Care Home: IW Cheshire Home

What the care home does well The home has a comprehensive pre-admission procedure, which ensures that the home only admits people whose needs it can meet. Evidence indicates that the home ensures that people`s health and care needs are met. Activities are provided and the home has an activities organiser. People enjoy the meals at the home. People are fully consulted and included in decisions about the home. People stated they were happy living at the home and staff that they are happy working at the home. Additional comments form people who live at the home included `most things they do well`, `looks after me and gives me plenty of things to do`, `since I came here my life is much better`. The homes environment is well maintained and has all the necessary equipment and facilities for the people who live there. The home retains a homely feeling. The home is generally well managed. What has improved since the last inspection? There were no requirements made following the previous inspection. The home registered a new manager in October 2008. The manager had previously worked at the home as head of care and acting manager and has the necessary skills and qualifications. The home has continued to improve the facilities at the home for the benefit of the people who live there. A new computer room with suitable computers and internet access has been provided. The home is in the process of refurbishing the activities room with plans being led by the people who live at the home. Other parts of the home have been redecorated and there is an ongoing maintenance programme. What the care home could do better: Two requirements are made following this inspection. People had commenced working at the home before all the pre-employment checks including references had been returned. People were therefore placed at risk. The home must ensure that all pre-employment checks have been returned and are satisfactory before people commence employment at the home. The provider has not ensured that monthly visits are made to the home to assess the quality of the service provided. This means that the provider cannot be sure of the quality of the service provided and people may be placed at risk. The provider must ensure that monthly unannounced visits are undertaken and that a report is compiled following these visits. Requirements were not made in connection with the failure to carry out weekly checks of the homes fire detection equipment as action was taken during the inspection toaddress the reason for missed checks. A requirement was also not made about the safe storage of substances hazardous to health as immediate action was taken and the majority if substances hazardous to health were stored appropriately. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: IW Cheshire Home Appley Cliff Popham Road Shanklin Isle Of Wight PO37 6RG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Janet Ktomi     Date: 0 2 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 34 Information about the care home Name of care home: Address: IW Cheshire Home Popham Road Appley Cliff Shanklin Isle Of Wight PO37 6RG 01983862193 01983866211 sarah.skeels@LCDisability.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Leonard Cheshire Disability Name of registered manager (if applicable) Sarah Skeels Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 13 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: Physical disability - PD Date of last inspection Brief description of the care home Appley Cliff (IW Cheshire Home) is a residential home for up to thirteen adults with a physical disability. The home is situated on the edge of Shanklin Old Village and is approximately one mile from the main shopping area, the post office, bus and train station. The home has extensive views of the English Channel and is adjacent to Ryleston Gardens. Ryleston Gardens are for public use and have a bandstand, mini golf and cafe. Care Homes for Adults (18-65 years) Page 4 of 34 care home 13 Over 65 0 13 Brief description of the care home The home is on two levels and has a passenger lift. All thirteen of the homes bedrooms are for single occupancy, none having en-suite facilities. There is one assisted bath and two assisted shower rooms. The home has plenty of communal areas including a lounge, conservatory, activities room, computer room and dining room. Smoking is only allowed in the conservatory or gardens. The home has gardens that are well maintained and easily accessible to the service users. Twelve of the bedrooms are for permanent service users with the other being used for pre-booked respite care. Day care is offered to a maximum of two people each day. The home is owned by Leonard Cheshire Disability and managed by Registered Manager Ms Sarah Skeels. Fees are individually determined based on the level of care required and information can be obtained from the registered manager. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This report contains information gained prior to and during an unannounced visit to the home undertaken on the 2nd June 2009. All core standards and a number of additional standards were assessed. The home was previously inspected in June 2007 and had an Annual Service Review in June 2008. The visit to the home was undertaken by one inspector and lasted approximately seven hours commencing at 10.00am and being completed at 5pm. The inspector was able to spend time with the staff on duty and was provided with free Care Homes for Adults (18-65 years) Page 6 of 34 access to all communal areas of the home, documentation requested, visitors and people who live at the home. Prior to the visit the registered manager completed an Annual Quality Assurance Assessment (AQAA), information from which is included in this report. Information was also gained from the managers registration report and notifications of incidents that have occurred in the home and surveys/comment cards completed by people who live at the home, staff and external health professionals. During the visit to the home the inspector was able to met with and talk to people who live at the home and staff on duty. What the care home does well: What has improved since the last inspection? What they could do better: Two requirements are made following this inspection. People had commenced working at the home before all the pre-employment checks including references had been returned. People were therefore placed at risk. The home must ensure that all pre-employment checks have been returned and are satisfactory before people commence employment at the home. The provider has not ensured that monthly visits are made to the home to assess the quality of the service provided. This means that the provider cannot be sure of the quality of the service provided and people may be placed at risk. The provider must ensure that monthly unannounced visits are undertaken and that a report is compiled following these visits. Requirements were not made in connection with the failure to carry out weekly checks of the homes fire detection equipment as action was taken during the inspection to Care Homes for Adults (18-65 years) Page 8 of 34 address the reason for missed checks. A requirement was also not made about the safe storage of substances hazardous to health as immediate action was taken and the majority if substances hazardous to health were stored appropriately. 