Care Home: Kernou

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What the care home does well The home provides a relaxed and friendly environment for people using the service. There is a maintenance programme and plans for the refurbishment of the whole premises to improve the environment for people using the service. The home is generally clean and staff receive infection control training to prevent the risk of cross infection. There is up to date information available for prospective residents that enables them to make an informed choice about the home. Care plans are compiled with people using the service and they are in a pictorial format that they understand. Each person has signed as agreeing their care plan. People using the service attend work placements and clubs of their choice and outings are arranged by the home with the use of their mini bus. Activities take place in the home and are being developed further. A holiday for people using the service is being arranged and will be an annual event. Relationships with the neighbours and local community are good. There are suitable complaint and adult protection policies in place. A varied and nutritional diet is on offer and people using the service can access drinks and snacks from the kitchen between meals. People using the service are involved in the preparation, cooking and serving of meals. Personal and healthcare needs appear to be met and people`s privacy and dignity are respected. People told us they are treated well in the home by staff that they like. The medicines system in the home is appropriate and records are well maintained. All of the care staff are qualified to NVQ level 2 in care. Training needs are recorded and there is a programme of training in place. Statutory training is kept up to date. Recruitment procedures are robust with all of the documents required by legislation kept on file. People using the service are involved in the recruitment process, they meet potential recruits and spend time with them when possible. A quality assurance system is developing, to listen and act on the views of people using the service, relatives and external professionals. Equipment and service checks are undertaken and the registered provider acts promptly to ensure that any defects are put right. What has improved since the last inspection? An improvement plan for the requirements notified in the last key inspection report has been received by the Commission with time scales for the work to be undertaken. Timescales to date have been met. The statement of purpose has been updated to ensure that appropriate information about the home is available for prospective residents and enquirers. The Department of Adult Care and Support have started the process of re-assessing the needs of people using the service and funding assessments will also be carried out. All of the care files have been tidied and the care plans have been updated to direct staff on the care provision. Separate pictorial care plans have been developed with people using the service and they have signed to agree these. The policy for managing resident`s money has been reviewed and updated and the system has been improved. No money is held on behalf of people using the service. Activities on offer to people using the service are being developed and there are now opportunities for people to go on holidays. The medicine`s policy has been reviewed and updated and all staff who administer medicines have attended appropriate medicines training courses. The complaint and adult protection policies have been reviewed and updated and the manager and staff have attended safeguarding training. There is a file of other printed policies in the home that are available for staff to refer to. Work has commenced on the building that includes the total refurbishment of all rooms, purchase of new furniture and the installation of a wet room shower. There are written plans in place for the work to be done with time scales to adhere to. The electrical wiring test has been done and the required work is in progress. Staffing has been reviewed and new staff have been employed. The recruitment system has been reviewed and made robust. There is a plan in place for staff training and development and training relevant to the client group is being sought. The registered manager receives appropriate support, guidance and training. She has gained confidence and is running the home well. A quality assurance system has commenced and there are plans to develop this further. Emergency lighting tests are kept up to date. The entrance to the home has been secured with a doorbell fitted. What the care home could do better: It would be beneficial to people using the service if the statement of purpose and complaints procedure were available in a format they could understand, for example easy read or pictorial. Some of the care plans need to be more informative and detailed to guide and direct staff fully on the actions they need to take in the provision of care. The weekly records tend to record mainly activities, there needs to be more detail on the wishes and feelings of people using the service, they should also give information on the personal care provided. The manager should ensure that people using the service are assessed on their capability to handle money so that appropriate support and training can be provided. A copy of the guidelines for the handling of medicines in social care should be available for staff to refer to alongside the home`s policy. Attention should be given to high cleaning to remove cobwebs and dust and make the home a more pleasant place. The proposed purchase of a cooker that is suitable for the number of people accommodated should go ahead. Records of interviews should be further developed to ensure that discussions that take place at interview are included. The manager should ensure that the induction programme for new staff complies with the skills for care induction standards. The registered manager should ensure that staff are formally supervised with records maintained. As formal resident`s meetings do not take place the registered manager should keep notes of who she has spoken with and the main issues that have been discussed to show that residents can air their views and action is taken where necessary. The oil boiler should be serviced as a priority for the safety of residents and staff. The registered persons need to ensure that the improvement plan they have developed for the premises is adhered to, this will then provide a safe , comfortable, homely environment for people using the service. Key inspection report Care homes for adults (18-65 years) Name: Address: Kernou Westcliff Porthtowan Truro Cornwall TR4 8AE     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: Diana Penrose     Date: 0 6 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Kernou Westcliff Porthtowan Truro Cornwall TR4 8AE 01209890386 01209891798 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Cornwallis Care Services Limited care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 8. