were supportive, helpful and enabled them to lead fulfilling lives. One person told us that living in the home had greatly improved their quality of life, and that staff had undergone special training to learn how to support them. Care records we sampled indicated that people are accessing the medical support they Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: need, and health care plans are in place. We sampled medication records for six people living in the home. We found that there was not advice to staff in place for when as required medicines are to be administered. We also found that sometimes staff were recording when as required medicines had not been administered and sometimes staff were not. We discussed this with the registered manager Mr Hossen who told us the need to provide this information to staff on as required medicines had been identified. We found that in the previous nine days some prescribed medications had not always been in stock for three of the six people whose medication records we sampled. This indicates that they had not always able to receive treatments prescribed for them during this period. The manager Mr Hossen told us that the problem of out of stock medicines had been identified and one nurse from each unit now had responsibility for ensuring this didnt happen. A requirement concerning safe administration of medication has been made. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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 has not always safeguarded people from abuse and neglect and must take action and put in place systems to ensure they do. Evidence: There is a complaints policy and procedure provided by the home. We sampled the records of three complaints received since our previous visit. We found that complaints were being recorded, investigated, and the outcomes given to the complainant within timescales specified. We are told in the AQAA that the home is not appointee for the finances of anyone living in the home. Where the home helps a person to manage a small amount of money the AQAA tells us that receipts are obtained, and receipts are given for money deposited. We are told that money deposited is held in an account for the individual at head office. Staff we spoke to told us that a statement on the small amounts of money held for people living in the home is sent to relatives once a month. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: There have been safeguarding allegations concerning the service which at the time of the visit were still being investigated. We discussed some of these with Mr Hossen who told us that in response to allegations the service had been proactive in better ensuring that, for example, staff have the opportunity to develop better communication skills, and that robust admission proceedures are in place. Following the site visit we have received from West Sussex County Council a report of their safeguarding conferences held on the 10th March 2010. Outcomes into the investigation of allegations of neglect in relation to three people living in the home are provided in the report. Allegations of neglect in relation to the three people living in the home were found to have been substantiated in all three cases. A requirement has been made, and we have written seperately to the provider concerning these outcomes. There is a safeguarding referral concerning a fourth person living in the home, and the outcome of this is not yet known to us. Staff training records sampled indicated that regular training in safeguarding is being provided for staff. Mr Hossen advised us that he had attended a briefing on the role of managers in the investigation of safeguarding allegations. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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 feeels like their own, it is comfortable and they feel safe when they use it. Evidence: The home is arranged in two purpose built buildings, Maple Lodge and Willow Lodge, each of which can accomodate up to ten people, with Maple Lodge in September 2008 being the first of the two to open. We found that the accomodation and grounds are being well maintained, and that the facilities are of a high standard. The accomodation is comfortable and spacious, and although it is new it is starting to become more homely, with art work on the walls by people living in the home for Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: example. Decoration and furnishing are of a high standard. Many people are wheelchair users and on the whole the accomodation and arrangement of the accomodation is meeting their needs. There is plenty of communal space and a number of storage areas for equipment, and it is helpful that all accomodation is on the same level. The provider needs to note however that the front door bells are placed too high up for people in wheelchairs to reach. Facilities such as the jacuzzi and the sensory rooms were well thought out and people really enjoyed using them. There was a tilt table in one house and it was good to see that such a specialist piece of equipment had been provided. Other community facilities included a dining and activities room in each unit, and a sitting room in each unit. Bathrooms with specialist baths have also been provided, which supplement the en-suite shower and toilet facilities. There are picture boards which show which residents and staff are in and which are out. The activity area in each unit includes a computer with a web camera to help people keep in touch with their relatives. One person offered to show us his room, which he demonstrated had adequate space for manoevering his wheelchair. He told us he liked his room and explained how he had personalised his room with pictures and other belongings. Other bedrooms seen had similarly been personalised by the person, sometimes with the assistance of their family. Bedrooms were found to be decorated and furnished to a high standard, and to have the equipment, furnishings and facilities - including en suite facilities - that the person would need. The AQAA tells us that following professional assessments a number of aids and adaptations have been provided including mobile hoists, wheelchairs, specialist beds, rails, toilets seats and standing frames and that all equipment is serviced and checked. All areas of the home visited were found to be clean and hygienic, and free of odours. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. Not all staff are receiving all the training they need to support people living in the home safely. People are not always being supported by a staff team who understand and do what is expected of them. Evidence: The AQAA tells that all staff in the home have received induction training, which introduces them to policies and procedures in the home and what is expected of them. Of twenty-four permanent staff, the AQAA advises us that eight permanent staff hold the National Vocational Qualification (NVQ) in care at level 2 or above, and that six staff commenced NVQ training in January 2010. A member of staff we spoke to said they had been one of the staff that started their NVQ training in January. Since our previous visit and the opening of Willow Lodge, additional van drivers and Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: activities staff have been employed. Residents told us that the staff were really good, and the interactions that we saw backed this up. Communication between residents and staff seemed relaxed, natural and good natured. We talked with one resident who had a new piece of equipment that staff were learning to use so that they in turn could support her to