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 set out 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 34 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 34 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. The home undertakes a comprehensive pre-admission assessment to ensure that only people whose needs can be met at the home are admitted. People or their relatives are able to visit the home as part of the admission process. Evidence: The homes admission procedure was detailed in the AQAA and pre-admission assessments were viewed for people admitted in the year prior to the inspection. The inspector discussed new admissions with the registered manager, staff and people living at the home. Responses in comment cards received are also considered. The AQAA stated that prospective service users are assessed to identify their specific needs so that the home can ascertain if their needs can be met. The AQAA also stated that prospective service users are given the information they need to make an informed choice and have the opportunity to visit the home. Comment cards were received from nine people who live at the home. Eight stated Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: that they had got enough information about the home to decide if they wanted to move into the home and the ninth person did not answer this question. The inspector spoke with people living at the home who confirmed that new people are able to visit the home prior to moving into the home. The registered manager stated that she was in the process of updating the written information about the home. This was viewed by the inspector on the registered managers computer. The format in use had been supplied by the provider and the registered manager was placing specific information about the home into this. Once completed the manager stated that copies would be provided to people living at the home for consideration and amendments suggested would be incorporated before the revised information was made available to prospective service users. The inspector viewed the files relating to the newest people admitted to the home including people admitted for respite care. The pre-admission assessments were those produced by the provider organisation and covered all the necessary areas for the home to determine if they would be able to meet a potential service users needs. The registered manager stated that people often have respite care at the home prior to moving in on a permenant residential basis. This had been the case with two of the care plans viewed. Copies of social service assessments were also present in care files viewed. The inspector spoke with care staff who stated that the home did not have frequent new admissions however they did feel they received enough information about new people to meet their needs on admission. Discusions and observations indicate that people living at the Cheshire Home (IOW), are happy at the home and appear to be suitably placed and settled. Care Homes for Adults (18-65 years) Page 12 of 34 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. People living at the home are fully involved in determining how their individual care and support needs will be met. Evidence: Care plans, including risk assessments for four people were viewed and discussions were held with people who live at the home and staff employed at the home. Information in comment cards received is also considered. The AQAA stated that service users are involved in care plans and risk assessments and these are updated every six months. The AQAA also stated that a communications project officer visits the home to facilitate specialist communication equipment that may be required by people who live at the home. Four care plans were viewed including one for a person receiving respite care and the others for people who had been living at the home for longer periods of time. The care Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: plans viewed were individual and followed a person centered format. Care plans had been reviewed. Care plans contained information about, and risk management plans in respect of, health needs as well as personal care, social and leisure needs. Care plans were noted to contain current and older information and this was discussed during the inspection. There may be a need to review the information held in care plans and archive some of the older information to make it easier to identify the current and in use information. The home uses a key worker system. Each care plan contained risk assessments relevant to the needs identified and incorporated into the persons care plan. Management of risk positively addressed safety issues whilst aiming for improved outcomes for people using the service in terms of lifestyles and independence. A number of people who live at the home were spoken with and they confirmed that they had been involved in their care plans and care plan reviews. Care plans were seen to have been signed by the person whose plan it was. The home has a key worker system. The inspector spoke with care staff who confirmed that they were key workers and were clear about their roles and responsibilities as key workers. Observation during the inspection visit confirmed that people are able to make decisions and that these are respected and acted upon by the home. Care plans and pre-admission assessments contained information about communication needs. A number of people who live at the home confirmed to the inspector that they are able to make choices and decisions about their daily lives. Comment cards from people who