Care Home: Karamea Care Homes

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What the care home does well The home make sure that they write down everything they know about the person, so that they can help them in the best way. Staff can see from what is written down how people like to live and how they like to be helped. People are helped to do as much for themselves, as they can as safely as possible. This is because staff have written down how to make sure people do things for themselves and say what they want. People have things to do ,during the day, that they like doing so that they don`t get bored or fed up. The home makes sure that people are helped to see Doctors or other people so that they feel as happy and healthy as they can. The home has lots of staff who have worked there for a long time and know the people who live there very well. They learn things to make sure that they can help people , in the best way. The manager has been in the home for a long time and makes sure that it is run so that the people who live there, enjoy their life. What has improved since the last inspection? The home has used pictures in some of the paperwork so that people might be able to understand what it is about. They have a good way of making sure that they can look at peoples` visits to Doctors and nurses so that they can help them to look after themselves. The home has new carpets and floors, which look nice and won`t trip people up. The staff know how to wash their hands properly so that they don`t pass germs to the people who live in the home or to each other. What the care home could do better: The home could look at how they choose what food to have, so that people don`t have the same thing alot. The home could look at how to make sure that staff know when and how to give people medicine that they only have occasionally. The home must make sure that the complaints papers follow the rules. The home could have a look at how it pays for staff meals and other things, when they are out and about with the people who live there. The home must look at, if the washing machine washes peoples` clothes safely and does not leave any germs on them. The paper that is filled in when someone has an accident could say how the staff are going to try to stop it ever happening again. The home must make sure that the radiators are safe as they are not covered up and could burn people when they are hot. Key inspection report Care homes for adults (18-65 years) Name: Address: Karamea Care Homes 1 & 2 Church Mews Church Street Theale Berkshire RG7 5BZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kerry Kingston     Date: 1 7 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Karamea Care Homes 1 & 2 Church Mews Church Street Theale Berkshire RG7 5BZ 01189303695 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Debbie Dickinson The registered provider is responsible for running the service care home 8 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 8 The registered person may provide the following category of service only : Care home only (PC) to service users of the following gender : Either whose primary care needs on admission to the home are within the following category : Learning disability (LD) Date of last inspection Brief description of the care home Karamea Care homes are located in 1& 2 Church Mews, Theale and currently provide care for five adults who have a learning disability; there are existing bedrooms for seven, and the service is registered to provide care for up to eight adults. The home is set back from the main road in a residential area close to local amenities and the town centre; the property consists of two adjacent houses. Both houses have two floors and there are some aids and adaptations in the bathrooms to allow service users to move Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 8 Brief description of the care home about more independently. One house accommodates three service users; the other two at present. The service users sometimes spend time together as a group; at other times they remain in their separate houses. Each has its own kitchen, dining room and lounge. Some meals are prepared and shared together; other meals are eaten within the individual houses. All of the bedrooms are single, four of them have en-suite facilities. There is one shared toilet on the ground floor of each house. Public transport services are close-by and the property has ample space for car parking. The fees are £1,303.33 per week. Care Homes for Adults (18-65 years) Page 5 of 29 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: The last inspection on this service was completed on the 28th of August 2007. This is a report for the key inspection, which included a routine unannounced site visit to the service. This took place between 10.30 and and 4.00 pm on the the 17th August 2009. The information was collected from an Annual Quality Assurance Assessment, a document sent to the service from the Commission for Social Care Inspection and completed by the service manager. Surveys returned to us by people who use the service, staff of the home helped them to complete them but because of peoples communication difficulties, they gave very little information. Discussions with the senior staff member on duty, the manager and two other staff members took place. People who use the service have difficulty communicating with people who do not know them so observation of people and their interactions with staff took place during the Care Homes for Adults (18-65 years) Page 6 of 29 visit to the home, which included a meal time. Reviewing records of the people who use the service and other records and procedures was also used to collect information on the day of the visit. All information received by the Commission since the last inspection, about this service was also taken into account when producing this inspection report. Care Homes for Adults (18-65 years) Page 7 of 29 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. Care Homes for Adults (18-65 years) Page 8 of 29 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 29 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 29 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 service has a pre-admission assessment procedure to make sure that people would be properly assessed, so that it could be confident that it could meet their needs. Evidence: The home has had no new admissions since it opened in 1991, there are currently five people in residence. The Statement of Purpose was reviewed and up-dated in August 2008. The Service User Guide was up-dated, using change picture bank ( a pictorial communication system), some of the content has been written quoting Adult Placement standards rather than residential care home standards. The registered manager agreed to review the appropriateness of this content. The home have new pre-admission paperwork to ensure proper assessments but it will not be used until a referral has been