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Kernou is registered to provide care to eight adults with a learning disability. At present seven people are accommodated. The home is located on the coast, in the village of Porthtowan, near Redruth. It is situated on the cliff top and has impressive views of the sea and beach below. The care home is accessed by the car park at the side of the building that provides access by a gentle slope. The boundary on the Cliffside has been fenced and two patios have been provided. The home was previously a hotel and internally has limitation given the size and layout of the bedrooms and width of corridors. Single accommodation is provided for residents but not all rooms have en-suite facilities, or facilities that are in use. There is a large dining room and a lounge on the upper ground floor. The lower ground floor is private accommodation Care Homes for Adults (18-65 years) Page 4 of 32 8 Over 65 0 Brief description of the care home used for staff sleeping in overnight. The people currently living in the home attend weekday activities and work placements. They are given opportunities for socialising and visitors are openly encouraged. Information about the home is available in the form of a statement of purpose service users guide, which can be supplied to enquirers on request. A copy of the most recent inspection report is available in the home. The manager told us that the fees range from 265 to 315 pounds per week, with one exception of 600 pounds. Private healthcare provision, hairdressing and personal items such as confectionary and toiletries are not included in the fees. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: Two Inspectors visited Kernou Care Home on 06 April 2010 and spent five hours at the home. This was a key inspection and an unannounced visit. The focus was on ensuring that residents placements in the home result in good outcomes for them. All of the key standards were inspected plus a few others. On the day of inspection seven people were living in the home, three were at home and the others were out at work placements; one returned later in the day. The methods used to undertake the inspection were to meet with the registered manager, operations director, staff and residents to gain their views and information on the services offered by the home. Records, policies and procedures were examined and an Inspector toured the building. We received completed surveys from four residents, three staff and one healthcare professional which were also used to inform this inspection. Additional information was received from the operations director following this inspection. This report summarises the findings of this key inspection. Care Homes for Adults (18-65 years) Page 6 of 32 It is evident that a great deal of improvement has taken place in the past six months and the management team must be commended for this. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? An improvement plan for the requirements notified in the last key inspection report has been received by the Commission with time scales for the work to be undertaken. Timescales to date have been met. Care Homes for Adults (18-65 years) Page 8 of 32 The statement of purpose has been updated to ensure that appropriate information about the home is available for prospective residents and enquirers. The Department of Adult Care and Support have started the process of re-assessing the needs of people using the service and funding assessments will also be carried out. All of the care files have been tidied and the care plans have been updated to direct staff on the care provision. Separate pictorial care plans have been developed with people using the service and they have signed to agree these. The policy for managing residents money has been reviewed and updated and the system has been improved. No money is held on behalf of people using the service. Activities on offer to people using the service are being developed and there are now opportunities for people to go on holidays. The medicines policy has been reviewed and updated and all staff who administer medicines have attended appropriate medicines training courses. The complaint and adult protection policies have been reviewed and updated and the manager and staff have attended safeguarding training. There is a file of other printed policies in the home that are available for staff to refer to. Work has commenced on the building that includes the total refurbishment of all rooms, purchase of new furniture and the installation of a wet room shower. There are written plans in place for the work to be done with time scales to adhere to. The electrical wiring test has been done and the required work is in progress. Staffing has been reviewed and new staff have been employed. The recruitment system has been reviewed and made robust. There is a plan in place for staff training and development and training relevant to the client group is being sought. The registered manager receives appropriate support, guidance and training. She has gained confidence and is running the home well. A quality assurance system has commenced and there are plans to develop this further. Emergency lighting tests are kept up to date. The entrance to the home has been secured with a doorbell fitted. What they could do better: It would be beneficial to people using the service if the statement of purpose and complaints procedure were available in a format they could understand, for example easy read or pictorial. Some of the care plans need to be more informative and detailed to guide and direct Care Homes for Adults (18-65 years) Page 9 of 32 staff fully on the actions they need to take in the provision of care. The weekly records tend to record mainly activities, there needs to be more detail on the wishes and feelings of people using the service, they should also give information on the personal care provided. The manager should ensure that people using the service are