live at the home stated that they always (four) and usually (five) make their own decisions about what they do each day. There is flexibility as to times for people to get up, activities, meals and where in the home people spend their time. Comment cards from care staff stated that they always (seven) and one (usually) get enough information about the care needs of the people they look after. One staff member included an additional comment about what the home does well stating we do very well promoting independence to our service users and bringing empowering positive attitudes. The arrangements for peoples personal money were discussed with the manager and people who live at the home. Within care plans there were individual financial plans. Some people manage their own money and others are assisted by an external person. Each bedroom has a safe. Alternatively the home will hold small amounts of personal money in the homes safe which the administrator and registered person have access Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: too. At weekends people can be provided with money via a float available to care staff. An audit of money held on behalf of people is completed each week by the manager and administrator. Records viewed confirmed the audits and that money is appropriately managed. Care Homes for Adults (18-65 years) Page 15 of 34 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 are supported to live the lifestyle they choose, and are supported to maintain regular contact with family and friends. People are offered meals they enjoy, which are varied and healthy. Evidence: Information from care plans, comment cards, discussions with care staff and observations during the inspection visit are considered. The homes AQAA stated that people have choice and control over their lives and that the activities room is being redeveloped in consultation with people who live at the home. The AQAA also stated that a new computer room has been provided with specialist computer equipment suitable for the people who live at the home and that activities staff are employed. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: The manager showed the inspector the new computer room and other communal areas of the home. The computer room is fully accessible and the person using the room at the time of the inspection visit confirmed that all the necessary equipment and internet access was provided. People are able to access the room and computers independently. With full consultation and involvement of the people who live at the home the activities room is being redesigned and when completed will provide facilities for people to prepare snacks and beverages as well as providing space for a range of activities and social occasions. The home has divided the conservatory to provide a designated smoking area and craft area. Discussions with the manager indicated that it is hoped to provide further craft activities in a building in the garden that is currently used for storage. Care plans contained information about peoples social and leisure likes and dislikes. With daily records showing how people had spent their time. The home employs two part time activities staff and has two vehicles appropriate for the people who live at the home. The manager stated that there are plans to replace one of the vehicles. The manager stated that they are encouraging people to attend activities outside the home with people going to college and day centres in Newport and getting more involved in the community. One of the homes activities staff is completing dreams and wishes lists with people. The manager explained how this has resulted in one person being supported to achieve a wish. One of the external health and social care professionals who completed a comment card stated residents seem happy and appear to have their social needs met. Nine people who live at the home completed comment cards and all stated that they could do what they wanted during the day and evening. One stated that they could not do what they wanted at the weekend as there was no-one to take them out at weekends. This was also reflected in a comment card completed by a member of staff who stated that the home could do better by providing more outings if more volunteers were forthcoming. And another staff member stated as we have young people living at our home I feel they should have more access to outside activities of their choice although this is in the process of being implemented. During the inspection visit people were observed using the computer room, sitting in the garden reading and in the lounge watching television. Others were spending time in their bedrooms. One person was away spending a week on holiday in a hotel with staff from the home supporting them. The manager stated that other people may also Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: go on holiday later in the year but this has not yet been arranged. Discussions with people during the inspection visit indicated that they felt they were able to spend their time as they wished and that the home would support them to undertake activities of their choice. People are supported to celebrate life events and are able to invite friends and family to visit them at the home. The inspector met some visitors and people confirmed that they can have visitors or are supported to visit friends and families. The home has a well equipped kitchen and employs catering staff. The inspector spoke with the person preparing food on he day of the inspection who was a carer covering for the cook who was on leave. The home is recruiting a second cook and the inspector was shown the returned application forms. The homes menus have been planned with the people who live at the home. People stated to the inspector that they have been involved in menu planning and that they have a choice at meal times. People are able to eat where they wish either in the homes dining room or in their bedrooms, the lounge or when weather permits on the patio outside. People were positive about the food provided at the home and confirmed that specialist equipment is provided when required. The inspector observed people being given drinks throughout the inspection and people confirmed that they can have drinks or request these at any time. The home has been awarded the maximum five stars for food hygiene by the local environmental health department. Care Homes for Adults (18-65 years) Page 18 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal care and support in the way they prefer and their health needs are met. Medication is appropriately stored, administered and recorded. Evidence: Information about personal and health care needs and that provided was viewed in care plans. Comment cards and discussions with people who live at the home and staff are also considered. The arrangements for the storage and administration of medication were viewed with any related records. Care plans contained detailed information as to how peoples personal care needs should be met. This included information about preferences as to baths or showers. The home has the necessary equipment to ensure people can have their personal care needs met. Care plans contained individual moving and handling assessments and plans as to how people should be moved and what equipment should be used. People living at the home stated that their personal care needs are met and that staff ensure that their privacy and dignity are maintained. All bedrooms are for single Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: occupancy ensuring privacy and dignity during personal care tasks. Care plans contained a record of the preferences of service users as to the gender of staff they would prefer for personal care. People confirmed that their preferences are respected in terms of gender for personal care. Care plans also contained information about peoples health care needs and how these were being met. There was information that people had attended dentists, chiropodists and opticians as well as GPs and district nurses. People had also been supported to attend well person clinics and health promotion such as stop smoking clinics. Discussions with people indicated that they felt their health needs were being met. Comment cards were received from an external health professional who stated that peoples health and personal care needs were usually met. An additional comment in the section asking what the home could do better being improve communication between staff, sometimes we give one carer instructions regarding the health care of a resident it may not be passed on to other carers thus delaying the change needed. The home was recording the fluid intake for two people who lived at the home. The records were viewed and discussed with staff at the home. The records had not been fully completed and were recorded out of time sequence indicating that they were not being recorded at the time that fluids were being given on all occasions. The fluid charts were being recorded as the people were spending additional time in their bedrooms as they had been unwell. A decision was made that in future fluid charts would be kept in peoples bedrooms so that staff could record them at the time when fluids were given. Discussions with care staff indicated that they felt they had sufficient time to meet peoples personal and health care needs and that they had access to all the equipment they required. Care staff also felt that they had the necessary skills and training to meet peoples needs. At the time of the unannounced inspection all medication was found to be stored correctly either in a medication trolley attached to a wall or in a locked cupboard in the treatment room. The medication administration records were viewed and had been fully completed. The inspector was informed that medication is only administered by staff who have completed additional training and been deemed competent. Medication coming into the home is recorded on the Medication Administration Records and the homes returns book was also viewed. The home uses a pre-dispensed system for most tablets with liquid medication dispensed at the time of administration. Care Homes for Adults (18-65 years) Page 20 of 34 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 at the home are able to complain and should be protected from abuse however the homes recruitment processes may have placed people at risk. Evidence: Information in the homes AQAA, comment cards received and from discussions with people who live at the home and staff are considered. Related records were viewed. The provider has a complaints policy which is made available to people or their representatives. The complaints policy should ensure that all complaints are appropriately investigated within twenty-eight days. The AQAA recorded, and the homes manager stated during the inspection visit, that no complaints had been received. No complaints have been received at the Commission in respect of the home. The manager explained how the home would deal with any complaints and these would initially be recorded at the home and then passed to the area manager who would arrange for the complaint to be investigated by the manager of another home owned by the provider. As well as the homes formal complaints procedure people would be able to raise issues at service user meetings or to the representative of the provider when they visit the home. The representative of the provider should visit the home on a monthly basis Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: however records of these visits evidenced that they had not been occurring every month. This is further discussed in the management section of this report. People stated that they knew how to complain and that they would raise issues however at the time of the inspection visit they did not have any concerns. People felt that the manager would sort out any complaints or issues raised. Nine service user comment cards were received and all stated that they knew who to speak to if they were not happy and how to make a complaint. All staff comment cards stated they knew what to do if someone had concerns about the home. Eight of the service users who returned comment cards stated that staff and managers always treat them well and one responded usually to this question. Discussions with people who live at the home showed that they felt safe living at the home. Discussions with staff confirmed that they had received safeguarding training and that they were aware of safeguarding issues and what action they should take if they had concerns that people living at the home may not be safe. Information provided by the manager in respect of staff training confirmed that staff have received safeguarding training and that training in respect of the deprivation of liberties and mental capacity acts have occurred or are planned for all staff. Discussions with the manager indicated that she was aware of the implications of this legislation on the home and