made. Existing residents have a full care management assessment and are reviewed , at least annually by the home and the social work team. Care Homes for Adults (18-65 years) Page 11 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know their assessed and changing needs, make as many decisions as possible about their lives and are helped to be as independent as they are able. Evidence: Plans of care for the five people who are resident in the service were seen. The plans of care are detailed consisting of all areas of need identified, with goals and how to offer help/support to the individual. Some examples of the identified areas of need are communication,out and about, finances,bathing,personal appearance,family contact and confidence. Each area has a risk assessment attached if it is necessary/appropriate. Plans of care also include a detailed pen picture of the individual,which gives and overview of the person and includes their likes,dislikes,preferences,preferred routines what they like to do/how and when, a communication plan, hobbies and activities enjoyed. Each person has two files one for reference with reviews, full care plans and history and one that is used by staff as a daily working tool, this includes the daily plans of care, goal/achievement charts and daily notes,aswell as any monitoring charts that may be necessary. Daily records are Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: kept to a good standard, they have a daily checklist system that is just ticked if the person has completed what is specified on their daily plan but detailed notes are written if anything out of the ordinary or unusual occur, particularly with regard to behaviour, positive and negative incidents are recorded. Plans of care and risk assessments are highly individualised to meet peoples very diverse needs such as health, physical needs, age, gender and emotional well being. How people make choices and decisions is noted in their plans of care. Staff were observed giving people choice in their daily lives, such as what to eat at lunch and what activities to participate in. Residents are invited to full staff meetings but most choose not to attend or attend for a short while only. Peoples communication is very limited and there was discussion with the senior and the registered manager about how staff might assist people with better communication methods so that they can participate more fully in the running of the home. People do participate fully in their day to day lives, they go shopping for their own groceries, choose what to eat on a daily basis, choose most of their activities, although some are planned in advance and choose the staff they want to work with (as observed on the day of the visit.) Risk assessments are detailed, up-to-date, regularly reviewed and of good quality. They are used to ensure people can be as independent and participative, as safely as possible. They include people helping in the kitchen, going swimming,bathing, the use of window restrictors (some have them some dont), money management and access to the community. Risk assessments identify problem areas for individuals and are imaginative in ensuring individuals safety whilst not limiting the freedoms of house mates such as ensuring only safely edible foods are stored in the fridge in one house. Care Homes for Adults (18-65 years) Page 13 of 29 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 given opportunities to take part in interesting and rewarding activities and are an integral part of the local community. They are offered nutritional meals that they are fully involved in buying, choosing and preparing. Evidence: Activity plans are developed for individuals, these reflect their age,ability level and choices. People do not often go at in the evenings because of ageing and choice. Each individual has specific goal plans for daily activities and participating in the house is a large part of their life , such as being involved in house chores and meal preparation. Goal plans are reviewed regularly,so that peoples progress or lack of progress can be easily identified. The people who live in the service are very much part of the community, four attend the local church and all attend local pubs and community events. People also have Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: easy access to a large town and a local shopping centre. The home is in the middle of the village, yards from the village high street. Two people indicated that they were happy and had lots to do. People are taken on day trips, rather than longer holidays as that appears to be their choice and suits their lifestyle. A variety of activities were recorded, these included a visit to a wildlife park,library,church,Beale Park,a wedding reception and numerous shopping trips. One person indicated that they had been to the seaside and seen fish in the aquarium. Daily notes are of good quality and describe activities people participate in and if they enjoyed them. Contact with family and friends is good and well recorded, everyone has family or friend involvement and two people have advocates, contact with families is noted in the plans of care and it is noted that family and friends must be welcomed into the home. Staff were seen interacting respectfully and positively with the people who live in the home, they were being given as much choice as possible and were asked if staff could enter their rooms . Relationships between staff and people who use the service appeared to be very positive. One person who has very special needs, was seen being dealt with sensitively and their needs were responded to very quickly. Residents seemed very happy and relaxed, staff interacted with them continually throughout the meal and for the duration of the visit. Meals and food are of good quality, because it is a very small home people tend to choose what meal they would like on a daily basis, they also time the main meal to suit the needs of the people, on the day. However they do record meals after the event rather than plan them which has resulted in having the same food several times in one week , such as beef in different forms three times.There was a discussion with the registered manager about ensuring a varied menu, whilst retaining the the informality and choice for people who live in the home. There are currently no nutritional problems noted , what people eat is recorded and people are weighed monthly, more often if there is any fluctuation in weight or concerns about peoples health. Care Homes for Adults (18-65 years) Page 15 of 29 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. The home meet the personal care and health needs of the People who live there very well and ensure that medication is administered safely. Evidence: Plans of care are very detailed and show that peoples changing needs have been reviewed. Reviews are completed every year and more often , as necessary such as frequent reviews for someone whos health is deteriorating