assessed on their capability to handle money so that appropriate support and training can be provided. A copy of the guidelines for the handling of medicines in social care should be available for staff to refer to alongside the homes policy. Attention should be given to high cleaning to remove cobwebs and dust and make the home a more pleasant place. The proposed purchase of a cooker that is suitable for the number of people accommodated should go ahead. Records of interviews should be further developed to ensure that discussions that take place at interview are included. The manager should ensure that the induction programme for new staff complies with the skills for care induction standards. The registered manager should ensure that staff are formally supervised with records maintained. As formal residents meetings do not take place the registered manager should keep notes of who she has spoken with and the main issues that have been discussed to show that residents can air their views and action is taken where necessary. The oil boiler should be serviced as a priority for the safety of residents and staff. The registered persons need to ensure that the improvement plan they have developed for the premises is adhered to, this will then provide a safe , comfortable, homely environment for people using the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The statement of purpose and residents guide have been updated to give prospective residents the information they need to make an informed choice; it would be beneficial to have this in a format that can be more easily understood by people who use the service. There have been no new people admitted to the home for us to be able to assess standard two, and the reports of recent assessments undertaken by the department of adult care and support have not been received by the management as yet. Evidence: The manager showed us the homes statement of purpose and we saw copies of the residents guide in the care files. The information had been updated since the last inspection but it would be beneficial to provide this in a format that people using the service can understand better. A few minor adjustments were discussed with the manager. There have been no new admissions to the home for seven years, therefore there was no recent pre-admission assessment documentation to inspect. The home is currently Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: operating at a maximum occupancy of 7 residents. The manager has reviewed the needs of people using the service and updated the care plans. We were told that care managers from the Department of Adult Care and Support have started to review the residents care needs and their reports were imminent. These reviews have been long awaited and assessments for funding were also in progress. Care Homes for Adults (18-65 years) Page 13 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have care plans that have been updated and include pictorial plans that they have helped to compile; some areas need to be more detailed to ensure staff know the actions they need to take when providing care. There is a good system in place for managing residents money that safeguards people using the service. Evidence: We were shown the care files that were stored in a secure cabinet. We examined two care files in depth and found them to be a vast improvement on the last inspection. The manager had reviewed all of the care plans and the format in use was now the same as at other homes owned by the Company. Some plans were well detailed but others needed more information to fully direct and guide staff on the actions they should be taking to meet residents needs. One person has diabetes but we saw no care plan for this; there was only information regarding his diet. We discussed this with the manager. We saw pictorial care plans which were excellent, the manager told us she had compiled these with each resident and we saw that the residents had Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: signed their plans. We were told that the care plans would be reviewed every six months and this was due to happen in July. However the plans would be updated prior to this if the assessment reports were received from the Department of Adult Care and Support. Some risk assessments were seen and included self administration of medicines, mobility and going out alone. Diet preferences were recorded and life histories had been compiled to assist staff in relating to residents. There was a photograph of each resident in their file. Individual weekly records were seen for people using the service. These contained information regarding activities and outings mainly. There was no information about the care and support provided and this was discussed with the manager and the operations director. The records should be more detailed to include peoples feelings, what they get out of activities and so on. Residents were seen moving freely about the home making drinks for themselves and so on. One person was watching television and did not wish to talk to the inspectors. Some residents were out at work during the inspection but when they came home they appeared to do as they wished. We received 4 surveys from residents, all had been completed with the help of staff. All of the surveys told us that people using the service make decisions on what they do each day and that they can do as they want all of the time. We were shown the Company policy for managing residents monies. The content was discussed with the operations director as it did not reflect the processes used in the home. Since this inspection he has updated the policy and sent a copy to the Commission. We were told that no money is held in the home on behalf of the residents. Each person has a bank account and we saw the bank statements. The manager told us that generally she goes with residents when they withdraw cash but occasionally another member of staff may go and she informs them of the security details. We were told that the personal allowances for each resident were received with their fees and then given to each resident in cash. We saw some money in envelopes ready to be given to residents. Residents told us they have money and go out shopping; records confirmed this. We were told at the last inspection that all of the residents were to be risk assessed in respect of their capability to handle money. This has not yet been done but we were shown some forms that the manager intended to utilise. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service attend work placements and go on outings according to their ability, more activity has been taking place in the home and there are plans for residents to have a short holiday; this encourages residents to live a fulfilling life. Peoples preferences are respected as part of their daily life. Food preferences are recorded, the menu is varied and residents are involved in cooking the meals; they told us the food is good and they enjoy it. Evidence: Three people were at home during this inspection, we were told the others were at work placements. One resident came in later in the day from work and talked about his day. Residents told us about their work and what they do. We saw an assortment of games on a table and there was a library of DVDs in the lounge. The manager said they have impromptu DVD nights when the staff and residents get together. She also said they had recently been to the cinema and that they were going to a play in the Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: local village hall soon. One resident talked about the film he enjoyed at the cinema at the weekend. Another resident was keen to do a karaoke night for the staff and residents. We saw the weekly records which showed that people participate in activities some are outside of the home, arranged by clubs, going to the pub, going shopping or going for walks. The records do not detail the level of participation or what people gain from the activity. The Company own a mini bus; staff surveys told us that a bigger vehicle is needed; the operations director said he is looking into this. Staff surveys also told us that they would like to do more activities with residents but the present funding arrangements do not allow them to do this. The manager told us that they have been trying to arrange a holiday for residents. She said that this year it will be a long weekend and some residents had expressed an interest in going to Cheddar Gorge. We saw a washing up rota which showed that all residents take part. We were also told that residents clean their rooms. Bedrooms were personalised to varying degrees with personal belongings and pictures, some interests and hobbies were apparent. We were told that some residents had a key to their room. One resident told us he did not have a key but that was his choice and he was happy. Some rooms had been re-decorated and we were told that the residents chose the colour schemes and that one resident is going to help to paint his room. We were told the visiting arrangements were flexible and there were no barriers to residents maintaining contact with their relatives and friends, however the degree of contact was variable. The manager said that residents have free use of the homes telephone. The visitors book was seen and showed that people visit the home. The manager told us they all get on well with the local community. The manager told us that generally she and the care staff prepare and cook the meals but that residents had started to take turns at cooking on Saturdays, if they wished. The resident shops for the ingredients and then prepares, cooks and serves the meal. We saw residents making drinks in the kitchen during this inspection. One resident told us he enjoyed cooking and the food he has at the home is good. Surveys from residents told us that the food provided is to their liking and they enjoy the meals. One resident commented that there could be a bigger menu. We saw a handwritten menu displayed in the home; the manager said it was flexible and sometimes a takeaway meal was included or they all went out to eat. Food stocks in the kitchen were good and fresh vegetables were seen. There was a large bowl of Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: fruit in the dining room. Care Homes for Adults (18-65 years) Page 18 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal support is given to residents according to their needs and they have access to doctors and other professionals as necessary ensuring their healthcare needs are met. There is a system in place for the use of medicines that is safe and ensures that residents are protected. Evidence: The manager told us that the residents were all independent and were encouraged to maintain their independence. She said that only two people required assistance with personal hygiene but they all needed some prompting to wash or shave and so on. The manager told us that the routines of daily living were flexible and we noted that some residents were up and about when we arrived but others did not get up until later in the morning. There was information about peoples preferences written in the care plans. The manager said that attention was given to ensuring privacy and dignity when delivering personal care and staff were sensitive to the needs of residents. Surveys received from residents told us that they could do as they wished and they made decisions on how to spend their time. We were told that all residents were registered with a GP and that the new surgery Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: arrangement was working well. We were told there were no changes to the dentist and optician arrangements which were satisfactory. We were told that input from social workers had improved. We were shown the medicines policy which had been changed since the last inspection, it was generic very long. The operations director has re-written the policy since this visit and made it more concise and it now details the actual processes used in the home. Relevant reference books were seen and we were told that a copy of the document The handling of medicines in social care would be obtained. The system used for the receipt, administration and disposal of medicines was explained to us by the manager. Records were examined and were seen to be appropriate and up to date. The storage arrangements were shown to us and these were secure and complied with legislation. We observed the manager administering medicines in the correct manner. The manager told us that all staff had undertaken medicines training and we saw up to date certificates for this in a file. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 suitable complaints policy however an easy read format will help people using the service understand it more easily. An appropriate adult protection policy is in place that informs staff and safeguards residents from potential abuse and harm. Evidence: We were shown the complaints policy which was available to staff and residents. The content of the policy was suitable and the format was suitable for people without a learning disability, for example staff, relatives and visiting professionals. The manager told us that the complaints procedure had been explained to all of the residents. The compilation of a pictorial or easy read summary of the policy was discussed with the manager. One of the residents said he would approach the manager if he had a problem. Four surveys were received from residents, two said they knew how to complain if the need arose but two said they did not. The manager told us she had received no complaints. She said she did not have a method for recording complaints should she receive any but she would ensure that a file or book for this purpose was provided. We were shown the adult protection policy which was available to staff. Some of the content was good but the actual procedure for what should be done if an allegation occurs was not appropriate and did not comply with the local authority procedures. The policy has been reviewed and updated since this inspection and a copy has been Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: received by the Commission. The policy is now appropriate and we have been assured that staff will be informed of the new policy. We saw certificates that showed staff had received training in respect of safeguarding adults in 2009. We saw a copy of the alerters guide displayed along with other information on abuse. The whistleblowing and the Deprivation of Liberties policies were examined and were satisfactory; they had been reviewed in January 2010. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some areas of the home need more thorough cleaning, refurbishment work has commenced and there is a plan in place to improve the environment and make the home a comfortable, homely, safe place to live and work in. Evidence: We were given a copy of the refurbishment programme for the home. It is a programme that runs from April to October 2010. It shows which rooms are to be redecorated and fitted with new furniture and carpets on a monthly basis. An inspector toured the building with the manager and operations director. We saw some areas where re-decoration had been undertaken and we were given more detailed information of the work to be done. We saw a workman busy in one bedroom and the room was looking very much better than before. We saw there had been no changes to the bathing facilities but a room had been cleared and we were told that work for a wet room shower was planned for May 2010. We were told that hand washbasins had been ordered for the toilet facilities that did not currently have them. We saw that the grounds had been well maintained and kept safe. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: We looked around the kitchen and saw that the dry food stocks, crockery and cooking utensils were still stored on open shelves; we were told that these will be stored in cupboards when the kitchen is refurbished. Staff surveys told us that they felt the cooker was not big enough to cater for the number of residents accommodated. The manager told us that they were looking into purchasing a five burner cooker and the operations director confirmed this. We saw that new appliances had been provided in the laundry; one washer and one drier. Some areas of the home smelt musty and we saw that high cleaning needed attention as there were cobwebs and dust on lampshades and high windows, for example. We were told that domestic staff were not employed; care staff do the cleaning and residents clean their rooms and assist with other household tasks. We saw certificated evidence that the manager had undertaken infection control training in March 2009 and one carer had done this training in February 2010. We were told that training was planned for the rest of the staff soon. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures are more robust, staff have received further training and training in respect of learning disabilities is being sought to ensure that the needs of people using the service can be fully met and they are protected from harm. Evidence: We were told that four staff were employed. One member of staff had left since the last inspection and that two others had been employed but had not commenced work yet. We were told and observed that agency staff were employed for one to one duties in respect of one resident. The rota showed that there was one carer on duty in the mornings, two in the afternoons and two in the evenings until ten oclock, then one person sleeps in overnight. The manager told us she works mornings and afternoons and helps the care staff as required. She also does the sleeping in duties five nights per week and said this works well as the residents sleep all night. We saw that some staff worked extra shifts and we saw signed working time directive disclaimers in staff files. We received three surveys from staff; when asked if there were enough staff to meet the needs of people using the service two said usually and one sometimes. We received four surveys from residents and they all said that staff treat them well. When Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: asked if the care staff and managers listen and act on what they say, two said always, one usually and one sometimes. Staff and managers interacted well with residents during this inspection in a friendly caring manner. The manager told us that all staff had achieved NVQ level 2 in care and that they were actively seeking training specific to caring for people with learning disabilities but none was available at the moment. We saw a list of training requirements and training certificates in a file; they showed that some training had taken place since the last inspection in October 2009. We were told the dates for training booked in April, namely moving and handling and challenging behaviour. We examined three staff files, two were for new employees that had not yet commenced work in the home. All of the files contained the documents required by legislation. We noted that interview records were sparse and although we were told that issues had been discussed there was no written evidence to support this. The induction programme for one person was seen and it was a very basic checklist. The skills for care induction standards or knowledge sets have not yet been introduced by the manager. She told us she had the information and intended to put this in place very soon. We were told that residents can be involved in the recruitment process and feed their views back to the manager. One resident said he had met potential new staff and spent time talking with them. One file held appraisal documentation but there was no evidence to show that formal supervision takes place at least six times a year. The manager told us she talks with staff informally and observes their work but has not recorded this to date. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has been supported and received relevant training which has improved leadership for staff and the overall running of the home. Quality assurance processes are being developed and systems are in place to ensure the safety of residents, staff and visitors. Evidence: The manager is registered with the Care Quality Commission, she has achieved NVQ levels 2, 3 and 4 in care and the Registered Managers Award. We saw certificates of training she had undertaken since the last inspection and these included conflict resolution, challenging behaviour, Deprivation of Liberties, Mental Capacity Act and care planning and report writing. We saw that the manager had gained confidence since the last inspection and she told us that she felt supported by the operations director. She said she has had contact with other managers in the group and this has been helpful. We saw that systems in the home had been reviewed, policies were in place and record keeping had improved. A great deal of work appears to have taken place in the past six months for the benefit of residents and staff. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: Staff surveys told us that staff receive support from the manager regularly or often. Staff we spoke with were happy with the running of the home. We were told there was a development plan for the home on the computer and we had received an improvement plan prior to this inspection. We were told that quality assurance surveys were distributed to relatives and health professionals in February 2010. The returned surveys were seen and in the main the results were positive. Comments included I feel the staff are constantly trying to find new ways of developing a better quality of life for the residents, I do not think the service can be improved, More communication with day services provider. The results had not yet been collated but the manager agreed to send a summary of the results to the Commission. The operations director said he visits the home each month to undertake an inspection and write a report in accordance with Regulation 26. Copies of his reports have been received by the Commission and they have shown that improvements have been made. We were told that formal residents meetings do not take place but the manager said she talks to them all of the time and they can express their views on the home. We recommended that she keep notes of who she has spoken with and the main issues discussed. Staff meeting minutes were seen for July 2009 and December 2009. We recommended that staff meetings take place regularly and that informal discussions with staff are recorded to show that staff views are considered and acted upon. We were told that no formal audits take place. We saw certificates that showed statutory training had taken place and we were informed of other training that had been booked. We saw the servicing and maintenance records which were up to date apart from the servicing of the boiler which was pointed out to the manager and operations director who said this had been an oversight and agreed to get this done as a priority. The electrical wiring test had been undertaken and several requirements were noted; the operations director told us that the work was in progress. We saw the recent Environmental Health Officers report which advised an upgrade of the hand wash sink and surrounding area in the kitchen. The operations director said this was going to be done. The entrance to the home had been secured with a doorbell fitted. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 1 The statement of purpose should be available in an easy read or pictorial format so that people using the service can understand it more easily. The manager should ensure that care plans cover all the needs of people using the service and that they are in sufficient detail to fully inform and direct staff this will enable staff to know what they need to do to provide person centred care. The weekly records need to be more detailed to include personal care and support and to include peoples feelings in respect of their daily lives, this will show that the records are person centred. The registered manager should assess the residents capability to handle money to ensure that appropriate support and training can be put in place. The manager should consider producing the complaints procedure in a pictorial or easy read format so that people using the service can understand and refer to it. The registered persons need to ensure that the improvement plan they have developed for the premises is Page 30 of 32 2 6 3 6 4 7 5 22 6 24 Care Homes for Adults (18-65 years) 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 adhered to, this will then provide a safe , comfortable, homely environment for people using the service. 7 34 The registered manager should ensure that detailed interview records are maintained as part of the recruitment process. She needs to ensure that the records include discussion of gaps in employment and other important issues that arise this will help to protect people using the service. The registered manager needs to ensure that the skills for care induction standards are introduced so that staff have a good introduction to the home and know what is expected of them to meet the needs of people using the service. The registered manager should ensure that staff are formally supervised at least six times a year and that records are maintained, this will enable staff to fulfil their roles for the benefit of people using the service. Staff meetings should be undertaken regularly and informal discussions with staff should be recorded to show that staff views are considered and acted upon. As formal residents meetings do not take place the registered manager should keep notes of who she has spoken with and the main issues discussed, this will show that residents can air their views and have a say in how the home is run. The oil boiler should be serviced as a priority for the safety of residents and staff 8 35 9 36 10 39 11 39 12 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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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