use it. One resident said to us its an amazing place. They see past the wheelchair and equipment and talk on your level. On the day of our visit there were enough staff to ensure that people were receiving the personal care they were in need of, and to engage people in activities and assist them on outings. Of the five staff who responded to our CQC survey, two said there were always enough staff to meet the individual needs of all the people who use the service, and three said there were usually enough staff to do this. The AQAA tells us that a number of registered nurse shifts are being provided by agency staff. We sampled records for two agency staff employed in the home, and found that the service was obtaining confirmation from the agencies of current nursing registration, criminal records check, references, and entitlement to work if applicable. Recruitment records for three staff working in the home were sampled. We found that the required checks and references had been obtained before the person started work in the home. This helps ensure they are safe to work with people in the home. We sampled the training records for five staff working in the home. We found that arrangements to receive regular training in topics such as safeguarding, communication, mental capacity and pressure relief were in place. Training certificates seen also indicated some staff had done training in conditions or treatments particular to a person living in the home. We are told in the AQAA that a number of staff have received training in picture communication, the Tel-us computer system, and makaton sign language. One member of staff responding to our CQC survey believed there was a need to give Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: staff the training before starting to work to ensure staff are knowledgeable and competent in dealing with service users. Another member of staff wrote in their CQC survey form that more training for staff for the service users individual needs was needed. We discussed with the manager Mr Hossen allegations being investigated that some staff were not communicating well in English. Mr Hossen advised us that more staff whose first language was English had been employed, and some staff whose first language was not English had been receiving support with this. Mr Hossen advised us that English tests were now part of the staff interview process. Staff we spoke to told us that they were receiving regular one to one supervision. One member of staff told us that supervision was useful for talking through issues and the best way to do things. A list of staff supervisions that had been arranged for January 2010 was displayed on one of the notice boards. The five staff who responded to our CQC survey all that us that their manager regularly gives them enough support and meets with them to discuss how they are working. Care Homes for Adults (18-65 years) Page 25 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. People have confidence in the care home because it is run and managed appropriately. Peoples 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 practicies are carried out. Evidence: We are advised in the AQAA that the registered manager Mr Rezaul Hossen holds management and nursing qualifications. At our visit we found that Mr Hossen has continued to update his skills and training. We found there was a good atmosphere in the home. People living there believe they have choice in the things they do. Staff working in the home are positive about the home and the work they are doing. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: One member of staff told us in their CQC survey form that there was a lovely, friendly and nice atmosphere. In their CQC survey form another member of staff wrote that there was a happy working environment. Good communication. Excellent working relationships between staff. We were advised by Mr Hossen that a consultation with parents and carers was planned for the following month. Mr Hossen told us that improvements which had taken place as a result of listening to the views of others had included the purchase of cups and saucers, starting a consultation group with relatives and carers, and inviting parents to attend spa sessions in the home. Other suggested improvements which have been done have included purchasing bean bags for the lounges, doing more painting, and starting a newsletter. The AQAA tells us that a trained health and safety representative does regular checks and risk assessments in the home. The manager has advised us in the AQAA of the most recent services and tests carried out on equipment in the home, as recommended by the manufacturer or other regulatory body. At our visit we sampled a number of weekly and monthly health and safety checks carried out in the home. These indicated that arrangements are in place for a safe environment to be maintained. We are told in the AQAA that all staff have undertaken training in the control of infection and in malnutrition care and assistance with eating. Staff training certificates sampled indicated that staff are receiving training in health and safety topics such as substances hazardous to health, fire safety, first aid and health and safety. The AQAA advises that five care staff and two catering staff have completed training in safe food handling. As care staff are assisting with food preparation, for example breakfasts, this indicates that some staff preparing and handling food may not have received training in safe food handling. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: This was discussed in a telephone call with Mr Hossen after our visit. He said that as main meals are being cooked by kitchen staff, the service did not believe there was a need for all staff to receive this training. As we have indicated, however, staff who may not have received food hygiene training are handling or assisting with meals. This may pose a health risk to people living in the home. A requirement concerning this has been included in the previous section of this report. Care Homes for Adults (18-65 years) Page 28 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 29 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 15 The plan of care is made 28/06/2010 available in a language and format the service user can understand and is held by the service user unless there are clear and recorded reasons not to do so. People living in the home are not being provided with care plans in a format that they can understand. 2 20 13 The provider must ensure 30/03/2010 that arrangements for the recording and administration of medicines safeguard the people living in the home. We found that some medicines prescribed had been recently out of stock, and written advice to staff on administering as required medicines was not in place. 3 23 13 The registered person shall make arrangments, by 28/06/2010 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 training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. There is evidence that some people using the service have suffered harm or neglect in the home. 4 35 17 The registered person shall 28/06/2010 ensure that the persons employed to work at the care home receive training appropriate to the work they are to perform. Staff have not always received the training they are in need of to ensure all the needs of service users can be met. Staff who are handling and preparing food for people living in the home may not have received training in food hygiene. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 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. 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