people who live there. The home has appropriate procedures in place in respect of peoples personal finances and safe places where people can store valuables. Issues were identified in respect of the homes recruitment procedures such that all the necessary pre-employment checks had not been carried out prior to people commencing employment at the home. This places people at risk and is further reported in the staff section of this report. Care Homes for Adults (18-65 years) Page 22 of 34 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. The standard of accommodation within the home is good providing people with a comfortable and homely place to live which meets their individual and collective needs. Evidence: Information in the homes AQAA, records viewed, discusions with care staff and people who live at the home are considered. The manager detailed in the homes AQAA the improvements that have been made to the home over the previous year. These have included the provision of a new fully equiped computer room with automatic doors for easy access and the ongoing refurbishment of the activities room. People who live at the home confirmed that they had been included in discusions about these improvements. The AQAA also detailed other improvements including new fire doors being fitted and new ceilings in ground floor rooms to meet fire safety requirements. The hallway has been redecorated downstairs as has the stairwell and upstairs landing. There are plans to replace the flooring in the hallway in the near future. The home has the necessary equipment to support the people who live there. All Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: bedrooms are fitted with overhead hoists and the home has a manual hoist and travel hoist. Serviceing details and certificates were seen for equipment in use in the home. People who live at the home stated that the home has all the equipment required to meet their needs. The home has contracted out the weekly checks of the fire detection equipment and the records of this were viewed. The checks are undertaken on a Monday however when there is a bank holiday a check had not been completed resulting in one missed check in April and two in May. The home had not realised this and took immediate action to contact the contractor during the inspection visit and arranged for the checks to occur on another day to ensure that they are done every week. Comment cards from people who live at the home stated that the home is always fresh and clean and there were no unpleasant odours at the time of the unannounced inspection. The home employs cleaning staff with two on duty each day. Care staff confirmed that they have all undertaken infection control training and have ample supplies of infection control equipment. The homes laundry is appropraite for the size of the home. Care Homes for Adults (18-65 years) Page 24 of 34 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. The home employs appropriate numbers of staff that ensure that peoples needs are met. Staff receive the necessary training and sixty-six percent have an NVQ of at least level two in Care. The homes recruitment procedures have placed people at risk as care staff have commenced working in the home prior to pre-employment checks being completed. Evidence: Records relating to recruitment and training were viewed. Discussions with staff and people who live at the home as well as comment cards received are considered as well as information provided by the registered manager in the homes AQAA. All comments from people who live at the home were positive about the homes staff. People stated that they felt there were generally enough staff to meet peoples needs. Nine people who live at the home completed comment cards four responded always and three usually and two sometimes to the question asking if staff listen and act on what they say. Duty rotas were seen during the visit to the home. Duty rotas stated that there are four care staff in the morning, three in the afternoon and evening and two at night. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: Cleaners, activities, administration and kitchen staff are also employed. The manager is generally in addition to these numbers. During the inspectors visit staff on duty corresponded to those on the duty rota. Comment cards from staff stated that one always, four usually and two sometimes there are enough staff to meet the different needs of the people who live at the home. The registered manager provided training and qualification information on the AQAA and this was confirmed by the person in charge at the time of the inspection. The home has twenty-one care staff, fourteen of whom have an NVQ in care. This equates to sixty-six per cent. The inspector spoke with care staff who stated that they felt they had the necessary training to meet peoples needs. The registered manager showed the inspector the homes training information on the computer. The home accesses training via the providers training team with training provided on the mainland and also at the home. Training certificates were seen in staff files and dates for training were seen on the duty rota. The training information showed that most staff have undertaken all mandatory and service specific training. Staff comment cards included additional comments in the section asking what the home does well included has good training and good reputation for providing good care, has improved to meet the needs of the service users, regular supervision and provides update information and supports staff. Another stated regular supervision and the opportunity to discuss any issues at staff meetings and training opportunities. The inspector viewed minutes of staff meetings. Information on the homes AQAA and from discussions with staff and people who live at the home showed that the home has a consistent staff team and that agency staff are not used with the homes own staff covering additional shifts when required. The recruitment records for three staff recruited over the past year were viewed and the manager explained the homes recruitment and induction procedures. Recruitment is managed jointly by the homes registered manager and the providers human resources department. Comment cards returned by care staff stated that all preemployment checks are carried out however the recruitment records showed that although checks are carried out these had not been completed before people commenced working at the home placing people at risk. One person