quite quickly, all the necessary professionals are involved in these meetings. Peoples plans of care include a pen picture which describes the person and includes their preferences and methods of communication, especially how they indicate their dislikes and likes and how they make choices. It is presented in a simple language and pictorial format. Individuals have comprehensive health care plans and a health book in which details of all visits to health professionals are noted, these are colour coded and put on a chart for easy reference and to ensure any follow ups are done. The home keep seizure charts,weight charts,enema charts and bowel charts for people who need it (weight charts for all). The service has good support from the local GP practise and work closely with district nurses, if necessary. Involvement of other Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: professionals is sought, as necessary such as psychologists and psychiatrists. Medication is kept in a wooden cupboard with a magnetic lock, to ensure the homely appearance of the house is maintained.All medication is administered by staff, no-one is able to administer their own. Staff are trained and their competence is assessed before they are able to administer medication to the people who live in the home. They use a monitored dosage system supplied by Lloyds pharmacy,the Pharmacist visited recently and had no requirements or recommendations ( the report could not be located on the day of the inspection.) The home has a detailed protocol and guidelines for the use of rectal diazepam, which is prescribed to be used as necessary and staffs competence to administer it is confirmed by the district nurse, the last review of staffs competence was in 2005. Other medication including enemas and paracetamol,which are prescribed to be taken as necessary, do not have written protocols or guidelines of when they should be administered. Records seen on the day of inspection were accurate and the registered manager advised that no medication errors have been reported since the last inspection. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home listens to people if they have complaints or concerns but their complaints procedure does not include enough detail. Staff, generally, have the ability and knowledge to protect people from all forms of abuse but people who use the service have to pay, informally, for staffs out of pocket expenses. Evidence: The complaints procedure is produced in the Service User guide in change picture bank (a pictorial format),which is very simple for people who use the service. The policy and procedure does not meet standards as there are no timescales and not enough detail, it does not include the address of the Commission. It is unlikely that residents would be able to access the complaints procedure without assistance but two people have advocates and all have family involvement, to a greater or lesser extent. Staff know the residents very well and would be able to identify if anyone was unhappy or showing signs of anxiety. The service have noted no complaints since the last inspection. Staff know if people have a problem or are not happy by their behaviour and there is evidence that they respond to any unusual behaviours quickly, such as a physical check up,for someone who appeared to be unhappy, this identified the problem. The Commission have received no information with regard to complaints about this service, since the last inspection. The service recorded (on the AQAA) and the registered manager confirmed that there Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: have been no safeguarding issues identified in the home since the last inspection. Staff receive safeguarding training and this is up-dated , as necessary.The local authorities safeguarding procedure is available in the home and three staff spoken to had a good knowledge about what constitutes abuse and what they would do about it. They were very confident about their legal and moral obligations to protect the people who live in the home. The Commission have received no information with regard to safeguarding concerns since the last inspection. The home does not use restraint as there are no behaviours that make this necessary, the registered manager and three staff members confirmed that they do not use restraint techniques within the home. People have temporary or long term behavioural plans included in their plans of care and staff were seen adhering to them, on the day of the visit. Financial records were seen for two people, they are records of peoples personal spending money and bank accounts. The registered manager does not have detailed knowledge about peoples benefits such as income and expenditure, it was discussed that she should have so that she can ensure that people in her care not being financially abused. People who use the service pay for staffs out of pocket expenses for meals out and social activities. Records showed that staff did not spend excessive amounts but the possibilities of abuse and discrimination within this informal system were discussed. Care Homes for Adults (18-65 years) Page 19 of 29 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 house is very comfortable and homely, people have plenty of space and it is a pleasant environment to live in. The home is kept very clean and tidy but the clothes/linen washing facilities might not be suitable for the changing needs of the people who use the service. Evidence: The home consists of two houses one with three people in and one with two, both have the capacity for four people. Four of the rooms have en-suite facilities, two are on the ground floor. Currently everyone has their own bathroom as the two people without en-suites have exclusive use of a communal bathroom. The houses are in a good state of repair, they share a back garden and some other facilities. The communal areas are spacious and there are plenty of opportunity for people to find areas of peace and quiet. The residents use both houses as their home, usually eating together. Peoples bedrooms are very individualised,fully reflecting peoples sexual identity,age,interests and choices. People indicated that they had chosen the colour and style of their private space. The kitchen floors and stairs have been re floored but the stair carpeting in one house is already showing signs of wear that need risk assessing as they could become dangerous once the wear on the risers becomes hazardous. Paper towels are available in all toilets and special adaptations and equipment have been obtained to meet one persons special and changing needs. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: The home has an infection control policy and staff are trained in this area of work but the washing machines do not have a sluice facility although they do wash up to 90 . The infection control policy is based on the standards for care homes for older people. Radiators throughout the home are uncovered and not all windows on the first floor have window restrictors, there are some risk assessments in place (see outcome area 8). Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a properly qualified and trained staff team, in sufficient numbers to meet the needs of the people who live there. The staff team are very stable and experienced and know the people who live there very well. Evidence: The home has 11 staff, five full time and six who work the evening and sleep in shift. There are a minimum of two staff on duty at all times and generally three during day time hours, which are 8am until 6.45pm. The majority of the staff team have worked in the home for over four years. Records were seen for two newest staff, both files had all the necessary information to ensure that staff were safe and suitable to work with vulnerable people. They also contained completed induction records, including competence test certificates, regular supervision notes and an annual appraisal. The home has a very low sickness record and does not use agency staff. The home now work with two people sleeping in rather than with waking night staff, the registered manager explained that the person who needed assistance during the night is no longer resident. It was discussed that it would be good practise to keep evidence of the staffing review that reduced the number of staff , aswell as evidence of any risks posed by the reduction of staff numbers. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: All staff spoken to said that there was enough staff to complete necessary tasks and spend quality time with the people in the home. People go into the community, do a large number of daily activities and are able to attend evening events, if they wish to, for instance one person attended a social event and did not return home until after 11 pm. Seven of the 11 staff have NVQ 2 or above and individual training records are kept, training in health and safety is generally up-dated as necessary. Three staff spoken to confirmed that they have good training opportunities and they get regular training up-dates. They also confirmed that they receive regular supervision and had received an appraisal this year. They described the management as supportive and said it was a good place to work. They all felt that they give the people who live there very good care and were able to describe how they protected people from any form of ill treatment or abuse and protected their privacy and dignity Care Homes for Adults (18-65 years) Page 23 of 29 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 well managed in the best interests of the people who live there. The home has ways of looking at the quality of care it offers and generally, keeps people as safe as possible. Evidence: The registered manager has been in post for approximately four years and has been working at the home since 1996. She has achieved an NVQ 4 and registered managers award. Staff describe her as supportive and the home is run in the best interests of the people who live there. The provider makes regular regulation 26 visits and writes a report on her findings, at the home. The home has a quality assurance tool which is sent annually to relatives,care managers,advocates and people who live in the home. There was a discussion about more imaginative ways of obtaining the views of the people who use the service and showing their involvement in the production of the business/development plan. A quality assurance report is written as a result of the information collected on the quality assurance tools and this forms the basis for the Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: action plan (not available for this year, as yet) according to the registered manager. Accident and incident forms are kept on peoples individual files and in a general folder so that they can be regularly audited, and any patterns noted. The forms contain detail about the accident or incident but do not record how the risk of recurrence is minimised. The home had an environmental health food hygiene inspection in March 2008 and attained a 4 star,very good rating. The AQAA noted and the manager confirmed that all the necessary safety maintenance checks are completed but did not know what the electric circuitry check referred to, was advised the 5 year general check of the mains and other electrical circuits in the home and to consult health and safety (electrical) legislation. None of the radiators in the home are covered, on the day of the visit all were turned off and the manager confirmed that they are all kept low even in the winter, however I noted that even radiators next to toilets and in bathrooms were uncovered and very close to the toilet with the risk of people using them as an aid to get up from the toilet or to get out of the bath. There are some risk assessments in place for the uncovered radiators but there was discussion about reviewing the safety of uncovered radiators, particularly in areas where people could use them as grab rails and have exposed areas of unprotected skin. The home has had only five residents for approximately 2 years and as it is an eight bedded home the financial viability may be compromised by so many empty beds, the provider e-mailed us to confirm that all the residents places are safe, at the present time. Care Homes for Adults (18-65 years) Page 25 of 29 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 26 of 29 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 22 22 To review and amend the complaints procedure to include all the necessary information and detail. So that anyone who wishes to make a complaint about the service knows how to do so. 01/10/2009 2 30 23 To review the linen and clothing washing facilities in the home. To ensure that the laundry arrangements safeguard people from cross infection. 09/10/2009 3 42 13 To review the practise of having uncovered radiators and review the risk assessments that are currently in place to support this practise. So that people can be assured that they are as safe as possible from the risk of scalding and burning 14/09/2009 Care Homes for Adults (18-65 years) Page 27 of 29 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 as a result of contact with uncovered radiators. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 To develop protocols and guidelines for all medication prescribed to be taken, as necessary so that staff give such medication, consistently to further safeguard and ensure the comfort of the people who use the service. To review the practise of the people who use the service, informally paying for staffs out of pocket expenses. This practise has the potential for abuse and discriminating against people who have less money than others. To include information, in the reports, about how the home is minimising the risk of recurrence of accidents or incidents. 2 23 3 42 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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