commenced working in the home at the end of September 2008, the POVA check had been received however one reference from the persons previous employer was not received until December 2008 and the other reference was provided by a friend and had not been dated. Another new staff member commenced working in the home on shadow shifts on the 17th April 2009 and on the full duty rota on the 26th April 2009. The persons POVA and CRB checks were both received on the 24th April and both Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: references were received on the 29th May 2009. The person had previously worked at another home owned by the provider however there had been a break in service. The third recruitment file evidenced that all the necessary checks had been completed before the person commenced working in the home. The recruitment procedures have placed people at risk. Discussions with staff on duty confirmed that they felt the induction provided them with the necessary skills and knowledge to meet peoples needs and that they had undertaken shadow shifts before becoming one of the staffing numbers. This was also the view of staff who completed comment cards. Care Homes for Adults (18-65 years) Page 27 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is appropraitely managed and run in the best interests of the people who live there. The provider has failed to undertake monthly unannounced visits to the service which may place people at risk. The home is generally a safe place for people and immediate action was taken when concerns were identified in relation to the checking of fire detection equipment and storage of substances that may be harmfull to health. Evidence: The homes AQAA, discussions with staff and people who live at the home, records viewed throughout the inspection and observations during the inspection are considered. Also considered is the commissions registration report for the new registered manager and other information provided to the commission. Since the previous inspection a new manager has been appointed and was registered in October 2008. The registration report states that the registered manager has the Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: necessary skills, qualifications and experience including an NVQ level 4 in care and the Registered Managers Award. During the inspection visit the registered manager confirmed that she continues to undertaken mandatory and other relevant training. The registered manager had previously worked at the home as the head of care. The manager is supported by a head of care, administrator and a team of senior staff. Comment cards from both staff and people who live at the home included positive comments about the way the home is run including open door management style, run well and makes me happy and most things they do well. The homes Annual Quality Assurance Assessment (AQAA) was completed by the Registered Manager and returned when it was requested. This was completed to a good standard and provided the information requested. The provider undertook an internal audit to the service in March 2009 and a copy of the report from this was viewed by the inspector. The home undertakes staff and service user meetings with the inspector viewing the minutes of recent meetings. Discussions with people who live at the home confirmed that they are included in discussions and decisions about the home. The provider sends out surveys to people who live at the home and other stakeholders. The manager does not get the results of these and the responses are collated on a national basis. This makes it difficult for the manager to identify what issues may be pertinent to the home and take any necessary action. The provider has a service user national association and a representative from the home was attending a local area meeting on the day of the inspection visit. The manager stated that feedback from these meetings is given to her by the person from the home who attends the meetings. The inspector viewed the reports provided to the manager by a representative of the provider when they undertake a visit to the home to assess the quality of the service provided. These are called Regulation 26 visits. These should occur unannounced every month and a report provided to the manager. The reports and discussions with the manager showed that these have not been occurring on a monthly basis and that they are aware when a regulation 26 visit is to occur. Regulation 26 visits did not occur in March or February 2009 or in November 2008. A range of records were viewed during the inspection. All were appropriately stored with access only available to people who should have access. Records were generally well maintained with the exception of fluid charts and recruitment records. The inspector viewed records relating to the servicing and checks on the equipment in use in the home. These evidenced that equipment should be safe. The inspector also Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: viewed records of the weekly check undertaken on the homes fire detection and prevention equipment. These are undertaken by an external contractor and had not been completed on a weekly basis. No requirement is made as the home took action during the inspection visit to ensure that this situation did not continue. The issue re the fire equipment checks had not been noted by the providers representative during the Regulation 26 visits. The inspector noted some substances hazardous to health had been left in a bathroom. These were immediately stored correctly by the staff member they were pointed out too. Care Homes for Adults (18-65 years) Page 30 of 34 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 31 of 34 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 34 19 The registered person must ensure that people do not commence working until all pre-employment checks have been returned and are satisfactory. So that people are safe. 01/07/2009 2 39 26 The responsible person must 01/07/2009 ensure that a representative of the provider visits the home unannounced on a monthly basis to undertake an assessment of the quality of the service being provided and provides a report to the manager. So that the provider is aware of any issues and people living at the home are safe. 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. Care Homes for Adults (18-65 years) Page 32 of 34 No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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